Many people take advantage of free health checks

They are drawn by the signs advertising gratis or “free” check-ups and by word of mouth.

The mobile clinic is one of the many ad hoc schemes designed to help some of the 400,000 people in New Mexico without health insurance.

As pulses are taken and blood pressure monitors strapped to arms, the patients tell the all too familiar stories of the uninsured.

Years without seeing a doctor, ailments ignored and treatable conditions becoming chronic.

Dr Roberto Gomez shakes his head with frustration as he says: “The system here is broken. Some of these people haven’t had medical attention in over a decade and many of them have chronic metabolic and cardiovascular illness.”

Phil and Leslie are struggling to pay

“Your health depends on your wealth in this country,” he says.

He has a point but you don’t have to be the poorest in America these days to be struggling.

Rising insurance costs and an ailing economy are putting healthcare beyond the reach of many working Americans – people like Phil and Leslie Tacetta-Reid.

In the space of a few weeks this year, Phil had a heart attack and Leslie was diagnosed with cancer.

Neither had health insurance because they could not afford it.

Leslie said: “The cost of insurance for an individual is just outrageous. We’re both self-employed and we just don’t make that much money.”

As we talk Phil reads from the bills that have come in: “Heart hospital $51,590, helicopter ride to the heart hospital $17, 642.”

The list is long and there is no way they can pay. They now fear losing the only thing they have – their home.

Leslie cannot stop herself sobbing as she says: “You try to pay your taxes and do everything right. We have never even paid a bill late before. I just feel abandoned.”

Like Leslie and Phil most uninsured New Mexicans are working people who either cannot afford coverage – or work for employers who do not offer it.

They often seek medical help in the one place it is guaranteed – the Emergency Room.

Federal law says they have to be seen but it is putting a huge burden on hospitals.

The CEO of Presbyterian Hospital in Albuquerque said: “You get people using the ER for minor things. Last year we provided $20m dollars of free care at our cost.”

“The uninsured shift the burden onto other people.”

And that is because hospitals and insurance companies pass their losses onto people who do have cover, driving up costs and forcing more people – particularly employers – to drop insurance.

It is a vicious cycle New Mexico has been in the grip of for years.

Everyone here agrees the system needs fixing. But who should pay – employers, individuals or the government?

Finding the answer to that conundrum is likely to prove one of the biggest headaches for any future president.