People watch the debate between U.S. President Barack Obama and Republican presidential candidate and former Massachusetts Governor Mitt Romney as they are seen on television screens at the Electric Avenue electronics store on October 16, 2012 in Miami, Florida. (Joe Raedle/GETTY IMAGES)

Benito Garcia is 56, a sturdy auto mechanic who lives in the working-class enclave of Hialeah. He came to the United States from Cuba in 2006, became a U.S. citizen and will vote for the first time next week. When asked if he prefers President Obama or former Massachusetts governor Mitt Romney, he replies “I haven’t decided” with a sardonic grin that tells the questioner it’s none of his business.

Garcia has brought his niece and her infant child for a checkup at the Peñalver Clinic, a cool, airy stucco building in Little Havana where the underserved residents of Florida’s Miami-Dade County can receive primary health care at nominal fees. The niece and child are covered by Medicaid, but Garcia has no medical insurance, which does not particularly bother him. His boss doesn’t offer it, and, anyway, he says with a shrug, “there’s nothing wrong with me.”

High uninsured rate

According to the Census Bureau, 771,874 uninsured people lived in Miami-Dade in 2011, which was 30.5 percent of the county’s total population and the fifth-highest percentage among counties in the United States.

Miami-Dade is Florida’s biggest county, and Florida, with 29 electoral votes, is the largest of the critical swing states in the Nov. 6 general election. Health care routinely polls nationally as one of the nation’s top two or three concerns, and in Florida in August, a Quinnipiac-CBS-New York Times poll of likely voters put it in second place, four points behind the economy and well ahead of Medicare and the budget deficit.

With this high profile, the availability of health insurance should loom as a pivotal issue for Miami-Dade’s uninsured voters, especially with the stark choice facing them: The goal of Obama’s Affordable Care Act is health insurance for almost everyone; Romney has promised to repeal the law.

Voting for the poor, Cuba

Yet most uninsured patients interviewed in mid-October visits to Peñalver and the Helen B. Bentley Health Center in Coconut Grove did not routinely link their concerns about health care to their voting intentions. Instead, preferences tracked much more closely with how the candidates’ positions were expected to help the poor generally, or with their stances on Cuba. (Miami’s anti-Castro exiles have been a reliable Republican constituency for most of the past 50 years.)

“I don’t like Obama’s plan,” said Antero Blanco, 61, a Cuban-born U.S. citizen visiting the Peñalver Clinic to seek help for his nephew, a construction worker with stomach cancer and no insurance. “It only benefits some people.”

Blanco has employer-based health insurance, but his nephew’s plight has no influence on his own views. “I’m a Republican,” he said. “Always have been.”

For Miami’s uninsured, the health-care rhetoric of battleground-state politics doesn’t appear to resonate. Instead, patients spend their time trying to gain access to medications and physicians and finding the money to pay for them. Linda Quick, president of the South Florida Hospital & Healthcare Association, noted that while neighborhood hospitals cannot refuse emergency-room treatment to the uninsured, patients get charged for follow-up procedures or specialty treatments.

Emergency rooms

“If they don’t have the money, Jackson [Memorial, Miami’s immense public hospital] has to take them,” Quick said. “But that says nothing about when they take them. Historically, they have had to wait weeks or months for an appointment.”

Three years ago, Yadiel Molina, then 25, was assaulted at a gas station and had his leg broken. He was treated at Jackson but has never been able to get enough money to have the steel pins taken out of his leg. “He’s at the emergency room now, trying to get an appointment,” said his mother, Elizabeth Lopez, 52. Molina is a U.S. citizen and works construction when he can, but his leg periodically swells up, all but crippling him. He has never had medical insurance.

The Peñalver and Bentley centers were created to provide preventive and primary medical care to Miami’s underserved populations and neighborhoods. Bentley is a federally qualified health center, supervised by the federal Health Resources and Services Administration. It receives some federal funding. ­Peñalver follows the federal guidelines, but is not a federally qualified health center and gets no federal funding.

Boris Alvarez, executive director of Peñalver, and Caleb Davis, his counterpart at Bentley, agree that despite some exotic ailments, the bulk of their business is the treatment of adult diabetes and hypertension, expectant mothers and children. “It has always been that way,” said Davis, in charge at Bentley since 1980.

“I ended up running out of insulin and borrowed it from my fiancee’s mother,” said Miami native Joseph Exantus, 33, an unemployed and uninsured cook and plumber who has diabetes and is recovering from back surgery. “And then I ran out again and went to Baptist [Hospital] emergency. I had to pay $50 and the doctor ordered blood work, but that cost almost $300, and I didn’t have it.”

Exantus, who is homeless, acknowledges that health care is “very important” to him but does not connect his concern directly to his support for Obama.

Kaiser Health News ( is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.