After Michele Ames had both of her breasts removed in April, her oncologist handed her a list of things she should not do until her body healed.

It could have been her job description.

The 46-year-old Laurel woman cooks and serves food in a diner and works as a relief janitor at a refinery. With most types of physical labor, and especially lifting, strictly forbidden, she couldn't work.

Since she was diagnosed with breast cancer in February, the single mother of four has gone to a doctor at least once and sometimes twice a week. Already, her medical bills top $65,000.

"It's mind-boggling," she said.

Ames has health insurance. But she must pay $4,000 out of pocket before her coverage kicks in. And because she can't work, she has no money to pay household expenses - including the premium for her health insurance policy.

"With my income, $4,000 might as well be $40,000 or $400,000," she said. "I don't have it."

As Congress tries to reform the nation's health care system, emphasis has been placed on securing insurance coverage for all. But coverage is pointless if it doesn't pay, said Amanda Harrow, a representative of the Montana AFL-CIO.

"Michele's case is one of so many examples that show that health insurance is no guarantee you can get the care you need at a price you can afford," Harrow said.

The AFL-CIO, a federation of unions, recently asked more than 23,000 Americans about health care. Almost half of them said they could not access affordable care, according to a report the organization released last month.

Almost three-quarters of those surveyed said they were worried about not being able to afford health care in the next year. Almost one-quarter reported that their insurer had refused to pay for medically necessary tests or treatment, and almost half said their insurer paid less than it should have for a claim in the past year.

"I would like to see everyone be able to afford health care that has reasonable deductibles and premium payments," Ames said. "I do thank God I have this insurance, otherwise I'd be looking at $65,000 in bills. I don't think I have enough years left to pay that off."

With help from family and her community, Ames has managed to keep her head above water.

Her 21-year-old daughter moved back home to help care for her. Samantha Ames went back to work as a waitress two weeks after her son was born in April so she could help her mother pay bills.

Ames' boss at the Railside Diner held a benefit barbecue for her, and a co-worker at the CHS Refinery, Darrell Johnson, has organized a fundraising raffle.

Johnson, president of the Greater Yellowstone Labor Council, is known for the fundraisers he holds for people in need.

"That's my worst nightmare - seeing my name on one," he said. "If you're on one, you're in big trouble."

The AFL-CIO supports a public option for health insurance, a plan similar to Medicare or Medicaid that people without health insurance could buy.

Whatever the government decides to do, it should improve access to medical care, not just access to medical insurance, Harrow said.

"The thought crossed my mind when I first found out about my cancer not to do anything," Ames said. "But then I looked around at my four kids. I want to see them raised."

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.