If you want to know what can happen when you don't have health insurance, consider the case of Denise Satterfield.

EUGENE — If you want to know what can happen when you don't have health insurance, consider the case of Denise Satterfield.

It's not the boot that stabilizes her left leg, which was broken in three places, or the fact that her skull hit the pavement so hard it caused her brain to bleed.

Those injuries could happen to anyone struck by a hit-and-run driver while walking their bicycle and left unconscious on the side of the road.

Rather, it's the $53,055 bill from PeaceHealth, plus additional bills from other providers.

"I don't know," Satterfield said, when asked how she will pay that and other medical invoices still arriving in the mail. "I still have all these bills in my pile, and they've grown."

Satterfield, 60, was walking her bicycle up West 29th Avenue, between Lincoln and Washington streets, when she was struck from behind about 10:35 p.m. on Sept. 25, according to Eugene police.

Satterfield held a full-time job at SouthTowne Living Center, an Alzheimer's and dementia care facility on West 28th Avenue. But her employer, part of a Bend-based network of care facilities, provided no health insurance.

"They just couldn't afford it, I guess," Satterfield said. She is one of an estimated 46 million Americans who live life one car crash, one severe illness, one catastrophic injury away from financial disaster.

Figuring out how to provide health care for this huge population has emerged as a bitterly contested issue nationwide as Congress works to finalize federal health care reform.

Satterfield and others who cannot afford to buy health insurance, or are unemployed, or who work for employers who do not provide insurance, are a major reason why the U.S. Senate spent most of last month debating sweeping health care reforms already passed by the U.S. House. The Oregon Legislature, meanwhile, passed two health care reform bills last summer that went into effect this month extending benefits to some needy groups.

Satterfield's injuries left her in a wheelchair for two months. She now uses a walker to get around. She has not been able to work since. She worries that she'll never be able to hold a job again because the severe concussion and subdural hematoma an accumulation of blood between the brain and the thick lining, the dura, that covers it have caused short-term memory problems.

Despite making just $9.10 an hour, slightly more than Oregon's $8.40-an-hour minimum wage, as a caregiver at SouthTowne, hers was the main household income in the west Eugene rental home she shared with her three granddaughters, ages 18 to 22. The girls' mother, Monica Perez, the oldest of Satterfield's three daughters, died in 2005 from complications of pneumonia, Satterfield said. She was 36.

Satterfield said she misses her work and the patients she used to attend.

"I love those people," Satterfield said. "Now I feel like I'm one of them."

Satterfield worked the swing shift at SouthTowne from 2 p.m. to 10 p.m. Thursday through Monday. She rode her bicycle to work every day, a two-mile one-way trip. Her routine was to walk her bicycle in the bike lane up West 29th Avenue about a half-block before hopping on at Washington Street.

Based on evidence at the scene, Eugene police say Satterfield was the victim of a hit-and-run. Residents in the area administered first aid, police said. Knocked unconscious and bleeding badly from the head, Satterfield was found in a driveway, her head at the curb.

A 17-year-old girl who lives across the street told police she saw a car heading north on Washington Street and heard its tires squealing, according to the report. Police have no suspects.

"I don't remember any of it," Satterfield said. "I don't remember the accident at all."

After the crash, she moved in with a friend in Portland because that home is wheelchair-accessible.

Satterfield said that when she was hit, she was wearing her helmet. But the police report says the helmet was found in the middle of the poorly lit street and did not "appear as though it had been worn."

The report says she was wearing a black fleece top and dark pants and that her bicycle had no reflector. Satter-field says she did not deserve to be left by the side of the road.

"It's awful," she said, sitting in her wheelchair in the front yard of the Eugene home she shared with her granddaughters, the sound of traffic rushing by on West 18th Avenue. "It changed my life, that's for darn sure."

Perhaps a drunken driver hit her, said Rayven Laury, 18, a Churchill High School student and one of the three granddaughters Satterfield looked after.

Satterfield was rushed to Sacred Heart Medical Center at RiverBend in Springfield.

"I saw her in the emergency room, and she was covered with blood," said granddaughter Crystal Morrison, 22. "I just can't imagine, in our society, someone would do that and leave her on the side of the road."

Satterfield did not need surgery for the head injury, but she did for her left leg. The tibia was broken in three places, and the fibula was displaced, requiring plates and screws to hold the bone together, said Dr. Bryan Andresen with Rehabilitation Medicine Associates of Eugene, who guided Satterfield's therapy. Several bones in her right elbow were broken, too. Those have healed, Satterfield said recently.

Satterfield lived at the Sacred Heart rehab center in Eugene for two weeks in October — after two days in the intensive care unit and a week in the hospital at RiverBend — undergoing physical, occupational and speech therapy.

Normally lively with a quirky sense of humor, Satterfield's personality was "flat and depressed initially," Andresen said. "She had a pretty significant head injury," he said. Her brain sustained damage to the left frontal lobe that controls personality and memory, Andresen said.

Recovery could take six months to a year, he added.

"That's the worst part of this whole thing," Satterfield said. "I get headaches, and I can't remember anything."

After being discharged from the Oregon Rehabilitation Center, Satter-field moved to the southeast Portland home of Victoria Reynolds, the daughter of one of her best friends.

Despite not having health insurance, she is receiving home health care from Providence Health & Services in Portland. Satterfield's two surviving daughters live in Portland and help her, she says.

She applied for aid through the Oregon Health Plan, the state program to provide care for low-income people, but did not qualify, Satterfield said.

She has applied for aid through the State Crime Victims' Compensation Program and for disability insurance.

And she has applied for charity care through PeaceHealth's Bridge Assistance program to help cover the costs of her medical bills at Sacred Heart Medical Center at RiverBend. The seven-year-old program ensures that patients receive free or low-cost care if they qualify.

A medical fund established at Oregon Community Credit Union after the crash had brought in just $145.

SouthTowne Living Center is holding her job for her, Satterfield said. But she is doubtful she'll be able to work there, given her memory problems plus her lack of strength to lift patients.

Her granddaughters have been scrambling to pay the $1,400 rent on the house they share in Eugene.

"It's been difficult," said Morrison, who is an assistant manager at Sbarro, an Italian eatery at Valley River Center. "Without her, it's going to be hard."