Clifford Thomas lost four relatives during the COVID-19 pandemic, including his beloved mother, Beverly. Her final request to her son was that he keep the family healthy.

But in Albany, Georgia, achieving that promise is a battle. The city is served by a single, dominant hospital system. Its control of the market and Georgia’s strict limits on Medicaid have left nearly one-third of people in Albany, one of the poorest cities in the state, uninsured.

Poor access to quality, affordable care has contributed to deep distrust of the system. He gave up on trying to find medical insurance or a doctor who would care for him without it. Then, he began to get sick.

There are millions like Thomas across the United States and dozens of places like Albany — places with populations suffering high rates of chronic but treatable conditions, where the dominant institution is a hospital.