Even a job and insurance may not guarantee health care.(Knight Ridder Newspapers)

SAN JOSE, Calif. _ The shaky status of two important Silicon Valley health-care organizations highlights a painful reality as the economic downturn drags on: Even if you still have a job and medical insurance, your health care may be at risk.

Even before the slump, smaller and midsize health-care groups such as insurer Lifeguard Inc. and doctors consortium San Jose/Good Samaritan Medical Group were stretched and stressed by the rising cost of providing health care.

But as layoffs have cost tens of thousands of people their health coverage, regional insurance companies and doctors groups have fewer patients and less revenue, and no financial cushion to protect them. If they have trouble staying afloat, their patients _ more than 250,000 people combined, in the cases of Lifeguard and the medical group _ are affected, too.

The state took over Lifeguard on Sept. 13 amid concerns about its finances and the HMO will be closed by year's end; San Jose/Good Samaritan Medical Group is reportedly on the verge of bankruptcy. There is growing concern that additional failures lie ahead.

"Physicians and physician groups have been warning that we have a medical crisis in this county," said Dr. Martin L. Fishman, president of the Santa Clara County ...