By Marisol Bello, USA TODAY
WEST CHESTER, Pa. — By his analysis, Edward Boyer should be dead.
Boyer, who lost his health insurance with his factory job last May, is an insulin-dependent diabetic who says he can't afford his medicine. He has a new job, working part-time in the kitchen of a chain-store restaurant, but can't afford insurance, he says.
A month ago, things looked grim. He had enough insulin to last a few days and didn't have $200 for a refill.
That's when a friend, also diabetic, told him about Community Volunteers in Medicine, a clinic in this suburb 36 miles west of Philadelphia.
The clinic provides free medical and dental services and medicine for the working poor — people who have no insurance but earn too much to qualify for federal or state programs.
"They kept me alive," says Boyer, 28, of Coatesville.
More Americans losing their jobs and health insurance are turning to volunteer-run free clinics and government-funded community health centers for free or low-cost medical care. The safety net is being strained as demand grows and budgets shrink.
For every 1 percentage point rise in unemployment, the number of uninsured people increases by 1.1 million, according to Families USA, a health-reform advocacy group. The U.S. unemployment rate is 8.5%.
"That's placing a major-league burden on health centers," says Tom Van Coverden, CEO of the National Association of Community Health Centers.
Community health centers are funded by states and the federal government and provide services to the poor, regardless of insurance. Patients receive free services or pay on a sliding scale based on their income.
In 2008, the country's 1,200 community health centers treated 7 million uninsured patients, up 3% from 6.8 million in 2007.
Van Coverden says the recession is likely to drive the number of uninsured up by 30%.
Free clinics are charity organizations that provide services to people who can't afford insurance or don't qualify for government health programs. They rely on donations and volunteer medical staff to care for 4 million patients a year, says Nicole Lamoureux, executive director of the National Association of Free Clinics.
Community health centers and free clinics treat a small portion of the estimated 46 million Americans the U.S. Census estimates have no insurance.
Among the challenges clinics and health centers face:
•In West Chester, Community Volunteers in Medicine treated 332 patients in February, up 26% from February 2008. The cost of care was up 21%. At the same time, the clinic was about $100,000 behind in fundraising for its $1.8 million annual budget.
•Ohio's 40 free clinics treated 56,000 uninsured patients in 2008, up from 43,000 in 2007. Marjorie Frazier, executive director of the Ohio Association of Free Clinics, expects the number to increase in 2009. In January, one clinic in Cleveland closed because it lacked funding. Ohio, one of the few states that helps pay for free clinics' operations, is cutting funding. Its two-year allocation for 2008 and 2009 was $2.1 million; for 2010 and 2011, proposed funding is $1.5 million.
•California's 800 community health centers saw increases of up to 20% in uninsured patients in the past six months. The state, facing a $42 billion budget shortfall, is eliminating payments for some services for poor adults, including dental care. As a result, the centers will lay off 1,000 dentists and other staff, leaving as many as 400,000 people without dental care, says Chris Patterson, spokesman for the California Primary Care Association.
Community health centers are getting a lifeline, though. They will receive $2 billion in federal stimulus funding for staffing, equipment and construction of new centers.
In Carrboro, N.C., Piedmont Health Services will receive $686,000 in stimulus money that will keep the center from laying off 19 of its 235 medical, dental and pharmacy workers, says CEO Brian Toomey.
Free clinics, which won't get any of that money, are stepping up fundraising. They are appealing to donors who want to contribute to charities that provide care for those who need it most in the troubled economy, says Maureen Tomoschuk, CEO of Community Volunteers in Medicine.
Anthony Hicklen hopes the donations keep coming. The owner of a janitorial business, Hicklen says he can't afford private insurance and has been going to the clinic since 2003.
This year, the clinic's volunteer doctors diagnosed him with prostate cancer. The clinic helped him join a state program for the poor that will pay for his surgery this month.
"The clinic is the only answer for a lot of people," Hicklen says. "This is a lifesaver for me. I'm 55 years old and I would like to see a few more years."