"We need to expand this lot," said Taylor, who runs Oakhurst Medical Centers Inc., which operates two clinics.
Oakhurst is among 1,200 community health centers, 1,100 public hospitals, and nearly 3,000 local health departments that are primary strands in the nation's healthcare safety net. Most say they have become significantly busier in the last seven months, as the economy has worsened.
These last-resort centers coping with waves of new customers are looking forward to a jolt of new money from the $787 billion federal stimulus package signed into law last month.
Safety net providers struggle as a rule, but times are unusually tough. Most community health centers and public hospitals are temporarily maintaining their razor-thin operating margins, but say they can't keep it up for long. Many health departments - which play a leading role in preventive care and are heavily dependent on waning state revenues - are doing worse, eliminating thousands of jobs and shedding services.
"We've never seen it this bad," said Dr. Georges Benjamin, executive director of the American Public Health Association.
The stimulus package includes $87 billion for government health insurance for children and the poor, and another $3.5 billion to bolster public health services and safety net care. Federal officials are still deciding specifically how and where to spend that money, causing hand-wringing at these facilities.
A survey released last month indicates most emergency room doctors are seeing more unemployed patients who have lost health benefits. About 88 percent of the 1,200 doctors who answered a survey from the American College of Emergency Physicians said they had patients who had been turned away elsewhere because they couldn't pay. (Federal law bars emergency rooms from turning away patients with emergency needs for lack of money.)
Perhaps the most common theme involves the recently unemployed who have chronic health problems, like heart disease, that require prescription drugs. When their work coverage runs out, they turn to safety net providers to keep the medications going, said Dr. Michael Brooks of West End Medical Centers Inc., an Atlanta-based community health center organization.
