Like millions of Americans across the country these days, Bob Payne is learning how to be poor.
Two years ago, the 57-year-old Santa Rosa resident was making a good living working at the parts counter of a local car dealership. Laid off in August 2007, Payne now must figure out where to get such things as free fruit and vegetables, cheap dental care and, most importantly, medical treatment for his chronic diabetes and hypertension.
That life-and-death need brought Payne to the Jewish Community Free Clinic in Rohnert Park, where he sat Thursday evening in a small waiting room with about two dozen other patients. The free clinic, a refuge for the working poor, many of them Latino immigrants whose jobs offer no health insurance, is increasingly a safety net for people who are unable to find work or recently lost a job.
With the economic crisis spreading like a virus, the pain is clearly visible at this small clinic whose patient load has soared in recent months. In January, the clinic saw 240 clients, compared with 100 in January 2008.
?The Hispanic population was always there, but now we?re seeing more Caucasian people,? said Rita Kagan, the clinic?s pediatrics coordinator.
Kagan and medical providers across the North Coast say they?re treating a growing number of out-of-work patients who cannot afford to continue paying for health insurance.
?We are seeing more people who are between jobs, who don?t have insurance, or they have a job but they don?t have insurance offered through their employers,? said Paula Kelleher, a registered nurse who has been with the clinic for years.
Kelleher said the clinic often serves as a ?stop-gap? for those who have not yet turned to one of the county?s larger community health facilities, such as Southwest Community Health Center in Santa Rosa or Alliance Medical Center in Healdsburg.
It?s a refuge for those whose health care options have been whittled down to the nearest hospital emergency room, and an indicator of the growing strain on people who can?t afford health insurance.
Behind every story is a dollar figure that is crippling medical providers.
Earlier this month, when St. Joseph Health System announced it was laying off 182 full-time employees at Santa Rosa Memorial and Petaluma Valley hospitals, officials pointed to the growing burden of caring for uninsured and under-insured patients.
St. Joseph said it would likely lose an additional $3 million treating new uninsured patients in the county this year because of the worsening economy. That?s on top of St. Joseph?s current $17.7 million shortfall.
It?s difficult to estimate how many local residents have become uninsured as a result of recent job losses, said Sonoma County Health Officer Mary Maddux-Gonzalez.
Maddux-Gonzalez said a 2007 survey identified about 60,000 uninsured individuals under 65 in Sonoma County, which has a population of 485,000, and that ?we know that the number increases as the number of unemployed individuals has increased in our county.?
Maddux-Gonzalez pointed to a recent study by Kaiser Family Foundation, which determined that for every 1 percent increase in the national unemployment rate, 1.1 million Americans become uninsured.
?This crisis is bringing the tremendous problems of our current health care system into focus,? said Maddux-Gonzalez. ?In spite of the fact that we spend twice as much on health care as most industrial countries, our key health indicators are among the worst of these industrialized countries and we?re the only industrialized country that does not provide universal access to basic health care.?
Marilyn Jaffe, a volunteer social worker at the Jewish Free Clinic, said it?s been difficult to find ?medical homes? for clients. The clinic, funded through grants and donations, has limited resources and is not a full-service health center that can provide longer-term medical care.
The clinic sees patients on a walk-in basis Monday mornings, Tuesday afternoons and Thursday evenings. Beginning in March, the clinic will open its doors Monday evenings from 5:30 to 7:30 p.m.
?Our population has just exploded, sadly because of the economy,? said Kagan.
That increasing demand is showing up across the county and, in some cases, health officials fear some patients who do not qualify for state-paid care are choosing to just stay away.
At the Petaluma Health Center, medical providers have begun to see a troubling trend among a group of clients it categorizes as ?self-pay.?
This group includes those who have no insurance or who have insurance with such high deductibles they have to pay for their health care at a clinic ?out of pocket? until they meet their deductible requirements, said Petaluma Health Center CEO Kathie Powell.
People in this group, she added, earn too much to qualify for the health center?s sliding scale payment, as well as programs such as Medi-Cal or the County Medical Services Program.
Powell said that through most of 2008, the health center provided $130,000 a month in services to patients who had no insurance to cover their care. But in the months of December and January, the figure dropped to $80,000.
?People who are losing their jobs are just not coming in,? Powell said.
?We?re finding that people are not coming in when their asthma is bad,? she said. ?Their blood sugar levels are going sky-high because of stress and they?re not coming in.?
This trend is likely to result in costlier care down the road for people with chronic illnesses such as diabetes, hypertension and asthma.
?When they come in they?ll be very sick and they?ll probably end up in the hospital emergency room,? she said.
At the free clinic, Kelleher said many people are letting their group insurance lapse because they cannot afford COBRA, the program that offers continued insurance coverage to people who have been laid off.
President Obama?s $787 billion stimulus package provides for $25.1 billion that would be used to subsidize 65 percent of the cost of COBRA premiums for up to nine months for those laid off between Sept. 1, 2008 and Dec. 31, 2009.
For those who are no longer receiving a paycheck, budgeting for a recession requires tough choices, said Deborah Roberts, clinical director of the free clinic.
?When you?re looking at a choice between food and health insurance, you?re just not going to buy health insurance,? she said.
You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.
UPDATED: Please read and follow our commenting policy: