Jessie McClure first turned up at Church Health Center a decade ago with a heart problem and no insurance. Today, the retired preacher says he doesn't know where he'd be without the clinic: "I'm doubtful I would be alive."
His voice is weak, his visage wizened, but he says he feels good, thanks to the clinic physician who has been his primary-care provider through it all. "He's been a lifesaver to me."
At the Church Health Center, the nation's largest faith-based, nonprofit primary health clinic, no insurance is no problem. It has treated tens of thousands of working people without health coverage in Memphis, one of the nation's poorest big cities. They are employed by businesses that don't offer health benefits or that hire part-time workers who can't afford health-plan premiums.
Across the country, community clinics are playing a bigger role in the nation's healthcare. Some are faith-based, like this one; some not. Some accept government funds; some don't. Some treat patients free of charge a few times a week, some offer broader long-term care like Church Health Center.
What they have in common is this: They are all trying to fill a growing gap in healthcare coverage. As of 2003, the number of full-time workers who got health benefits from their employers had dropped to just 60 percent.
"The cost of healthcare and insurance continues to go up, and more and more companies are not paying," says Bruce Jackson, executive director of the Christian Community Health Fellowship, a Chicago-based group dedicated to care for the poor. What Memphis's Church Health Center is doing, he says, "is a model."
Community clinics are also rising in number, in part, because churches are experimenting with new roles in their public ministries - including a growing focus on caring for the poor.
Here in Memphis, patients are treated at low cost by a small staff of doctors, dentists and nurses - some whom have accepted salary cuts of up to $70,000 to work at the clinic - and by a citywide network of more than 400 volunteer physicians who see patients in their own offices or at the clinic on evenings and weekends. The patients' medicines are donated by drug companies and others. The clinic is funded by various organizations, including churches and business foundations.
It is a grass-roots response to a rapidly changing healthcare landscape. Some 31 million were uninsured when the clinic opened in 1987 with 12 patients. Today, that number is 45 million.
"The need for it has become unbelievably important," says Dr. G. Scott Morris, the clinic's founder and executive director. "The problem has penetrated into the middle class."
In Tennessee health providers are bracing for even more uninsured. To remedy spiraling costs that had thrown the state budget into turmoil, the governor introduced a plan to alter TennCare, the state's health program for the poor and uninsured. A federal appeals court recently cleared the way for the cuts, which would eliminate care for 323,000 people. Critics say the cuts would be the biggest ever to a state health program.
Mr. Morris is passionate about his belief that it is the church's duty to step up. He grew up in Atlanta and was drawn to the church early, but loathed the idea of preaching. He became a United Methodist minister, went to medical school, and began traveling the country for ideas on starting a health ministry. He eventually settled in Memphis because of its high poverty rate.
"He's quite a visionary," says David Jennings, a full-time physician at the clinic.
The clinic is in many ways typical: Morris believes his patients should get the same quality care as their more affluent, insured counterparts. The waiting room is sunny and spacious. Toys litter the floor. Patients who call first thing in the morning are seen the same day.
But when it comes to payment, this operation is different. The clinic treats the working uninsured, children, and the elderly, and working-age patients must show proof of employment. Payment is based on a sliding scale, because Morris believes patients want affordable care, not a handout.
The clinic also offers training to congregations on building health ministries and to communities on how to replicate the clinic. In its eight years, the training has spawned at least 25 other clinics nationwide. Church Health Center accepts no government funds. It also offers a low-cost health plan to small businesses and the self-employed.
The clinic is ecumenical and steeped in the idea that spiritual health promotes physical health. A wellness center called Hope & Healing has a room where prayer groups gather. Nutrition and health classes open and close with prayer. In the clinic's waiting room the verse James 5:14 is painted on the wall: "Is any one of you sick? He should call the elders of the church to pray over him."
Deadrick Carroll, who has been visiting Hope & Healing for a year, says the spirituality has motivated him in his rehabilitation from an aneurysm that left his left side partly paralyzed. Doctors told him it was unlikely he would ever walk again. Now he walks with a cane, and his slurred speech is hardly noticeable. "My spiritual strength gives me the confidence and fortitude to say, 'Hey, I'm not going to settle for this,' " says Carroll, perched on a weight machine. He is jobless, is drawing disability benefits, and is covered by his wife's insurance.
The clinic's 80,000-square-foot wellness center opened in 1996 after clinic doctors found that two-thirds of their patients had been diagnosed with illnesses considered preventable. The center is available to clinic patients and the community. There is a fee for membership, but some programs are free.
Mr. McClure, the retired preacher from nearby Forest City, Ark., is now on Medicare. But he doubts he could afford all his medicines without the clinic's support. It can be embarrassing to need help paying for healthcare, but he says that Morris, his "lifesaver," puts him at ease.