A troubling new pattern has surfaced at the Free Medical Clinic of Northern Shenandoah Valley in Winchester. In the past, many of its patients could get health insurance within six months after receiving treatment at the clinic, which provides health-care at little or no charge to low-income and uninsured people. From 2007 to 2008, though, the clinic, which serves the city of Winchester as well as the counties of Frederick and Clarke, saw a 57 percent increase in patient recertification, said Vicki McClelland, the clinic’s executive director.

The reason for the increase is simple. Rising unemployment is keeping the clinic’s patients from cycling back into jobs that offer health care coverage or pay enough to make health insurance affordable. So they stay on the clinic’s rolls, which swell as new patients continue arriving. From 2007 to 2008, the clinic saw an overall increase of 46 percent in the number of patients seeking services, McClelland said.

And the numbers continue to climb. In February, the clinic received 125 new patient applications. “A year ago, it was 40 to 50,” McClelland said. “We’ve seen a significant increase. One of our recent applicants lost her job in an automotive supply company. Another lost her job in the finance department of an automotive dealership.”

With the clinic’s patient population growing, the delays for treatment have increased to as much as six weeks this year, compared with two in 2008. “We’re still not at capacity for our acute- care clinic, but we’re near it for the chronic-care clinic,” McClelland said.

The Winchester free clinic isn’t alone. The recession is straining free clinics around Virginia as the number of people seeking treatment climbs and funding sources dry up. The commonwealth’s free clinics — which form a health-care safety net with community health centers — treated 61,013 patients in 2007, said Lou Markwith, executive director of the Virginia Association of Free Clinics. Last year, its patient rolls ballooned by 27,000, an increase of nearly 45 percent. (The association has 49 members with 62 sites around Virginia, and another six free clinics are applying for membership.)

“The number of uninsured isn’t simply growing,” said Debbie Oswalt, executive director of the Virginia Health Care Foundation, a public/private partnership that advocates and provides funds for the commonwealth’s health-care safety net. “It’s skyrocketing. People are losing their jobs left and right. As more get laid off, it’s just going to get worse.” The overwhelming majority of uninsured Virginians — 83 percent — work fulltime or parttime, but the recession is increasing the number of uninsured individuals who can’t find work at all, she added. “In many instances, they’ve never been uninsured before. It’s a new population we’re seeing emerge.”

A rapid increase in the number of people unable to afford health insurance translates into longer waits at free clinics around the commonwealth. “The period between qualifying for care and seeing a health-care provider doubled at 75 percent of our free clinics in the last six months of 2007,” Markwith said. “There’s a wait up to five months in the Hampton free clinic now, and we’re starting to see long delays in Southwest Virginia, too,” where factory closings have swelled unemployment ranks.

The number of people losing health insurance due to factory closings and layoffs has increased so much in Southwest Virginia that the Free Clinic of Franklin County placed a temporary moratorium on new patients until Feb. 1, and currently it is accepting only eight new patients a month.

“In 2007, we registered 110 new patients, and in 2008, we registered 202,” said Karon Jones, RN, executive director of the clinic, which is located in Rocky Mount.

As demand increases and the number of professional volunteers at the Free Clinic of Franklin County falls, patients are waiting longer for appointments. Until November, patients could expect to see a medical professional at the clinic within a week. Now, they have to wait 3½ to four weeks. “We’re trying to hire a nurse practitioner to work 20 hours a week,” Jones said. “The position has been open for a year, and we can’t fill it. It’s scary.”

The Fan Free Clinic in Richmond also is seeing demand exceed its capacity. “The number we treat is limited because we have pretty much the same staff and budget” from year to year, said John Baumann, the clinic’s executive director. The clinic saw 3,000 different patients last year. “But the need is much greater. With the economic decline, we’re probably turning away 200 folks a week.”

Baumann has recently seen a new trend emerge: Potential clients are querying the clinic through e-mail. “They’re people who are underinsured or uninsured for the first time, and they’re used to using e-mail,” he said. “If you look at the last five years, you wouldn’t say that’s the segment that would be needy. But now, suddenly, they’re in a very different place, and they’re not sure what to do.”

The Free Clinic of Franklin County is receiving e-mail from clients as well. “I’d never, until this year, received e-mail from a client or potential client,” Jones said. “This week, I had six.” It’s an indicator of how the typical free clinic patient has changed, she added. “Fifteen years ago, we were seeing young mothers with two or three kids. Now, we’re seeing middle-aged people who have lost health insurance through no fault of their own — they simply lost their jobs.”

Ironically, as demand for health care is rising at free clinics, the funding to provide it is shrinking. Volunteers account for a large portion of the health care offered at free clinics, but operating costs are still high. In 2007, for example, Virginia’s free clinics spent $4.5 million on pharmacy operations and medication purchases, Markwith pointed out. (Including donations, the total value of the medications dispensed to patients at Virginia’s free clinics was $43 million in 2007.) And some clinics are hiring staff to meet growing demand, thereby putting greater pressure on their budgets, Oswalt said.

“Free clinics raise their money every year from scratch,” Oswalt added. “Most of them have annual fundraising drives and special events that generate revenue for them. The state gives money to free clinics, but it’s a small percentage of the whole.”

Free clinics also receive grants from foundations and corporations, and hospitals are sources of cash and in-kind contributions. The Fan Free Clinic’s Baumann said the corporate donations to his clinic are drying up, and the foundations have warned him that he will see a slowdown in funding from them, as well. “2009 and 2010 will be really tough,” he said.

A legislative initiative that brought $3.5 million to Virginia’s free clinics and community health centers this year has helped them meet surging demand, Oswalt said. “But they’ve only put in half — $1.75 million — for fiscal year 2010. We’re asking the General Assembly to add $1.75 million to keep it the same.”

For now, the future looks grim. Offering universal health care would ease the pressure felt by free clinics, Oswalt pointed out, but with the Obama administration scrambling to pull the economy back from a deep recession that threatens to slip into a depression, universal health coverage doesn’t seem imminent.

“The only light I see at the end of the tunnel is an improvement in the economy and people being able to get more income so they can afford health insurance,” Markwith said. “I believe we’ll be under tremendous stress through 2010, unless the economy picks up more than current projections suggest.”