By Ceci Connolly
Washington Post Staff Writer
Monday, April 20, 2009

GREENSBORO, N.C. -- It's right there on the wall, hectoring David Talbot as he races from one exam room to another.

"You want to see the recession? There it is," Talbot says, pointing to a row of multicolored graphs. "We began to spike in October 2008, and we're losing the battle now. We just can't keep up."

Recessions are tallied in numbers -- jobless claims, home foreclosures, plant closings and bailout dollars. Here at the HealthServe community clinic, Talbot, the medical director, tracks the recession in days -- the number of days that patients wait to see a doctor.

Just six months ago, the clinic delivered same-day care to most callers, the gold standard from a health perspective. But in October the delays crept to four days, then 19 in November and 25 in December. In January, HealthServe temporarily stopped accepting new patients, and almost immediately 380 people put their names on a waiting list for when the crunch eases.

In North Carolina, more than any other state, the recession has triggered a burgeoning medical crisis. A steep rise in unemployment has fueled a commensurate increase in the number of people who do not have health insurance, including many middle-income families.

"I used to be upper middle class," said Amy, who called HealthServe every morning for weeks before getting in to see Talbot. "I've paid my taxes for 30 years."

Last fall, when she moved here from Florida to care for her parents, she got trapped in the economic tailspin. The former resort manager who bought jewelry in tony Palm Beach now does temp work and sits in the clinic's crowded waiting room with dozens of others who cannot afford insurance.

"I haven't told anyone I'm coming here," she said, asking that her last name be withheld because she is embarrassed to be seeking discounted medical care.

Though in relatively good health, Amy, 54, needs a doctor to monitor her allergies and high cholesterol. "It's kind of depressing," she said. "But thank God it's here."

In the past two years, North Carolina's number of uninsured has climbed 22.5 percent, the biggest jump in the nation, according to an analysis by the North Carolina Institute of Medicine, a quasi-state agency. Nationwide, about 22 percent of adults do not have health insurance. Here in North Carolina, 25 percent of adults -- or 1.8 million people -- have no coverage. An additional 9 percent are underinsured.

For most Americans, health insurance and employment are linked. Every 1 percent increase in the jobless rate translates into 1.1 million people losing coverage nationally, according to the independent Kaiser Family Foundation. North Carolina's unemployment rate has doubled in the past year to 10.7 percent, making it the fourth-highest in the country.

"Relative to other states, North Carolina is still a manufacturing state," said North Carolina State University economist Michael Walden. "And manufacturing takes it on the chin during a recession."

The downturn has hit the state's textile industry, auto-parts factories and real estate businesses. Charlotte, the nation's second-largest financial hub, has seen layoffs. Drugmakers in the Research Triangle are scaling back, and so is Dell Computer.

Unsure where to turn, many patients head to the nearest hospital, said R. Timothy Rice, president and chief executive of the nonprofit Moses Cone Health System. Emergency room traffic there has risen 3.6 percent in the past six months. That increase, coupled with the surging demand at HealthServe, which the system runs, has prompted Rice to open another clinic just a mile away.

The clinics cost Moses Cone between $1.5 million and $2 million a year, but they are cheaper than treating those patients in the emergency department, Rice said.

"I can lose some money in one place or lose a lot more in the other," he said. And at the clinics, social workers and pharmacists provide additional services that patients do not get in the ER.

At Piedmont Health Services in central North Carolina, chief executive Brian Toomey measures the recession in job applicants. Until the economic meltdown, health professionals had their choice of good jobs. Many changed often for higher pay and benefits.

A year ago, Toomey scrambled to fill 40 openings. Now there are five. When Piedmont recently advertised for a part-time dentist, he received 10 résumés. "It's just unheard of" in the normally recession-proof industry, he said.

With revenue down and the number of uninsured patients up, Toomey had been poised to trim the staff. But an infusion of $680,000 in federal economic recovery aid means he can retain 10 to 15 positions.

In all, North Carolina community health centers have received $11.2 million in stimulus money, said Mary Wakefield, head of the U.S. Health Resources and Services Administration.

The clinics are lifelines for people such as Becky Pattishall who do not qualify for Medicaid but have been buffeted by the economic squalls.

Last month, her full-time job as a dental hygienist in Durham was cut to two days a week and her health insurance disappeared. At age 62, private coverage is exorbitant, and her 401(k) "has tanked."

Pattishall's boyfriend, a 49-year-old computer technician who has had blood clots in his lungs, was laid off in the fall. Keeping his health insurance is a top priority.

"We just didn't see this coming," Pattishall said. "I've gone back on my anti-anxiety medication."

North Carolina's hospitals, which have received no stimulus money, count the recession in dollars lost.

The sprawling University of North Carolina Health Care System provided $215 million in free care in the fiscal year that ended last June, said chief executive William Roper. This year, the nonprofit hospital network is on track to deliver $270 million in "uncompensated care."

It's not just the uninsured who are adding pressure to the system, Roper said. Even the insured are reluctant to come in for profit-generating "optional" procedures such as eye surgery or knee replacement because of fears about the eventual impact of the bad economy.

"Our paying customers are slowing down, and our nonpaying customers are surging to unprecedented numbers," he said. "We're getting hit in both directions."

At the HealthServe clinic, Talbot's team has whittled the waiting list to about 180. But that number troubles him, too. Decades of experience tell him that many people will fall through the cracks, discouraged by the long waits, unable to get transportation to the clinic or overwhelmed by the succession of woes that accompany an unemployment rate near 11 percent.

"The problems just cascade. It's that last little blow to the household income that puts them in crisis," he said. "And the scary thing for them is they know if they lose their insurance now, there's a good chance they'll never get it back."