Joe Delbert hadn’t needed the Tree of Life Free Clinic in three years.

The 55-year-old man, who moved to Tupelo from Georgia to take care of his dying father nearly four years ago, found manufacturing work that came with health insurance. But last month, he joined 26 million other Americans who have lost their jobs because of COVID-19 in the past five weeks.

With the job went Delbert’s health coverage — and the money to pay for medications to control his diabetes and cholesterol. Insulin alone would cost him $600 a vial. Delbert said he would be sunk without the free clinic, which opens twice a month to provide health care at no charge to anyone without insurance.

“My medications are so expensive,” Delbert said. Because of the medication assistance, he added, “I can keep my head above water.”

Typically, three rows of benches outside the clinic are filled hours before it opens. Forty volunteers coordinate paperwork, eye screenings and prescriptions. A dental clinic performs extractions based on referrals from the clinic. Through the eight hours it is open each month, the Tree of Life provides basic medical care for 175 patients, fills around 700 prescriptions and provides dental services for 30 patients.

But at the beginning of March, Dr. Joe Bailey, the clinic’s founder, consulted with local infectious disease specialists and pulmonologists to figure out how the clinic could continue to safely care for its patients as COVID-19 spread.

“They advised us to close, but I didn’t have the heart to do that,” Bailey said. “We came up with a workable compromise.”

Now, though the Tree of Life continues to open twice each month, its operations are far from routine. Patients wait in cars for the volunteer physicians to review their charts and pull together prescription refills. Volunteer medical staff cannot do physical checkups. The dental clinic is closed because the state health department ordered all elective dental care to be deferred.

The same 10 volunteers handle each session to minimize exposure for others. Six of them are over 50, with Bailey and retired cardiologist Dr. Mike Boland both 73. They’ve tried to get coveted N95 masks but do not have any personal protective equipment, known as PPE, beyond gloves and two boxes of basic disposable masks.

Across the country, other free and charity clinics are facing similar challenges as the need for them will only grow larger as more people lose their job-based insurance and struggle to pay their bills.

To adapt, the clinics are turning their delivery models on a dime, said Nicole Lamoureux, president and CEO of the National Association of Free & Charitable Clinics, which represents 1,400 organizations. Some clinics are like the Tree of Life, focusing on medication refills. Some screen patients for fever before they come in for appointments. Others are trying to establish telemedicine options, even as such clinics have been left out of federal relief packages thus far.

“It doesn’t matter if they have a $1 million budget or $95,500,” Lamoureux said. “There’s no federal funding and no access to PPE.”

Still, charity clinics are finding ways to continue their free care.

“Our role is to help people stay as healthy as they can during a scary time,” Lamoureux added. “Without that service, they would be going to the ER, no question.”

Surge Of Need Looming

The Tree of Life operates out of a West Main Street building provided rent-free by neighboring Calvary Baptist Church in this city of 38,000 in northeastern Mississippi. It sees anyone without public or private insurance, regardless of residency, work requirements or immigration status, drawing patients from around the region. In 10 years, the clinic has recorded more than 22,000 patient visits.

“It has exceeded our wildest expectations,” said Bailey, a retired gastroenterologist. “The need is greater than I anticipated.”

Yet on April 18, the clinic handled just 224 prescriptions, including 74 bottles of insulin. Bailey worried people are going without at a time when it’s most important for people with diabetes and hypertension to stay healthy.

“Ordinarily, we have 25 to 30 new patients each time,” Bailey said. “We had two or three.”

The clinic can take new patients who need help getting refills to keep their chronic conditions stable if Bailey feels he can safely prescribe to them. But the volunteers are limited in what else they can do, given the lack of protective equipment.

“We can’t do complete physicals or blood tests,” Bailey said. “We try to provide what they need. It’s not ideal.”

Charity clinics are bracing for a tsunami of new patients, though, because so many people have lost health insurance and income, Lamoureux said. The influx could come as donors and foundations are forced to scale back clinic funding because of the economic downturn.

“They see a wave coming,” she said.

Although economists can track layoffs via new unemployment claims, tracking the uninsured in real time is trickier, as each worker can carry insurance for multiple family members, and some are able to shift to other sources of coverage. An analysis by the Economic Policy Institute estimated that 9.2 million workers were at risk of losing their health insurance coverage.

The Coverage Gap

Before COVID-19, Mississippi had a high rate of uninsured: 18% for adults ages 19-64 compared with 12% nationally, according to the Center for Mississippi Health Policy. The state did not expand Medicaid eligibility under the Affordable Care Act and very few able-bodied adults can qualify under the state’s requirements.

“We anticipate we will see a lot more people falling into the coverage gap,” said Roy Mitchell, executive director of the Mississippi Health Advocacy Program, a nonprofit that operates a help line for consumers with Medicaid, ACA and private health insurance issues. “It will only get worse.”

He does not see how the state can continue to avoid expanding Medicaid eligibility on ideological grounds as the long-term effects of the pandemic and economic disruption hit Mississippi families and rural hospitals.

“Right now, the state needs every tool to fight coronavirus and stay safe,” Mitchell said.

Jacqueline Vance was trapped in the coverage gap even before the COVID-19 pandemic. The 37-year-old Pontotoc, Mississippi, resident has acute asthma, sarcoidosis, fibromyalgia and coronary artery disease.

“I make $100 too much for Medicaid,” Vance, who works as a school bus monitor, said as she waited at the Tree of Life clinic.

With her weak lungs, she needs to stay as healthy as possible. The ER is the last place she needs to be.

“This is really scary for me,” Vance said.

Delbert, the man who joined the uninsured after losing his manufacturing job last month, said that he hopes he will soon be back at work but that he is deeply grateful for the Tree of Life.

“They were here for me when I couldn’t help myself,” Delbert said. “This is a really big help to the community.”