Nurse practitioner Matt Tomlin steps into a small patient exam room, logs on to a computer and pulls up a formidable list of ailments for the 57-year-old woman sitting in front of him.
Hypertension. Diabetes. Congestive heart failure. Obesity. Anxiety disorder. Multiple heart attacks.
Rosemary Ricks, hunched over in a bright yellow dress, moans and describes a fall she took earlier in the week. Dropping her head in her hands, she says she can't take the pain and needs some of her prescriptions refilled. For emphasis, she pulls a dozen medicine bottles, most empty, from her black purse.
"Wow, you are on a little bit of everything," Tomlin says.
After a quick exam, Tomlin steps out to call the pharmacy. "I'm pretty overwhelmed, to tell you the truth," Tomlin says, letting out a sigh. "She's got a lot going on."
Nonprofit community clinics like this one in South Los Angeles are part of medical safety net created a generation ago to help fill the unmet needs of poor, uninsured and chronically ill patients in struggling rural and urban communities.
With the major elements of President Obama's healthcare reform set to begin in 2014, they are being tested like never before.
There are 1,250 federally funded clinics nationwide that provide healthcare and social assistance, surviving on a mix of grants, fundraising and reimbursements from government insurance plans.
The Great Recession brought waves of additional patients who had lost jobs and health insurance, and the federal government provided $2 billion in stimulus money to help with the influx.
Millions more low-income Americans are expected to begin seeking out doctors and routine healthcare in 2014 when they become eligible for insurance coverage. The Obama administration sees the clinics as a proven model for serving disadvantaged neighborhoods and, just as important, a cornerstone of efforts to control costs.
Federal officials are investing $11 billion to increase the clinics' capacity and help address the major shortage of private doctors in poor communities. Health centers serve more than 20 million Americans and by some estimates could add 10 million more as health reform rolls out.
It's a big bet that assumes the centers can attract new, insured customers and deliver cost-effective care that keeps low-income patients out of high-priced hospital emergency rooms.
The clinics are already feeling the pressure of competition, aware they won't be able to survive solely as providers of last resort for those who remain uninsured after healthcare reform is implemented. California clinics launched a new marketing campaign earlier this month, calling themselves California Health+, a community health service network offering complete care "under one roof."
"This is our future," said Dan Hawkins, senior vice president of the National Assn. of Community Health Centers. "We're going to have a lot more paying customers, and whether they come back or not is going to depend on how we treat them."
The clinics' future also depends in part of on the outcome of state and national elections, which could affect healthcare funding and policies.
Ricks gets her medical care at the To Help Everyone Clinic — T.H.E. Clinic — where the name frames the challenge: Will such centers be able to help everyone?
T.H.E Clinic — a community fixture at 38th Street and Western Avenue for more than 30 years — is a place where the grand expectations of Washington policymakers meet the sobering realities of treating patients who often have poor health habits, limited resources and complex illnesses.