Young and old, rich and poor, whites and Latinos come to the health center on Cloverdale's main street for medical care, and their numbers will increase, especially patients with no insurance, officials say.
But a $600 million federal budget cut enacted last month is likely to quash the Alexander Valley Regional Medical Center's bid for a $650,000 grant to expand its services to residents of the Cloverdale-Geyserville area.
Five other community health centers covering the rest of Sonoma County applied for about $1.5 million in federal grants to serve an additional 10,000 patients.
The funding decisions have been delayed, but the health centers are expecting significantly less money, if any.
"Expansion of health center services will have to be scaled back," said Mary Szecsey, chairwoman of the Redwood Community Health Coalition, which represents local health centers.
The budget cut comes as local health centers are ramping up to care for more than 45,000 residents who will gain health insurance in 2014, under provisions of the health care bill signed into law last year.
The law also authorized $11 billion for community health centers to double the number of people they serve by 2015.
This year's $600 million spending cut amounts to a "defunding" of the health care law, Szecsey said, referring to a strategy cited by Republicans as an alternative to repealing the law.
Rep. Lynn Woolsey, D-Petaluma, who voted against the cut, said it would "pull the health care safety net away from the uninsured."
The cut was part of a measure, negotiated by President Barack Obama and leading Democratic and Republican lawmakers, to avert a government shutdown early last month. The measure included $38 billion in federal spending cuts, scaled back from the $61 billion in cuts approved by House Republicans in February, driven by tea party members intent on curbing the federal deficit.
The Alexander Valley health center, founded in 1996, is now the only primary health care provider between Healdsburg and Ukiah.
The last of Cloverdale's private physicians retired or relocated by 2002, leaving the center to serve an area of about 13,600 residents, said Debbie Howell, executive director of the Alexander Valley center.
"Who is going to take care of all these people if we can't?" asked Howell. "It doesn't make any sense to me. We are the most cost-effective providers of health care."
The center, which has to date received no federal or state funding, treated 3,800 patients last year, a 36 percent increase from 2,800 patients in 2005, she said.
More than one-fourth of the center's patients (28 percent) are uninsured in an area with 15.6 percent unemployment, 50 percent higher than the countywide jobless rate.
The $650,000 federal grant, which would be a first, would boost the nonprofit center's budget by 34 percent, enabling it to provide health care in Cloverdale and Geyserville schools, establish substance abuse services and expand chronic disease case management for the elderly, Howell said.
Alliance Medical Center, which serves 15,000 patients, applied for a grant to expand its Windsor facility while shelving plans to expand the Healdsburg clinic, chief executive Jack Neureuter said.
"How are we going to service the people coming in 2014?" he asked. "Therein lies the challenge."
Alliance sees 3,000 uninsured patients, a number that has doubled in the last 18 months, Neureuter said.