COEUR d'ALENE - As Ruby Turner picked up her prescription meds on Thursday afternoon, she fell easily into the usual small talk with Dirne Community Health Center staff.

"I love you people," the Coeur d'Alene woman said with a laugh.

Because of a prescription assistance program Dirne helped Turner enter, she receives her 90-day supply of her medication there for free.

She goes to Dirne about twice a month for other services, she added, like blood work.

Currently jobless and without health insurance, the 50-year-old couldn't afford that anywhere else, she said.

"It's just such a blessing," Turner said. "I don't know what I would do without Dirne."

The community health center has been long established as Kootenai County's affordable health care provider.

And demand is definitely up right now.

With a significant uptick in uninsured clients due to the economic crisis, the nonprofit is facing a dip in revenue, said CEO Mike Baker.

That puts a strain on maintaining services, he said.

"Things are tight right now," Baker said. "We're evaluating all the services we offer, like most places, trying to figure out are there areas we have to cut back?"

Today, about 63 percent of clients for Dirne's dental, medical and mental health services are uninsured, Baker said.

That's double from the 30 percent three years ago.

It's not surprising, said COO Stan Shapiro.

"In this economy, that's just our mission. We're glad to see these people," he said.

But the more uninsured clients, the more costs Dirne has to cover, Baker said.

"All of our services, we're just barely getting by," he said. "Trying to find that balance is difficult."

The center tries to keep a specific payer-mix, he explained.

Each patient visit costs $100. Of that, an uninsured patient only has to pay $25, and federal dollars cover another $25.

That leaves a $50 hole for the Dirne Center to fill, Baker said.

"We fill that with revenue from insured," he said.

If about 45 to 50 percent of clients are uninsured, then payments from insured clients will successfully cover all the costs.

But now that balance is off.

If something doesn't change soon, Baker said, cuts will be in store.

"Right now we provide dental and medical and mental health services, and those are not necessarily luxuries," he said.

That would be bad news for individuals like Amanda Sepanski.

The 26-year-old visited Dirne for the first time on Thursday. After months of job searching, the center was her only option for seeing a professional about stomach pains, she said.

"It's wonderful. Everyone is very nice, it's been a good experience being here," she said after providing her information to the front desk staff. "I wouldn't be able to see a doctor, if it wasn't for Dirne."

To keep that up, Dirne is asking for more insured folks to drop by.

Every payment from patients with health care coverage provides care for someone without, Baker said.

"By bringing my health care dollars to Dirne, I'm supporting my neighbor down the street," he said.

A community health center still has high-quality care, Shapiro said.

"People think of it as a clinic only uninsured people go to," Shapiro said. "But by coming here, they can help subsidize the cost for others. Not only can they get care, but they can help somebody. They pay it forward."

The center accepts both Medicare and Medicaid.

It's all the more important to support the Dirne Center on Ironwood, Baker said, since Dirne won't be expanding into Post Falls or Shoshone County as previously planned.

Federal funding to open new offices didn't come through, he explained.

"It would have doubled our size. We would've been able to provide care to another 10,000 patients," he said. "All those patients are going to have continue to go to emergency departments, and it's so much more expensive to do that."

But the original Dirne Center isn't going anywhere, Baker said.

"We've been around 25 years. We'll be here another 25," he said. "But we can't do this alone."