Country Doctor—the community health-care clinic on Capitol Hill that has served low-income, uninsured people for 35 years—is fighting to survive.

That fight is being waged on three fronts: The clinic is treating more uninsured patients—an increase of about 50 percent since 2000. At the same time those patients have paid less out of their own pockets. Meanwhile, the government has grown stingier about health-care reimbursements.

King County, for instance, was responsible for 2,000 patients who went to Country Doctor in 2004, yet the county paid out only $9,575. (The clinic's operating budget was $8 million.) This small contribution is a result of Medicaid's increasingly restrictive design, made that way by a Republican Congress and president hostile to the program. Because fewer patients qualify for the program, Country Doctor is not reimbursed for providing those patients' treatment.

To make matters worse, United Way contributions are down and private donations have not come close to making up the difference. During the same period, health-care costs have climbed, making it more expensive to administer care and to insure Country Doctor staff.

"Obviously, our goal is to not go out of business," says Linda McVeigh, a founder and executive director of Country Doctor. "If we weren't here, we're not sure where people would get health care." Country Doctor, one of 14 clinics citywide, served about 31,000 people in 2005.

The clinic, whose powder-blue façade occupies the corner of 19th Avenue and Republican Street, has already begun to cut services: The pharmacy hours have shrunk, and if funding doesn't materialize soon it may close completely.

Country Doctor has also raised the minimum payment it requests from patients: to $15, up from $10 in 2005. However, it's an open secret within the transient community that you can get care without paying a dime. "Nobody is ever turned away because they don't have money in their pocket," concedes McVeigh.

Caring for the mentally ill is one of the most prohibitive costs for Country Doctor and other community health providers. Because many in that population struggle to get well-paying jobs, they're often uninsured. Yet the psychotropic medications they need are enormously expensive. Again, at Country Doctor these patients only pay as much as they can afford, which is often zero.

It's such a common scenario that when I ask Country Doctor's medical director, Dr. Rich Kovar, for an example, he tells me the story of a woman who just left his office.

"M," as Dr. Kovar calls her (he's bound by patient-doctor confidentiality), is a 55-year-old married woman who suffers from schizophrenia. She has a low-wage job that keeps her below the federal poverty level, which for a family of four is an annual household income of $19,350.

Like many mentally ill people, M's condition is severe, but not quite severe enough to qualify her for Medicaid. So in effect, she is expected to pay for her own drugs, which cost about $550 per month.

Country Doctor is her salvation. The clinic gets special rates on drugs and stocks up on samples from the manufacturer. M drops by the clinic once a month to get her supply.

"There is no other system that would take care of this woman," says Dr. Kovar, who is one of 10 full-time physicians. "She can't see a private practitioner, can't see a psychiatrist for her mental health, and can't go to a community mental-health clinic because she doesn't qualify."

M also gets crisis counseling and all her medical care at Country Doctor. For all this, Dr. Kovar guesses she pays no more than the $15 minimum, if that. On average, each patient visit costs Country Doctor $135.

On the same day, Dr. Kovar treated two uninsured working men who feared they may have cancer. They didn't, but in both cases it might have developed had they not sought treatment when they did.

Such cases underscore the important role Country Doctor fills in the health-care system. A mentally ill woman without medication and men who feared cancer might otherwise have ended up in a hospital emergency room, which are already overcrowded and where the care would have been far more expensive.

With George W. Bush in the White House, it will only get worse. The budget proposal Bush submitted to Congress on February 6 calls for cuts in Medicare amounting to $36 billion over the next five years and $45 billion over 10 years for Medicaid.

Much of Country Doctor's hopes, then, ride on the whim of potential donors. Leading that effort is Lindsey McDonald, who was hired last August as the clinic's director of development. McDonald is planning an aggressive mailing campaign in Capitol Hill and the Central District that reminds potential donors about all the free medical care Country Doctor gives to the community.

McDonald might also be wise to employ the term "domino effect" when explaining Country Doctor's importance to the community. That is, if the clinic closed, its patients would flood another community health provider, threatening that clinic with closure, and the next, imperiling every medical center in the region.

The dominos fall from the other direction as well: With the increasing restrictions on qualifying for Medicaid, along with cuts to Medicare, more and more uninsured people will be flocking to Country Doctor.

"I think the assumption is 'they will always be there,'" she says. "But the fact is we might not, and that would be sad for us and our patients."