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In 2003, the program now known as Health 360 helped about 300 people get free prescriptions. Last year, it served more than 3,000 people with everything from filling out paperwork for a drug company prescription program to helping with the costs of surgery and physical therapy for a man whose hand was crushed in a snow blower accident.

There are plenty of stories about others who have benefited:

* A young woman new to the community, who wasn't yet working enough hours to get company health insurance, was set up with a private clinic appointment. She didn't have to interrupt her depression medication.

* A 59-year-old woman found a lump in her breast soon after she lost her job and her health insurance. Health 360 helped with the mammogram, surgery, chemo and radiation. And she’s been cancer-free for three years.

* Parents of an 11-year-old, with an income just a few dollars too high for Medicaid coverage, had no way to pay the full cost of their child’s hernia operation -- around $2,200 for the surgeon and anesthesiologist.

The Medical Society has helped provide a safety net for the uninsured, taking on new jobs as the health care system itself changed.

As it celebrates its anniversary, local health leaders are looking ahead to see how the federal Affordable Health Care Act will change community needs.

A decade ago, the local county-city health department provided general health care for low income people, using doctors who donated their time at a free clinic.

But once a person was diagnosed -- with high blood pressure or with high cholesterol -- there was no money for prescription medication, especially expensive medication, said Judy Halstead, director of the Lincoln-Lancaster Department of Health.

The Lancaster County Medical Society stepped in to help people get the medicine they needed.

Many drug companies offered low-cost and free drugs to low-income, uninsured people. But the programs came with nightmare paperwork requirements, the equivalent of several tax forms to fill out every three months.

And it required patients to get doctor’s prescriptions every three months.

Plus every pharmaceutical company had a different system, different forms. So someone taking four prescriptions had four sets of rules to follow, said Joan Anderson, executive director of the Lancaster County Medical Society, representing 677 physicians in the county.

It was overwhelming, she said. People simply gave up.

So the Lancaster County Medical Society stepped in, with financial help from the Community Health Endowment, a trust established with the funds from the sale of Lincoln General Hospital, to continue work with low-income residents.

That first year, a staff person filled out the applications for patients at the city-county health clinic. Eventually, what was then called the Medication Assistance Program expanded beyond county health center patients to uninsured people in doctor's offices citywide.

As the health care system changed, the Medical Society’s role expanded to fill in other medical gaps for people without insurance.

When People’s Health Clinic -- which gets federal funds for its work with low-income patients -- began providing general care for many of Lincoln’s uninsured, the Medical Society began coordinating a specialty care program, encouraging Lincoln’s specialists to provide services.

And when People’s Health Clinic could no longer handle the number of uninsured patients who needed lower-cost medical care, the Medical Society began the Medical Home Program, encouraging local general practice providers to take patients on a rotating basis.

In 2007, the program became known as Health 360, as in 360 degrees make a full circle. It now takes on about 20 new patients each week.

The program has been a “godsend� for Lori McAlister and her family over the past few years.

The help began with prescriptions for her husband, after he lost his job at Pegler Sysco during the economic downturn. That job was also the source of the family’s health insurance.

During his almost two years of unemployment, the family became “intimately acquainted with some of the help in this community,� said McAlister. That included Health 360 and Clinic with a Heart, she said.

Health 360 helped with their daughter’s regular dermatology care for a scalp condition. And it helped McAlister take care of removing early skin cancer from her face. “I’m very fair and was a foolish teenager, who did not use sunscreen."

Under Health 360, doctors are paid the Medicaid rate, and patients pay the Medical Society based on their income and ability. Lincoln hospitals provide the hospital care through their charity programs.

The Community Health Endowment provided a seed to start each program and continues to provide some financial support, Anderson said.

McAlister, who is a part-time administrative assistant at the Lincoln Arts Council, is on a payment plan for her skin care. Her husband has health insurance through his job and her daughter through her college program.

Without an insurance company to negotiate lower rates and help pay the bills, just pursuing health care takes a tremendous amount of time, she said.

McAlister said the experience has made her appreciate “the ease and the access that health insurance provides.�

The program also helps the community and the taxpayers.

The medication program saves taxpayers more than $1 million a year, money that the county's general assistance would be paying for the very poor.

It provides another $1.5 million in prescriptions for others without insurance. 

The specialty care program benefits the community because people get what is optional care at the time -- like gall bladder surgery -- before it becomes a more expensive emergency, said Dr. Art Molnar, current president of the Medical Society.

The specialty care and the medical home programs spread out the care of lower income people without health insurance among hospitals and doctors, so no one is inundated.

Last year, the specialty care program paid physicians almost $59,000, about a third of the market rate. Patient fees, grants, donations and fundraising picked up that cost.

Health 360 allows people to get health care without feeling guilty, said Molnar.

"It’s not a handout . But it is a lower rate, with the ability to pay over time."

The role of the Medical Society, the cooperation of hospitals, the help from the Community Health Endowment have created a unique climate.

“We’ve had our own health care reform for the past 10 years, a community version of it,� Anderson said.

Most medical societies do not get involved at this level, Halstead said. “We are very fortunate to have a medical society that is willing to look out for the uninsured and the under-insured to make sure they have access to medical care.�

Starting next year, the federal Affordable Care Act is supposed to provide a bigger safety net.

And the community health leaders are watching to see how it unfolds and what their role might be.

If Nebraska state lawmakers agree to expand the Medicaid program to another 18,000 low-income adults in the county, the need for Health 360 will diminish, though not disappear, said Halstead.

She expects some invincible-minded young adults, who don’t see any need for health insurance to go uninsured, then blow a knee playing basketball or need an appendectomy.

And people may need help just navigating the system that will be created to purchase health insurance, Anderson said.

The next 10 years of Lincoln's safety net program is still on the drawing boards.