MILLINOCKET – About 1,800 Great Northern Paper Inc. employees and retirees are joining thousands of other Mainers who have little or no health insurance.

Great Northern’s self-insured health care plan essentially ended when the paper company ran out of money, leaving coverage in peril for 1,130 employees at its mills in Millinocket and East Millinocket and for 677 people who have retired since 1992.

For now, GNP employees and retirees are receiving limited coverage for prescriptions and emergency care as part of a $1.9 million interim health plan approved by a federal bankruptcy court judge last week.

But employees – out of work for 46 days – and post-1992 retirees are wondering how they will pay for medical care. Pre-1992 retirees are covered under other plans.

“There is no reason for anybody [who] is within reach of our facilities to go without health care,” said Durwood Humphrey, executive director of the Katahdin Valley Health Center, with facilities in Patten and Island Falls.

Humphrey knows something about the costs of insurance.

About 14 years ago, when he was 39, Humphrey had major heart problems. He wound up undergoing a heart transplant in 1996. In between, he faced some tough times. Humphrey said he was forced to sell about everything he owned to pay for health insurance.

“In order to cope and maintain health insurance, which is very expensive today, you have to give up certain things in life or go without insurance,” he said. “I didn’t dare give it up.”

He and other medical providers are concerned that people affected by Great Northern’s shutdown won’t seek the medical care they need.

Kevin Lewis, executive director of the Maine Primary Care Association, believes a safety net is in place. The association represents Maine’s primary care providers or those giving care to the underserved and uninsured.

He said federally qualified health care centers, or FQHCs, are the answer for GNP employees and retirees. Federal funding allows the centers to offer primary and specialty care services at reduced rates.

Such centers have been approved by the government to give low-cost health care, according to the federal Centers for Medicare and Medicaid Services. The FQHCs also provide services, including preventive care – often not covered by private plans – under the supervision of a physician.

Through such arrangements, the value of personal assets is not considered in calculating the cost of primary care. Fees are set by comparing a person’s income with annual federal poverty guidelines.

Current guidelines are $17,720 for an individual and $36,200 for a family of four. Fees range from free to 100 percent of the cost.

More than 70 percent of all patients qualify for so-called sliding fee discounts on all out-of-pocket payments, Lewis said.

The 12 federally funded centers in Maine saw 78,773 patients in 2001, or 5 percent more than in 1996. Data for 2002 are not available.

“I expect this rate will increase in the coming months and years, given the current economy, the rate of job losses and the increasing costs of health insurance,” Lewis said.

Of the total payments the federal centers receive, private insurers are now paying just 23 percent. “This demonstrates the prevalence of the underinsured patients who are able to benefit from the sliding fee discount provided by the federally qualified health centers,” Lewis said.

Humphrey agreed. He said as the economy falls, businesses either aren’t providing health insurance anymore or employees are paying more for the coverage.

Three years ago, Katahdin Valley Health Center’s medical facilities saw about 7,000 patients. They see nearly 12,000 today. He said the center has a prescription assistance program in which one employee does nothing but cut deals with drug companies. “We give away $15,000 to $20,000 a month in prescription drugs,” Humphrey said.

Katahdin Valley has two family practice physicians. Other services include podiatry, mental health and substance abuse counseling, diabetes education, optometry, lab services, occupational medicine and well child clinics. For information call 528-2285.

Humphrey said the center hopes to expand by locating two new facilities in the Millinocket and the Houlton areas. If approved, the new centers could be available in 2004.

Dawn Cook, executive director of The Health Access Network, a 2-year-old nonprofit with six facilities in the Lincoln area, said she expects her center will become federally qualified next month.

Health Access Network’s main office is in the former Bangor Savings Bank building on Main Street in Lincoln.

Cook said Health Access Network serves about 6,000 people in 16 Penobscot County towns. The network employs 41 people. There is a doctor at every site, except with the network’s rural outreach program. Services include full family health care, lab, industrial medicine, general surgery, podiatry, foot surgery, radiology, obstetrics-gynecology and ultrasound.

Cook said services to be added this year include dental health, mental health and a low-cost prescription drug program. For information call 794-6700.