The headlines are sobering: More than 2,000 residents lose jobs as Aloha Airlines and ATA close up; Molokai Ranch shuts down and 250 people are suddenly out of work in a place where jobs are hard to come by; and gasoline prices are inexorably increasing and that affects the cost of everything in import-dependent Hawai'i.

Meanwhile, the worrisome national economic news can't be good for tourism. Our Legislature is certainly calculating all these factors in their budget negotiations. However, the correlation to decreased revenues is an increased need for safety net services. For those whose lives are thrown into chaos by job losses in high-cost Hawai'i, one of these services is healthcare, as people lose employer-sponsored insurance.

Private, nonprofit community health centers across the state already care for 30,000 people who are uninsured. Most of them are adults with modest incomes, most work part-time or are between jobs. Few of them qualify for public insurance like QUEST but virtually none of them can afford either health insurance premiums or the full out-of-pocket cost of healthcare.

Particularly for uninsured people, community health centers are a great choice for primary medical, dental, and mental health services. Health centers offer high-quality clinical services supported by case management and guidance with other kinds of assistance. As with all good healthcare, this service isn't cheap. Community health centers rely on support from the state and federal governments to cover costs since the people who need their help don't have much money.

This year community health centers are asking the Legislature for $2 million, which pays for about 21,000 uninsured visits. This will just sustain community health centers at the 2007 level and doesn't even take into account the looming probability of lot more uninsured people in 2008-09.

What happens if this funding isn't provided?

Community health centers won't be able to keep up — nor increase — their services to meet the demands for the newly uninsured. That means that more uninsured people who can't pay for care will go to already overburdened emergency rooms for primary care needs.

Uninsured people will also delay getting care they need because they can't pay for it and some of those delays will result in health conditions so much worsened that the person ends up in the hospital. That scenario, played out daily across the state and country, further adds to the economic woes of both the hospitals and the uninsured patient. The fact is it's 43 percent less costly to take care of uninsured people at community health centers. If the $2 million we're seeking now isn't available for primary care, the price tag will eventually be millions more.

When times are tough decisions have to be smart. One of those smart decisions is to invest in basic preventive safety net services. For the health of Hawai'i, that includes additional funding for the uninsured.

Beth Giesting is chief executive officer for the Hawai'i Primary Care Association. She wrote this commentary for The Advertiser.