The phones at Mosaic Health Center have been ringing more than usual.

Residents who tried to purchase health insurance through the public marketplace in November and December found higher premiums and unaffordable options. A charitable clinic in the state is seeing more patients seeking care.

Mosaic Health Center, formerly known as Clarkston Community Health Center, is a charitable clinic in DeKalb County, Georgia. Jeremy Cole, executive director of Mosaic, said the clinic had received calls for new patient appointments during the last two months of 2025, and those calls have continued into the new year. The clinic only serves uninsured patients, and as healthcare and medication costs rise, the clinic is using creative approaches to continue serving the community. They’re rallying for volunteers, leveraging local partnerships, and in late January, the clinic will extend daily hours to meet with patients in the evenings.

“We’re bracing for more,” Cole said.

The charitable clinic opened in 2015 and serves the county’s adult population. Most patients are experiencing chronic conditions, which include high blood pressure, high cholesterol, diagnosed diabetes, or a combination of the three, requiring daily medication assistance.

“We’re really focused on folks who don’t have any health insurance, and therefore access to medication is very challenging,” Cole said.

In a June 2025 report from the Georgia Budget and Policy Institute, nearly 200,000 uninsured, low-income residents were estimated to be without health insurance. In DeKalb County, where the health clinic is located, a June 2025 county report shared that 13% of its residents were uninsured.

That uninsured rate is expected to increase exponentially, with subsidies ending on insurance available to purchase, which could cause premiums to rise.

Cole said that the clinic is using the strength of its partnerships to prepare to serve more people. The executive director said that local government has supported the clinic when federal dollars dropped.

“Shout out to the county for recognizing (the need),” Cole said during a phone call with Direct Relief.

Mosaic has also partnered with the local nonprofit Project Open Hand on a nutrition program for its diabetic patients. Cole shared that the first cohort had 14 registrants who spoke six different languages. The participants learned ways to prepare affordable, nutritious meals and were given free produce for six months.

“It’s common sense, but it’s so much cheaper to treat somebody on the front end of a disease, rather than to wait until they’re really sick,” he said.

Cole hopes to start a paramedicine model for patients with transportation and mobility issues, rally more volunteers, and hire additional medical assistants in 2026 to manage the influx of patients.

Dallas Smith has served as a volunteer pharmacist at the clinic for five years. The former Peace Corps member said he learned ‘the value and incredibleness’ of being part of a community, and when he moved to the Atlanta area, he wanted to contribute.  

“I love being able to communicate with and interact with patients over a five-year period—that’s a long time to know someone,” Smith said. “(I’ve seen) them learn and grow, and some have been able to get full-time jobs and leave the clinic. Some are still with us, thriving as their blood pressure decreases, or they’re able to control their A1C. It’s just been really, really incredible.”

The clinic continues to fill a gap for medications and care, but challenges with affordability remain. Smith said that some vital medications, like blood thinners, are no longer covered by insurance and have become more expensive to procure.

“Medications like metformin and amlodipine and some of your basic hypertension or diabetes medications, they aren’t the most expensive, but patients who don’t have a lot of room to work with in terms of their budget, that adds up,” said Smith. “Even if it’s only $30 to $40 a month, that could be spent on food for their kids.”

The clinic has partnered with corporate and nonprofit organizations in medication assistance programs. Their patients have access to flu vaccines but have a more difficult time finding free or reduced costs vaccines for hepatitis and pneumonia.

Smith shared that he became frustrated when over 50 patients registered for a free Covid-19 vaccine, only to be told that the donation would no longer be available. The clinic tried to purchase vaccines on it’s own, but they couldn’t help everyone.

“There’s a huge gap, and it’s getting worse and worse and worse with everything going on,” said Smith. “I think we’re trying to find creative ways to address it, but it’s very hard because they’re still so expensive.”

Since 2017, Direct Relief has provided more than $920,000 in medical aid to Mosaic Health Center to support patient care.