Every Sunday, eight to 10 people who can't afford health insurance visit a free clinic in west St. Louis County.

People like Kelly Caswell of Ellisville, who makes $19,000 a year working full time at a restaurant in Chesterfield, where she's noticed the economic decline.

"The tips are 10, 12 percent instead of 20," Caswell said. "They put an Aldi (discount grocery) in Chesterfield. It's a sign of the times."

The 850,000 Missourians without health insurance live all across the state, including Chesterfield, Wildwood and Town and Country, areas served by the free medical clinic that recently opened in Manchester.

The Volunteers in Medicine-West County clinic takes patients from 18 to 64 years old who are uninsured and have a household income of twice the federal poverty level or below. For a single adult, the eligible income could not exceed $21,780. Because children from low-income households and people 65 and older automatically qualify for Medicaid or Medicare, they aren't seen at the clinic.

The patients are working-class people who might not seem like they'd qualify for free medical care, said Dr. Rashid Dalal, who volunteered at the clinic on Sunday.

"There's a hidden number out there that need the help," Dalal said. "A lot of people have lost their jobs. These are patients that don't get these things checked out, so we provide basic services."

The clinic's volunteers include a respiratory therapist, a dietitian, a social worker and pharmacy students. The equipment for the three-room clinic at 14395 Manchester Road was donated, and the Islamic Foundation of Greater St. Louis pays the rent.

There is no money exchanged at the clinic or its affiliates, which donate lab and radiology services. Volunteers work with pharmaceutical companies to get deals on medical equipment, like asthma inhalers. Most patients can afford Walmart's $4 cost on generic drug prescriptions for high blood pressure or diabetes. The clinic's doctors do not prescribe narcotics or painkillers.

If the health care reform act stands up to political and legal challenges, most Americans will be required to buy health insurance or pay a fine starting in 2014. Volunteers in Medicine doctors said they believe there will still be a need for free clinics because the cost of health insurance could still be out of reach for many people.

The first Volunteers in Medicine clinic opened in Hilton Head, S.C., in 1994, when a group of retired medical professionals wanted to continue practicing. Now there are clinics in about half the states, not including Illinois.

A Volunteers in Medicine clinic opened in St. Charles in 1996 and has grown to treat more than 2,200 patients a year.

Dr. Maimuna Baig opened another volunteer clinic in Lake Saint Louis in 2010 with help from nearby St. Joseph Hospital West. The hospital provides lab work and radiology to the clinic's patients under their charity care program.

Baig and her husband, Sajjad Baig, opened the Manchester clinic in November for patients outside the ZIP codes generally served by St. Joseph West. Each Sunday, about 10 patients with appointments are seen for chronic and acute ailments such as diabetes, arthritis or bacterial infections.

Providing patients with basic health needs keeps them from going to emergency rooms, Dr. Baig said.

"They go there because they run out of blood pressure medicine, they have uncontrolled diabetes or just to get routine medications, and they keep the doctors from taking care of really sick people who are there for critical care," she said.

The west St. Louis County clinics don't fit the traditional Volunteers in Medicine mold because most of the staff members are not retired. Sajjad Baig, who manages the Manchester clinic, said he has a medical degree but has not passed the exams required for licensure in Missouri. He's trying to recruit more volunteer doctors to enable the clinic to open on a weekday.

The clinic does not have a religious affiliation beyond the financial support from the Islamic Foundation. Several doctors in the local Islamic community initially wanted to open a free clinic in the mosque on Weidman Road, but decided on a more accessible location. The clinic staff contacted more than 200 churches, synagogues and temples in the county to announce the opening.

Helen Porter, who volunteers as a dietitian in the clinic, said she thinks there are plenty of patients in the area who need free nutritional counseling.

"West County has the perception of being affluent, but I go to St. John (United Church of Christ in Manchester) and there are a lot of people out of work and the food pantry can't keep up with the demand," she said.

Every winter, Lois Brady gets laid off from her job at a nursery for lack of work. She came to the clinic on Sunday to check out a bump on her skin, which turned out to be harmless.

"I don't have insurance," Brady, 63, said. "I wish Medicare would hurry up but I've got a little over a year."