She lost her job in January, she had no health insurance and her diabetes and cataracts were going dangerously untreated. That's when a neighbor intervened, pointing Shirley Ruffner to the Free Health Care Center, Downtown, operated by the Diocese of Pittsburgh's Catholic Charities.

Today?

"Both of my cataracts were removed," the North Side woman said. "My vision is now better than it ever was when I wore glasses. ... My diabetes is now under control."

Her care was provided -- and in the case of the cataract surgery, set up via referral -- by the Free Health Care Center, which opened in November 2007 at 212 Ninth St., and is busier than ever. On Tuesday, Catholic Charities and Highmark Inc. jointly announced a $500,000 gift from the health insurer, and Ms. Ruffner was on hand to speak of the clinic's ongoing impact and importance. It was a message likewise delivered by the head of the Diocese of Pittsburgh, Bishop David Zubick.

"There is no question, as the need was present in 2007, it still continues -- the need to provide quality, low-cost health care to all of those people without insurance who do not qualify for medical assistance," he said.

The clinic serves the region's uninsured and working-poor communities, providing them with medical, dental and vision care, as well as low-cost or free prescription medication. About 7,000 have come through its doors since the opening, and the waiting lists for some services are growing longer, especially the wait for routine dental care, which is almost 1,000 people deep. That demonstrates both the critical importance of the free care center mission, as well as the dearth of health-care options for the uninsured.

The Highmark donation will help keep the clinic operating into the coming year, and through the first few years of federal health insurance reform, said Highmark CEO Ken Melani.

Even after the health insurance exchanges take effect, "8 percent of our population will remain uninsured," he said. The Pittsburgh region has "one of the lowest uninsured rates in the country right now, [but] the reform legislation will help us to narrow that gap some."

The health insurance exchanges, which take effect in 2014, are community insurance marketplaces that would allow more "retail" style competition among insurers, and also would allow employers and individuals to select from among those insurers in the marketplace.

And what of 2014 and beyond, when the health insurance marketplaces start offering policies to the public? Will smaller companies use that as an excuse to cut health insurance benefits, creating a new class of needy?

"I don't think you'll see a massive dump into the exchange," Dr. Melani said. Increased use of community-rated pricing policies will allow Highmark to offer more competitive prices within a given territory, rather than pricing separately per company -- "it will stabilize the cost of health insurance for those companies, and that will play a big role in helping us to keep small employers in the fold, buying health insurance for their employees."

On the other hand, "there's going to be a new group of uninsured," because people and families making more than 400 percent of federal poverty wages will not be eligible for health care premium subsidies.

"We'll probably start to see an unaffordability issue," he said.

Highmark's financial support for the Free Health Care Center represents about half of its operating budget; it relies almost entirely on corporate and philanthropic contributions for funding. The care center also has applied for a separate grant from the Highmark Foundation, the insurer's philanthropy division.

The number of volunteers at the center is always churning, but since 2007, there have been 135 volunteers, some retired, including unpaid doctors, dentists, nurses, optometrists and physical therapists.

There also is a four-person paid office staff and two paid dental assistants. On the pharmacy side, a rotating staff of university students works as part of required pharmacy school rotations.

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