On a recent Wednesday morning, Michelle Nepton, enrollment specialist at Vineyard Health Care Access, took a quick moment in between clients to put on a pot of coffee. It was the second full pot of the day. It was only 10:30.

“Today is actually pretty quiet,” said administrative assistant Carol Seale. Mrs. Seale has her thumb on the pulse of activity in the small building, which sits unpretentiously off New York avenue in Oak Bluffs. Hers is the face greeting each client who walks in with questions about health insurance, filling prescriptions or finding a doctor they can see without breaking their bank account.

“Sometimes it can be a total zoo. People show up at eight on their way to work and we can be here until six at night,” she said. If a slow morning needs a full pot of coffee before 10:30, imagine how it flows when the place is buzzing.

Vineyard Health Care Access opened its doors nine years ago behind Cronig’s Market. The opening came on the heels of a survey through which the Dukes County Health Council discovered Vineyard residents were twice as likely as those on the mainland to be without health insurance.

With few large employers and a community characterized by seasonal unemployment, the avenues for Island residents to acquire health insurance were few and far between, explained Sarah Kuh, director of the program, from her small nook at the back of the access offices.

With the survey as its impetus, the council hired Ms. Kuh in 1999 to direct the new program. Working only half time, Ms. Kuh was the sole employee during that first year. “The focus when we started was finding insurance for people who couldn’t get MassHealth,” she said of the only public health insurance program available in the state at the time.

Many Island residents were unaware of MassHealth. Many more did not qualify to receive it. The state program only provides health insurance to pregnant women, children, low-income families and the disabled. It does not cover single working people, many seniors, those in need of emergency medical assistance, or someone trying to figure out how to qualify for disability insurance, to name a few. “I was helping all the people who didn’t meet those criteria,” said Ms. Kuh. “There is no one who negotiates for the uninsured.”

Ms. Kuh began helping Island residents enroll in and maintain health insurance. She made referrals for primary, specialty and complementary care. In the first three years of the access program, MassHealth enrollment tripled on the Island. “More people got coverage and we reduced the amount of uninsured,” Ms. Kuh said.

Over time, the program and the services it provides have grown. Vineyard Health Care Access now has a staff of five including a bilingual outreach coordinator. Today, its services include dental assistance, prescription medication assistance and a reduced-fee program for low-income patients.

In 2000, the Dukes County Commission began to fund a position for Ms. Kuh as health access coordinator. Over the years, the county added funding to the program and in January 2004, the operation moved to its present home in a county-owned building which had been slated for demolition. The county provided no money towards the renovation, but the access program does not pay rent to stay in the space.

The county presently funds one-third of the program’s budget, which last year was $280,800. The remainder is scrabbled together through state and private grants and individual donations. The program does not currently receive any federal grants, although it has in the past. “We’ve been phenomenally successful getting grants,” said Ms. Kuh. “But counting on grants is not a wise long-term strategy. It’s not sustainable.”

The numbers speak for the success of the program. In the last fiscal year, the program provided nearly $14,000 in financial assistance to 450 uninsured or underinsured Island families. It processed more than 1,700 individual applications from some 1,100 Island households. This was up from 1,300 individuals and 815 households in the previous year. On a typical day, the three enrollment staffers each see an average of six to eight clients. There is a two-week wait for an appointment and the only charge is a voluntary one dollar donation at the door.

Even more powerful than the statistics are the words from those who have used the program. “If it wasn’t for them, I’d be dead,” said a Tisbury resident who has been battling cancer for several years. “I didn’t know what to do because I didn’t have health insurance,” she said. “I thought people without insurance just died.” Instead, she went to Health Care Access. That was three and a half years ago. With their help, she has signed up for MassHealth, visited hospitals in Hyannis and Boston, and taken advantage of programs which provide free transportation to get there.

Recently Massachusetts became the first state to make health insurance mandatory for all residents. The state created two public insurance programs to facilitate the mandate and last month began imposing penalties on those still uninsured, driving even more Island clients to the access program. “Now that there’s a requirement paired with new affordable programs, we’re seeing somewhere on the order of twice as many people as we were seeing before,” said Ms. Kuh.

Abigail Leighton, who has never been offered insurance through her seasonal restaurant jobs, is one of those new clients. “I’ve never really needed it, but now it’s mandatory to get it,” she said. “It’s nice to go somewhere where they actually explain it to you.”

“With mandated health insurance a reality, a huge number of Vineyarders now depend on the access program to connect them with affordable coverage and to keep it,” said Cynthia Mitchell, chairman of the Dukes County Health Council. “There is no other place for people to turn.”

As the costs of housing and health care premiums rise, Ms. Kuh expects demand will only increase. “Most people will put a roof over their heads before they go out and buy a prescription or go to the doctor,” she said.

Tom Bennett, associate executive director of Martha’s Vineyard Community Services, agreed. “Vineyard Health Care Access is indispensable to the Island community,” he said.

Despite the apparent need, the future of the program is unclear. Last month, in the face of ongoing budget constraints, the county commission voted to reduce its funding to three county programs, including Health Care Access.

In fiscal year 2009, the county plans to slash funding to the access program by 50 per cent and will ask Island towns to contribute the rest. The county plans to decrease funding incrementally each year until, at after five years, towns would fund the programs entirely. The County Advisory Board, which oversees the budget, approved the plan this week, but receiving support from the towns is still up in the air. Selectmen in Edgartown already have declined to put articles seeking voter support for the plan on the warrant for their annual town meeting.

Ms. Kuh is confident the program will continue, yet she is realistic about what could happen if funding is not provided and grants begin to dry up.

“The people that can do applications on their own do,” she said. “The people we do help are the people who need and want our help. These are the people who might end up with difficulty maintaining their insurance without us, the people who are subject to being penalized and not covered, the elderly who will not be filling their prescriptions because they think it’s not covered.

“These people who are sick or injured or who need help will be on their own,” she said.