Squeezed by higher costs and lower patient counts, the Rimrock Foundation (site: http://www.rimrock.org) in Billings is an example of how the health care crisis has begun to cause financial strain for some health care providers.

The Rimrock Foundation has a staff of 147 and last year served about 5,000 people in its various programs which treat patients with addiction and mental health issues. Each year, the foundation offers about $500,000 in free care. Gov. Brian Schweitzer's administration has touted the organization's pilot programs that have helped people manage addiction and stay out of prison.

But that important work may be in jeopardy. Worrisome to Rimrock director David Cunningham is a trend that started months ago and accelerated in August: The numbers of patients has dropped by about 30 percent over the past three months.

The reason, suspects Cunningham, is the rising number of people without health insurance or with monstrous deductibles. Also, more insurance companies are becoming "freer and freer to 'Just say no,'" he said. The insurance companies typically will cite "pre-existing condition" clauses to avoid paying for the foundation's services, he said.

The upshot is that more and more people are waiting longer to seek treatment.

"What we are seeing is people who are acutely ill. People are holding off unless they have no other way to survive," Cunningham said.

On the other end of the foundation's financial worries are the rising costs of health care for the staff, which have gone up 88 percent over the last seven years.

Cunningham has hedged the facility's financial bets by leaving vacancies unfilled. He plans to wait and see, and to press for health care reform that keeps costs down, insures more people and puts an emphasis on prevention and wellness.