Welcome to Steve Horton’s life.

He’s 53, sleeps each night at Portland’s Oxford Street shelter and starts each morning with a shot of insulin for his diabetes at the nearby Health Care for the Homeless Clinic on Portland Street.

Without the clinic, Horton said this week, “I’d probably be out either robbing people or holding up a sign trying to get money for insulin. Or I’d be in the hospital someplace.”

Welcome to Edgar Gato’s life.

He’s 60, lives in a single room at the Greater Portland YMCA on Forest Avenue and, thanks to his weekly recovery group meetings at the homeless clinic, has held his opiate addiction at bay for 15 months and counting.

“If it wasn’t for this place,” Gato said, looking around the clinic, “I’d probably be dead right now.”

Welcome to Bobby Davis’s life.

He’s 56, works 2½ hours a day at Dyer’s Variety, across from the clinic, and hands all but $3 of his $113 weekly paycheck back to his boss (also his landlord) to cover his weekly rent for an apartment above the store.

Without the medications Davis receives through the clinic for his high blood pressure and his addictions to alcohol and crack cocaine, he said, “I’d be a basket case. I’d be back on the drugs, the drinking. I’d be screwed.”

Just to be clear: Nobody’s asking you to like these people — although if you already despise them, perhaps it’s time for a little soul searching.

But with $35 million in proposed cuts to the state’s MaineCare program bearing down like a fiscal tsunami on the eight-year-old Health Care for the Homeless Clinic, folks like Horton, Gato and Davis find themselves at the center of an inevitable paradox.

Put simply, fellow taxpayer, you can pay to maintain their safety net now — or you can pay to clean up the mess later.

“If they can’t come here, the only other option is either not being treated at all or showing up in the (hospital) emergency room,” said Dr. Shuli Bonham, the clinic’s vastly overworked and underpaid medical director. She’s also its only doctor.

“The overall cost to the city and to society as a whole is going to be much greater by not being able to do what we do here,” Bonham said. “Our daily work is keeping people out of the emergency room.”

The city-run clinic, open Monday through Friday from 8 a.m. to 5 p.m., sees about 2,200 patients a year for everything from treatment of infections and chronic medical conditions, to substance abuse and mental health counseling, to dental care.

About half of its patients have MaineCare coverage — and most of those are “non-categoricals,” who don’t fall into any of the groups (people over 65, pregnant women, the disabled, to name a few) who automatically are covered by MaineCare.

The other half of the clinic’s patients have no insurance at all. Nor, this being the place of last resort for those who are on the streets or at serious risk of becoming homeless, do they have money to pay for the treatments they receive.

But the clinic, which annually receives $600,000 from the city and another $650,000 from the federal Health Resources and Services Administration, turns away no one. In addition to its direct government subsidies, it relies heavily on reimbursements for its patients who have MaineCare to help cover the costs of those who don’t.

At least that’s how it’s worked until now.

Take away MaineCare coverage for the “non-categoricals,” as Gov. Paul LePage’s current budget proposes to do, and the homeless clinic’s already rickety financial underpinnings will start to collapse.

In fact, according to Douglas Gardner, director of Portland’s Health and Human Services Department, “this change could force Health Care for the Homeless to close its doors.”

Big deal, you say?

You’re right.

Take away Steve Horton’s insulin, which he gets from the clinic’s catch-as-catch-can pharmacy (he’s waiting just to get on a waiting list for MaineCare) and he’ll go into diabetic ketoacidosis. That translates into a Medcu ride and a costly admission to Maine Medical Center — courtesy of taxpayers and the hospital.

Take away the Prozac and Wellbutrin that the homeless clinic provides Horton for his depression and it’s hard to say what might happen.

“I get this hopeless feeling,” Horton said. “I’ll start doing things that you wouldn’t normally do. I walk across the street and don’t give a (expletive) if there’s a car coming down the road. If it hits me, great. If it doesn’t, that’s another day I gotta go through.”

Take away the Soboxone, which dulls opiate cravings, from guys like Edgar Gato — not to mention their weekly counseling sessions and recovery group meetings — and, as Gato puts it, “it wouldn’t be good.”

“They’re going to have to hire more police and build more prisons,” Gato said. “Because people are going to go out and start robbing and stealing for their addictions. There’s a big picture (the politicians in Augusta) ought to take a look at before they start shutting places like this down.”

Take away Bobby Davis’s blood pressure medication and he’s a heart attack waiting to happen.

“I need these pills,” Davis said. “They keep me regulated, know what I mean?”

Davis, who had a good job with the city’s Public Services Department before he got hooked on crack and lost everything several years ago, isn’t asking for your sympathy.

“I made my own mess. I don’t blame nobody,” Davis said. “I had a good job and I never should have left there.”

But if you truly think the state can afford to pull the plug on places like the Health Care for the Homeless Clinic while it bestows tax breaks on even the wealthiest Mainers (not to mention their multimillion-dollar estates), you’d best be bracing yourself for the aftermath of this war on all things “welfare.”

“Take this place away and you’ll have a lot of people who come here for meds all of a sudden running around the streets,” Horton warned. “It’s not solving a problem — it’s creating a bigger problem.”

Dr. Bonham, who’s now battling one of the many head-cold viruses that come through her door each day, has a simpler answer for those who wish all these people and all their problems would just go away.

“My response is that they are us,” Bonham said. “They’re living on the streets and sleeping in the shelters — but they’re still people.”

Columnist Bill Nemitz can be contacted at 791-6323 or at:

bnemitz@mainetoday.com