CARRBORO - Talking to Aaron Nelson and Brian Toomey, one gets the sense that providing affordable health care does not have to involve the brutal drama playing in town hall meetings across the country.

Instead, Nelson, CEO of the Chapel Hill-Carrboro Chamber of Commerce and Toomey, CEO of Piedmont Health Services, collaborated in December 2008 to form the Small Business Health Service. The program provides affordable primary health care to a group that sometimes struggles to find it in the current system: small businesses.

Eight months after the program started with focus groups and a pilot phase, the Small Business Health Service serves more than 100 individuals from three area chambers.

Members of the Chapel Hill-Carrboro, Chatham and Hillsborough/Orange County chambers of commerce and their families can access primary care at any of Piedmont Health Services' six locations. A $60 fee covers a visit with a nurse practitioner, physician's assistant or doctor. Labs that must be sent off-site cost $20, and $10 pays for prescriptions filled at the health center.

Addressing the initial challenges of setting the right price and determining which services to provide put the program on a solid foundation. So far, the fees cover the costs,but in Toomey's mind, mission fit gives the program its real sustainable value.

"It's the middle class that's challenged to figure out how to afford [health care]," he said. "And we're trying to figure out how to come up with something that's the right care for the right price. So that's why I think this is worth it."

Nelson echoed that view: "Our number one commitment as an organization is to bring value to members... And this is an example of us delivering on that commitment."

With initial success, Toomey and Nelson can now look to what is next for the program. Toomey stressed the need to "continue to listen to what people like and don't like about us." He cited the recent opening of a Friday dermatology clinic as an example of the kind of improvement that can result from listening to patients' needs.

But Toomey is positive about the health center's ability to expand its capacity to serve small businesses. The center is adding exam rooms and making other improvements with money from the American Recovery and Reinvestment Act. Toomey has also met with the Roxboro Area and Caswell County chambers of commerce and discussed participating in the Small Business Health Service.

In the futures, Nelson and Toomey see more employer involvement.

One idea involves health care "gift cards." Employers would give employees cards, loaded with money like a gift card, which they can use to purchase health care at Piedmont Health Services.

Another possibility is the "gym membership model." Employers would pay a fee to Piedmont Health Services, giving employees access to health care services. The employee could then pay a lower per-use fee since the costs would be shared.

In both these models, employers provide employees with health care directly, rather than health insurance.

But how important is the focus on care vs. insurance?

"[The Health Service] is certainly one of the local innovations that improves the status quo," said Daniel Gitterman, associate professor of public policy at UNC, "but it is not a long term solution."

In Gitterman's view the need for broad access to affordable insurance, not just care, cannot be ignored. "A lot of patients are just one sickness or one injury away from great hardship," he said. Even with the Small Business Health Service, uninsured patients who get a major illness or injury could face large costs, he said, especially if they need to be hospitalized.

The founders of the Small Business Health Service acknowledge their program is not the answer but say it is a valuable measure for now.

"We're going to make sure we do something to make sure people get access to care, and so we'll go directly to how we can be a community health center and make that happen," Toomey said.

"We're not waiting for that to happen, we're doing something in the meantime."