MANCHESTER — Fourteen years ago, health insurance plans had pesky annoyances like $5 co-pays. Hilarycare was dead; Obamacare had yet to be conceived. A merger of Manchester's two major hospitals was starting to tear apart.

And Ed George walked through the doors of the Manchester Community Health Center, the second chief executive officer of the little known health clinic.

George, who is 69, announced recently that he will leave his position at the end of this year.

He leaves an organization that attributes its growth — a tripling of patient population during George's tenure — to the fact that health care has become more expensive and less accessible to more and more people.

“The need in Manchester is growing significantly. There are just times when we don't have the capacity to meet the needs,” he said last week. “It's a constant battle.”

George left a Massachusetts hospital where held a senior vice president title to take the Manchester job. He found that health care in New Hampshire is a different animal than the Bay State.

New Hampshire has much tighter eligibility requirements for government-provided Medicaid, so more people without insurance rely on federally funded clinics such as Manchester Community Health Center.

When the health center does treat the state's Medicaid patients, it receives higher payment rates than other providers. In exchange, it can't turn anyone away.

So the health center maintains a sliding scale for those who can pay some. It seeks out grants. And George networks with hospital executives, government health officials and nonprofits, all in an effort to find treatment for his patients.

In Manchester, that means maintaining relationships with what George calls the Big Three Providers — Elliot Hospital, Catholic Medical Center and Dartmouth-Hitchcock Medical Center.

“We've been very lucky to have a very healthy working relationship with the major players in the city,” George said.

Doug Dean, president and chief executive of Elliot Hospital, said George has been able to keep the center both vibrant and financially viable.

“It's a unique combination of management skills, financial skills and humanity,” Dean said. “You have to be very much committed to the unserved and underserved in the community.”

Internally, George had to run an organization that includes 60 employees.

“He's our model. He's the godfather of this clinic,” said Ibgal Mohamed, a physician assistant who works at the clinic. She praised his open-door policy, monthly brainstorming sessions and approachability.

The clinic maintains a patient count of 9,500, up from 3,000 when George started. Its budget is $6 million, up from $2.75 million.

During his tenure:

--The health center launched a preventive health program in public schools.

-- The center implemented electronic medical records for its patients.

-- The center spent $2.5 million to convert an old furniture store into a new location.

-- The center hired a director of advancement to improve its profile.

The center has moved forward with plans to open a satellite operation at the Easter Seals facility on Auburn Street. George anticipates another 2,500 patients within two years.

“It's going to put us smack dad in the middle of one of the neediest areas of the city,” George said.

Meanwhile, the board of directors is conducting a search and hopes to have a replacement on the job by year's end.

George said he's “not interested in relaxation 100 percent of the time” and sees himself working on an interim basis.

“You have to keep yourself cheerful,” George said about his 14 years on the job. “There's a lot of things that can get you down. I refuse to lose my humor.”

mhayward@unionleader.com