Community health centers provide care for 1 in 10 Americans, but funding cuts threaten their survival
**The Vital Role of Community Health Clinics Amidst Growing Challenges**
Community health clinics play a crucial role in the U.S. healthcare system, providing primary care to approximately 1 in 10 Americans, and 1 in 5 in rural areas. Despite their significance, these clinics often operate on razor-thin margins, facing increasing pressures from funding cuts and rising healthcare costs. The recent government shutdown, which lasted 43 days and became the longest in U.S. history, highlighted ongoing concerns about affordable healthcare access—issues that have persisted even after the implementation of the Affordable Care Act 15 years ago. As of 2024, around 27.2 million Americans remain uninsured, with many more struggling to afford care even if they have insurance. A tax and spending package signed into law in July 2025 threatens to exacerbate this crisis, potentially leaving 16 million Americans without health insurance by 2034, according to the Congressional Budget Office.
Community health centers, which emerged from the Civil Rights Movement in the 1960s, are designed to offer affordable healthcare to everyone, regardless of their ability to pay. They were initially established to combat the health disparities faced by marginalized communities and have since evolved into a cornerstone of the U.S. healthcare system. Federally Qualified Health Centers (FQHCs) receive the majority of their funding from the federal government and are mandated to serve low-income populations while minimizing barriers to care. In 2023, these clinics received over $5.6 billion in federal funding and provide care on a sliding scale based on income, ensuring that those below 200% of the poverty level can receive care at no cost. In total, there are over 1,500 federally funded health clinics and more than 775 free or charitable clinics across the U.S., collectively serving over 30 million people.
However, the sustainability of community health clinics is under threat. Rising operational costs and insufficient Medicaid reimbursements are forcing these clinics to do more with less. The 2025 government shutdown added to the uncertainty, slowing access to essential funds due to reduced administrative support. The potential cuts to Medicaid outlined in the recent tax and spending package could further limit funding and strip millions of Americans of their health coverage, increasing the demand for affordable care at community health centers. As these clinics face mounting challenges, their ability to serve as a vital safety net for healthcare access is jeopardized, potentially overwhelming other parts of the healthcare system, such as emergency rooms. The ongoing struggle for community health clinics underscores the urgent need for policy solutions that prioritize equitable access to healthcare for all Americans.
Community health clinics provide primary care to 1 in 10 people in the U.S., but they often operate on razor-thin margins.
Ariel Skelley/Photodisc via Getty Images
Affordable health care was the
primary point of contention
in the longest government shutdown in U.S. history, which hit 43 days on Nov. 12, 2025.
This fight highlights a persistent concern for Americans despite passage of the landmark Affordable Care Act 15 years ago.
In 2024,
27.2 million Americans, or 8.2%
of the population, lacked health insurance entirely. A significant number of Americans
have trouble affording health care
, even if they do have insurance. The tax and spending package signed by President Donald Trump into law in July 2025 puts a further 16 million Americans at risk of
losing their health care insurance by 2034
, according to the Congressional Budget Office.
Many people who lack or have insufficient health insurance seek health care from a network of safety net clinics called community health centers. Even though community health centers provide care for
1 in 10 people
in the U.S. – and 1 in 5 in rural areas – many people are unaware of their role in the country’s medical system.
As an
emergency physician
and the director of the
student-led community health program
at the University of South Carolina School of Medicine in Greenville, I collaborate with the community health center in Greenville and am closely familiar with how these types of providers function.
These clinics often operate on razor-thin margins and already function under continual demands to do more with less. Slated cuts to health care spending from the tax and spending bill and funding uncertainties that were driven by the shutdown threaten to destabilize them further.
What are community health centers?
Community health centers are clinics typically located in low-income areas that provide affordable health care to everyone, regardless of their ability to pay. Their history is
rooted in the Civil Rights Movement
.
In 1964, as activists traveled through the South to register Black voters, a group of doctors, nurses and social workers that
called themselves the Medical Committee for Human Rights
formed to provide emergency first aid and to support civil rights workers, volunteers and the local communities they engaged with.
Witnessing how intimately poor health in some of these communities was tied to living in conditions of extreme poverty, the group embraced the mission of providing health care as a way to
fight the injustice of racism
. Their idea was that treating illnesses and chronic conditions that stemmed from poverty would enable people to rise out of poverty and shape their own destiny.
Federally funded community health centers have their roots in the Civil Rights Movement.
The original community health centers were called
Neighborhood Health Centers
, and the first two – one in Boston and the other in Mississippi – opened in 1966. They were funded as part of President Lyndon B. Johnson’s
War on Poverty
, which introduced
legislation that launched safety net programs
, including Medicare and Medicaid, designed to support Americans experiencing economic hardships.
Community health centers
quickly multiplied over the following decades
and became a cornerstone of the U.S. health care system. These health centers took a broad approach to patient care, focusing on preventive nutrition and health education. They also sought to help with challenges that weren’t strictly medical but also affect people’s health, such as language barriers, lack of transportation and housing insecurity.
Different types of community health centers
Most community health centers
receive the majority of their funding
from the federal government. These clinics, called Federally Qualified Health Centers, must fulfill some specific requirements.
For one thing, they must be
strategically located to be accessible
to people in low-income communities with fewer available medical professionals. They must also minimize other barriers to care – for example, by providing language interpreters and offering telehealth services if appropriate. Additionally, they must be governed by a board in which at least 51% of the members are people who live in the local community.
In 2023, such clinics
received over US$5.6 billion
in federal funding. In addition to direct federal government support, they often
rely on reimbursements from Medicaid
to cover their costs. Some also receive state funding and private funding, as well as money from private insurance of the few patients who do carry it.
People who lack Medicaid or private insurance, or who are underinsured, receive care at no cost if their
income is below 200% of the poverty level
, and on a sliding scale otherwise.
Another type of community health center is often referred to as a “free clinic” or a
“look-alike” clinic
. These clinics typically rely on private grant funding or charitable donations. They are usually run by volunteers, and they often operate on limited schedules and have limited access to specialists.
In 2024, there were more than 1,500 federally funded health clinics providing services in over 17,000 different locations and more than
775 documented free or charitable clinics
across the U.S. Together, these two types of community health centers
provide free care to over 30 million people
.
Community health clinics deliver care at no cost to people whose income is below 200% of the poverty level.
ADAM GAULT/SPL/Science Photo Library via Getty Images
The community health project that I direct,
called Root Cause
, falls into a third category of free safety net health care generally referred to as “pop-up” or makeshift medical clinics. These projects vary widely, but Root Cause, which is run by medical students, operates as a monthly health fair that provides simple screenings for high blood pressure and diabetes as well as education on preventive care and healthy lifestyles.
Pop-up projects like ours are more precarious than other types of community health centers, but through grants and partnerships with organizations in Greenville, we have managed to keep this program funded for eight years.
Compounding stressors
Community health centers
are extremely cost-effective
, providing primary care to more than 10% of the U.S. population at the cost of just 1% of the country’s total health care spending. But with
health care costs rising
and Medicaid and insurance reimbursements failing to keep up, community health centers are increasingly being asked to do more with less.
The 2025 government shutdown added further uncertainty to community health centers’ operations. Although government funding and reimbursements through Medicare and Medicaid continued, having fewer government workers to complete the administrative tasks that these clinics rely on slowed their access to funds.
In the long term,
cuts to Medicaid of up to $1 trillion
included in the government’s tax and spending package are likely to decrease community health centers’ funding by limiting Medicaid reimbursements.
Simultaneously, those cuts and other policy changes, such as
new work requirements for Medicaid
, are likely to
strip millions of Americans of health coverage
– pushing more people to seek free or low-cost care. Cuts to
Supplemental Nutrition Assistance Program benefits
would increase food insecurity as well as stress – both
factors that directly affect health
– and thus may have the same effect.
Given that community health centers provide a kind of long-term stopgap for health care in high-need areas, decreasing their capacity could destabilize other elements of local health care delivery systems. For example, uninsured people who can’t access care at community health centers may turn to
already overburdened
hospital emergency rooms
, which are
required by law to treat them
.
As funding cuts imperil health care access, the need for safety net health care only grows. These opposing forces may be putting an untenable strain on a vital service so many Americans rely on.
Jennifer Spinghart does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
