Community health centers provide care for 1 in 10 Americans, but funding cuts threaten their survival
Community health clinics play a crucial role in the U.S. healthcare system, providing primary care to approximately 1 in 10 Americans, and serving as lifelines for those without adequate insurance. Despite their significance, these clinics often operate on extremely tight budgets and face increasing pressure due to funding uncertainties. The recent government shutdown, which lasted 43 days and was the longest in U.S. history, underscored the ongoing struggle for affordable healthcare, a concern that has lingered since the passage of the Affordable Care Act 15 years ago. As of 2024, around 27.2 million Americans remain uninsured, and the Congressional Budget Office warns that proposed cuts in healthcare spending could jeopardize coverage for an additional 16 million by 2034.
Community health centers, established during the Civil Rights Movement, are designed to provide accessible healthcare to low-income populations, regardless of their ability to pay. The origins of these clinics date back to 1964, when healthcare professionals recognized the link between poor health and poverty. Over the decades, these centers have expanded significantly, offering comprehensive services that go beyond medical care, addressing social determinants of health such as transportation and housing insecurity. Federally Qualified Health Centers (FQHCs) receive substantial federal funding, which accounted for over $5.6 billion in 2023, and they often rely on Medicaid reimbursements to sustain their operations. Yet, with rising healthcare costs and insufficient reimbursement rates, these centers are increasingly strained, particularly in light of recent legislative changes that threaten their funding.
The future of community health clinics hangs in the balance as funding cuts loom and the demand for affordable care rises. The anticipated reduction in Medicaid reimbursements could severely limit the ability of these clinics to serve the growing number of uninsured individuals, potentially leading to increased reliance on overburdened emergency rooms for care. As the healthcare landscape shifts, the importance of community health centers as a safety net for millions of Americans cannot be overstated. They not only provide essential health services but also work to address broader issues of health equity and access. The challenges they face highlight the urgent need for sustained support and innovative solutions to ensure that these vital resources remain available for those who need them most.
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.
