Community Health Centers: Unsung and Under Siege

Front entrance of the Esperanza Health Center. Photo by Monica Hamill.

Reaching the landing at the top of the stairs on the second floor of the Esperanza Health Center in Philadelphia’s Hunting Park neighborhood, Susan M. Post, D.Min., MBA, pauses a moment to gaze out a wall of windows onto a vista of red-brick rowhomes.

“I like this space in our building that overlooks our neighborhood because it reminds us all the time that we belong to the community and that we are a part of it, and it is us,” says Post, executive director of the community health center (CHC) located in a predominantly Latino and Black section of the city.

The windows, she says, also allow neighbors to see into the CHC and know that its providers are there to care for their health and well-being.

“It embodies to me that we belong together,” says Post, a soft-spoken former New York City hospital administrator who joined the health organization in 2005. That, she says, is “the definition of community health.”

The origin story

In 1964, Congress passed the Economic Opportunity Act as part of President Lyndon B. Johnson’s War on Poverty. The Great Society law created the Job Corps, Volunteers in Service to America (known as VISTA) and Head Start. It also fashioned a new agency, the Office of Economic Opportunity, and that’s where H. Jack Geiger, a Harvard-trained physician and civil rights activist, and Count Gibson Jr., who was also active in the Civil Rights Movement and would go on to lead Stanford’s Department of Community and Preventive Medicine for many years, would go with their idea for establishing neighborhood health centers. A year later, the first two — one in Mississippi, the other in Boston — opened their doors. “Dr. Geiger noticed that a lot of his patients in rural Mississippi suffered from malnutrition at the time,” says Amy Simmons Farber, associate vice president of communications and public relations for the National Association of Community Health Centers (NACHC). “So, he wrote prescriptions for groceries.”

The Public Health Services Act of 1944 is the basis of public health services in America. In 1978, Congress amended the act; Section 330 of the amendments outlined the requirements that health centers must meet to receive federal grants. This led to the evolution and renaming of the Geiger and Gibson neighborhood health centers into federally qualified health centers, or FQHCs, one of the more ungainly initialisms in U.S. healthcare’s lexicon. However, FQHCs may be falling out of fashion. “CHCs and FQHCs are the same, just a different terminology,“ Simmons Farber explains. “FQHC is written into the authorizing statute, but we’re getting away from that now.”

Today, approximately 1,500 community health centers and so-called look-alike CHCs serve almost 34 million patients across 17,000 sites in all 50 states, the District of Columbia and U.S. territories, according to the NACHC. The look-alikes meet all of the eligibility requirements of a CHC but do not receive federal Section 330 funding and must carry liability insurance. CHCs and look-alikes provide medical and behavioral care and social services to people living in low-income and medically underserved areas. Patients pay on a sliding fee schedule, based on their ability to pay. By law, no one can be turned away.

“Some do vision care and a lot do mobile health and outreach to targeted populations,” says Simmons Farber. In 2023, CHCs and the look-alikes registered 32.5 million visits, according to the NACHC’s Analysis of the 2023 Uniform Data System Chartbook. One out of every 10 Americans received their health care from a CHC or a look-alike.

Eric Kiehl

“We have wonderful facilities,” says Eric Kiehl, director of policy and partnerships for the Pennsylvania Association of Community Health Centers. “You can walk through our doors and get your dental care, your physical health care [and see a] psychiatrist or psychologist all in the same building in the same day.” Many of the staff members at CHCs come from the National Health Service Corps, according to Simmons Farber. “It will pay for your graduate medical education if you agree to serve in an underserved community,” she says.

According to several studies, the care provided at CHCs is among the best offered by private primary care practices. A 2019 study published in the Journal of General Internal Medicine found that “on a number of high-value and low-value measures of care, CHCs performed similar to or better than private practices” and that “CHCs are well positioned to provide high-value healthcare.”

Rural hospitals became something of a cause célèbre during the intense negotiations this summer over the contents of the One Big Beautiful Bill Act that President Donald Trump signed into law on July 4. The bill included $50 billion in funding over five years for rural healthcare. In comparison, there was little, if any, high-profile attention paid to CHCs. The massive tax-and-spending bill will mean large tax cuts and sizable cuts to the federal funding of Medicaid programs in the form of work requirements and stricter enrollment. That’s bad news for CHCs because Medicaid payments account for 50% of their revenues.

“It is a scary outlook for health centers,” says Steve Weinman, MBA, a former chief operating officer of a Florida CHC and now principal with FQHC Associates in Gainesville, Florida, an industry consulting firm. “I completely expect to survive this. But it is going to look a lot different in four years.”

Community ties

Esperanza’s Hunting Park clinic is one of three CHCs owned by Esperanza Health Center Inc. and one of 11 nonprofit organizations operating 79 clinics in Philadelphia.

Esperanza opened its first CHC in 1989, not far from the current Hunting Park site. In 2011, the organization purchased an abandoned two-story warehouse and converted it into the modern medical hub that now houses the Hunting Park clinic. In 2014, Hunting Park was recognized as a Level 3 Patient-Centered Medical Home. Last year, the CHC location logged more than 55,000 visits.

Monday through Saturday, 15 doctors each see as many as 15 patients. Dentists check the teeth of 40 patients a day, while behavioral health practitioners talk with 70. Patients can access pediatric and primary care, women’s health, prenatal care, dental care, podiatry, behavioral health, telehealth, substance abuse support and HIV care.

Esperanza conducts healthy cooking and parenting classes and is connected to a food pantry. It has a small fitness center, a café, and an indoor basketball and event space. “When a patient comes here, we are adopting them and being a part of whatever their care is,” Post says. “They get tied to a doctor, nurse practitioner or physician assistant, and we’re responsible to help them get the full complement of care that they need.”

Mural at the Esperanza Health Center in Philadelphia. Photo by Monica Hamill.

One area of medical care CHCs have struggled with is specialty care, which is typically not provided at the centers. It has always been an issue, says Simmons Farber. CHCs, she says, should try to partner with a local hospital. That’s exactly what Esperanza has done. “We have really nice agreements with Temple University Hospital,” says Post, referring to Temple University’s teaching hospital, which is located in the same North Philadelphia part of the city as Hunting Park. “They will see our patients on a sliding fee so patients can pay what seems reasonable based on their income.”

By law, 51% of each CHC board must be made up of patients served by the center. Those board members, the thinking goes, will be aware of the community’s unique needs and be attentive to them. Ideally, the services offered at every CHC are tailor-made to the needs of its own community. Services needed in, say, rural South Dakota may not be needed in the Bronx, New York, and what works in the Bronx may not work in Philadelphia’s Hunting Park neighborhood.

“CHC board members are really the crown jewel of the movement,” Simmons Farber says. “They know better than anyone their neighborhood and the health care needs. The way they approach health care is very targeted to their communities, which are just as diverse.”

But these structural connections to the community can lead to some entrenchment and, ironically, a lower profile for CHCs. Both Simmons Farber and Kiehl say that has to change.

Photo by Monica Hamill

“When I got here, many of our members were the old guard and had the [attitude that] ‘We’re the best-kept secret,’ and they were proud of that,” Kiehl says. “I kept saying that we should be yelling from the rooftops about how we are the largest network of primary care across the entire state and across the entire country.”

Simmons Farber agrees it’s time to get the word out about CHCs. “To that end, we are, as a national association, preparing a national branding campaign,” she says. “In the past, it was enough that the members of Congress knew who those centers were in their district and really worked hard to protect them. Now there are too many people who need health care. Too many people are going without it. And too many people who could use care at a health center.”

George W. Bush and Barack Obama

When Simmons Farber joined the national association in 2002, CHCs were caring for 12 million patients. Twenty-three years later, that number has almost tripled. She believes the reason the numbers have ballooned can be traced to two presidents.

“In terms of national recognition,” she says, “one was George W. Bush, who made the expansion of CHCs the centerpiece of his health care plan and vowed to double the number of patients served by health centers and actually did it.”

The other was President Barack Obama. With the passage of the Affordable Care Act, he also expanded CHCs.

“Those two presidencies found that rare bipartisan consensus in terms of agreeing that health centers were effective, brought cost savings, and saved lives and tax dollars,” she says.

Of 32.5 million patients seen by CHCs in 2023, 9.4 million were children and 3.8 million were over 65 years of age, according to an October 2024 report by the national association. CHC patients included 1.4 million people who are homeless and 419,000 veterans, according to the report.

That same report noted that 18% were uninsured patients and that 50% of the 62% publicly insured were Medicaid beneficiaries. Overall,
90% of patients had low incomes, and 64% were people of color. In a January 2025 report, KFF reported that 67% of CHC patients had incomes at or below 100% of the federal poverty level.

Amy Simmons Farber

“It’s important to note that there are 100 million Americans who struggle to access basic primary care services,” Simmons Farber says. “They may have insurance, just no place to go for care. That is nearly 1 in 10 people. Our goal is to serve 1 in 3 people to close that gap.”

Reaching that goal would mean certifying more CHCs and look-alikes. And although there are currently 600 unfunded FQHC community applications, Simmons Farber says there hasn’t been new access point funding, which unlocks federal grant money, in almost a decade.

According to KFF’s figures, in 2023, CHCs received 43% of their revenue from Medicaid, 16% from grants and other sources of revenue, 12% from private insurance and 10% from Medicare. Federal funds from Section 330 accounted for 12% of their revenues.

CHCs also depend on money from the 340B Drug Pricing Program, which requires drugmakers who sell to Medicaid programs (and they all do) to sell outpatient drugs at discounted prices to healthcare organizations that care for uninsured and low-income patients. For many CHCs, 340B rebates not only make expensive medications affordable for their patients but also contribute significantly to their bottom lines, Simmons Farber says. CHCs reinvest the savings into services like mental health and substance abuse disorder treatments and other care not covered by Section 330 grants. But pharmaceutical manufacturers, who contend that hospitals have manipulated the well-intentioned 340B program to their advantage, have made several moves to pull back on the 340B program

“There have been a lot of challenges over the course of the last few years, and it is really affecting a lot of health centers and their operating margins,” Simmons Farber says, noting that 42% of CHCs have 90 days or less of cash on hand. “I will say that health centers are probably experiencing one of the greatest financial challenges they have ever faced, not only with this [One Big Beautiful Bill Act] but also with the 340B manufacturers.”

‘Scary future’

The effect of the Medicaid cuts has yet to be felt; the work requirement rules don’t go into effect until Jan. 1, 2027. But Simmons Farber expects it to have a “dramatic and far-reaching impact.”

“Our initial analysis of this bill is that it is going to result in job losses at CHCs,” she said. “It is going to result in patients losing their health insurance. It is going to result in site closures and higher mortality rates.”

That is backed up by a May 2025 study funded by the Centers for Disease Control and Prevention and the National Institutes of Health. It found that “CHC site losses were associated with increases in mortality. Preserving CHC access may be important for maintaining population health, particularly in underserved areas.” Simmons Farber says the national association is projecting 34,000 job losses at health centers and as many as 1,800 site closures.

“Based on a recent study, we did an analysis,” she says. “This level of disruption could lead to 5,000 to 6,000 preventable CHC patient deaths per year, in addition to $13 billion in total economic impact. Our own analysis is we anticipate that it will jeopardize health care reach for at least 4 million CHC patients.”

Then came the July 10, 2025, announcement from HHS ordering all federally funded health programs, including CHCs, to stop providing care for people who are not legally in the U.S.In an email, Simmons Farber said NACHCs was “still assessing what the policy directive means.”

“There is a lot to assess, and we’re looking forward to participating in the upcoming comment period to communicate relevant perspectives on the impact to more than 32.4 million patients who rely on CHCs for important cost- and life-saving primary and preventative care services,” Simmons wrote in an email.

It’s little wonder that CHCs are worried about what the policy changes in the One Big Beautiful Bill Act will mean for CHCs.

“We are coming up on a scary future, and we’re just really trying to figure out how do we navigate that,” Kiehl says.

Kristopher Ahn, M.D., left, an associate medical director at the Esperanza Health Center, confers with Rebekah Weber, M.S.N., a midwife at the center. Photo by Monica Hamill.

But, says Simmons Farber, CHCs are resourceful and resilient. CHCs have survived attempts by other administrations to derail the program.

“The main thing is CHCs are bipartisan,” she says. “Republicans and Democrats agree that the work CHCs do saves taxpayer dollars and saves lives. Our hope is that we continue to build on that record of success and continue to show our return on investment. You cannot afford not to invest in CHCs and primary care."