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A woman walks into the Community Healthcare Network\u2019s Long Island City Health Center in Queens, N.Y., this month. This community health center is one of more than 1,300 across the country that serve patients regardless of their background or ability to pay. (Photo by Shalina Chatlani\/ Stateline)<\/p>\n
NEW YORK \u2014 On a busy street in Queens, New York, just around the corner from a halal hot chicken sandwich restaurant and a barber shop, the Long Island City Health Center welcomes its patients into a brightly lit waiting room, painted baby blue and filled with soft white and gray seats.<\/p>\n
A woman working behind the desk on a recent weekday answered one patient\u2019s questions in Spanish. Other patients came dressed in hijabs, kurtas or other traditional clothing from countries around the globe. A caseworker assigned to the center rolled one woman, wheelchair-bound because of a stroke, toward an examination room.<\/p>\n
The Long Island City Health Center is part of a national network of more than 1,300 community health centers<\/a>, safety-net clinics that served more than 31 million patients in 2023, according to KFF, a health research nonprofit. The clinics are located in areas where there aren\u2019t many doctors or hospitals, and they provide care to all patients, regardless of their ability to pay.<\/p>\n Thanks largely to their broad reach, the centers have long enjoyed bipartisan support<\/a>. But the federal government shutdown, freezes to federal grants, looming cuts to Medicaid and new Trump administration policies barring some immigrants from receiving care at the centers have put them under financial stress.<\/p>\n Community health centers disproportionately serve low-income people, people of color and rural residents. In 2023, 90% of patients had incomes at or below 200% of the federal poverty level, according to KFF. Forty percent of patients were Hispanic, 17% were Black and 31% were rural residents.<\/p>\n More than 80% of patients were insured, and about half of all patients were covered by Medicaid.<\/p>\n The health centers are funded<\/a> by the payments they get from Medicaid<\/a>, Medicare and private insurers, plus federal and state grants. Money is always tight, but between 2010 and 2023, average operating margins remained in the black. That changed last year, as the average margin dipped to -2.1%, according to an audit<\/a> conducted by the National Association of Community Health Centers.<\/p>\n Half of community health centers have fewer than 90 days of cash on hand, and one-quarter operate with margins below -4%, according to the audit.<\/p>\n When the Trump administration froze some federal grants in February<\/a>, it forced some clinics, particularly in rural areas, to reduce hours or shut down. The broad domestic policy law President Donald Trump signed July 4 is projected to increase the number of uninsured patients<\/a> seeking care at the health centers. And the ranks of the uninsured would grow further if Affordable Care Act insurance plans get much more expensive at the end of this year, as would happen if Congress fails to extend tax credits that have kept prices down.<\/p>\n Meanwhile, the government shutdown has prevented Congress from renewing the Community Health Center Fund, which expired on Sept. 30<\/a> and provides<\/a> about 70% of the centers\u2019 federal funding. And the centers worry that a new Trump administration policy barring them from providing care to some immigrants would force them to dedicate scarce resources to verifying patients\u2019 legal status. A federal judge has temporarily blocked the change.<\/p>\n Andrew G. Nixon, director of communications for the U.S. Department of Health and Human Services, told Stateline that the administration is \u201cfully committed to protecting America\u2019s community health centers, which play a vital role in serving millions of families nationwide.\u201d<\/p>\n \u201cThe Trump Administration is working to reopen the government and restore full funding, while also ensuring that federal resources are prioritized for American citizens and lawful residents in accordance with the law,\u201d Nixon said in an emailed statement.<\/p>\n This year, some states<\/a> \u2014 including Connecticut, Illinois and Minnesota \u2014 approved more money for community health centers. But Illinois<\/a> and Minnesota<\/a> also have scaled back or ended health care programs that served low-income people regardless of their immigration status, which might prompt more of those patients to seek care at the centers. And California Democratic Gov. Gavin Newsom in June signed<\/a> a state budget that bars immigrants who are here illegally from enrolling in the state\u2019s Medicaid program.<\/p>\n \u201cHistorically, health centers have had bipartisan support, but we\u2019re operating in a very different world now,\u201d Feygele Jacobs, a professor of health policy and management at George Washington University, told Stateline.<\/p>\n Jacobs said health centers are a target for the Trump administration because they serve people of color, low-income residents, immigrants and the uninsured.<\/p>\n \u201cIt\u2019s those very communities that are really being challenged right now by the administration,\u201d Jacobs said. \u201cSo I don\u2019t know that the focus is so much on health centers as entities, but really more on an administration whose views are antithetical to many of the people that health centers have historically cared for.\u201d<\/p>\n But Chris Pope, a senior fellow at the conservative-leaning Manhattan Institute, questioned whether the Medicaid changes included in Trump\u2019s One Big Beautiful Bill Act would lead to a significant increase in the number of people without insurance or a dramatic reduction in the program\u2019s finances.<\/p>\n Pope also noted that the law doesn\u2019t take direct aim at the federal funding of community health centers.<\/p>\n \u201cThere\u2019s no direct cut in terms of reimbursement for community centers,\u201d Pope said. \u201cIt\u2019s not the intent of the bill to slash and attack health center revenues.\u201d<\/p>\n The first community health centers were created in 1965<\/a> in Mississippi and Massachusetts as federal demonstration projects under President Lyndon Johnson\u2019s War on Poverty. The program became permanent in 1975.<\/p>\n Doctors at the Long Island City Health Center describe it as a one-stop shop for patients. In addition to providing primary care and mental health services, the center has an in-house pharmacy and provides laboratory tests, vaccinations, drug treatment, HIV\/AIDS treatment, and support for transgender patients and their families. Including its dozen medical residents, the center has doctors who can speak French, Tamil, Kru, Ibo, Yoruba, Spanish, Hindi, Nepali, Russian and Tagalog, among other languages.<\/p>\n Dr. Libby Brubaker, an attending physician at the Long Island City Health Center, told Stateline that providing a welcoming atmosphere for everybody is at the core of the center\u2019s mission.<\/p>\n \u201cOur social workers go to bat for our patients and help them get access to housing. \u2026 We write letters to allow our patients with asthma to be able to have air conditioners inside their apartments,\u201d Brubaker\u00a0said.<\/p>\n \u201cReally what we\u2019re providing for our patients is all encompassing, and that sets us apart,\u201d she added. \u201cHospitals don\u2019t do all of those things. They do some, but being able to offer that breadth of services in an outpatient setting is invaluable.\u201d<\/p>\n Sandra Tap\u00eda, a Long Island City resident from Bogot\u00e1, Colombia, walked into the clinic on a Friday to see her nutritionist for the first time. She\u2019s been in the U.S. for seven years, is a green card holder and has Medicaid. She said she likes the center because \u201cit\u2019s close and it\u2019s safe.\u201d<\/p>\n Tap\u00eda said she can\u2019t imagine not being able to have access to health care, and values being able to speak\u00a0to her provider in her native Spanish.<\/p>\n \u201cHere, they offer really great services,\u201d Tap\u00eda said. \u201cI don\u2019t want people without as many resources, like me, to be punished.\u201d<\/p>\n The idea of cuts frightens patients such as Olga Scott, 65, who said she has been coming to Long Island City Health Center for years. Scott lives in the Bronx, but takes an hourlong subway ride to the center so she can see her favorite doctor.<\/p>\n \u201cThese community health services around the whole community of these five boroughs are needed \u2014 it\u2019s really needed,\u201d she said. \u201cI just hope that they don\u2019t do too much cutbacks, because we need every service we can get.\u201d<\/p>\n Dr. Sindhura Manubolu, director of the family medicine program at the center, said she\u2019s sensing \u201ca lot of anxiety\u201d from her patients, especially those who rely on Medicaid.<\/p>\n \u201cMost of the questions from our patients have been around, \u2018Oh, will we lose coverage?\u2019\u201d said Manubolu, who is an immigrant from India. \u201cFor someone to be here in an advanced country like America, and then not being able to access the health care that probably is even available to a person in a less developed country is not acceptable.\u201d<\/p>\n On Capitol Hill, community health centers are an increasingly rare example of bipartisan agreement.<\/p>\n In May, Republican U.S. Sen. Roger Wicker of Mississippi and Democratic U.S. Sen. Jack Reed of Rhode Island wrote a joint letter<\/a> to the chairperson and ranking member of the Senate health appropriations subcommittee, urging them \u201cto provide robust funding\u201d for community health centers, describing them as \u201ca bipartisan solution to keeping Americans healthy and saving taxpayer dollars.\u201d<\/p>\n Wicker and Reed argued in the letter that the centers save the overall health care system billions of dollars by reducing the burden of chronic disease through prevention and early intervention, and lower long-term Medicaid and Medicare spending by curbing expensive emergency department visits, hospital admissions and invasive procedures. The senators also noted that the centers employ more than 310,000 people and generate more than $118 billion in economic activity.<\/p>\n \u201cRepublicans in particular have always argued that one of the reasons for not pushing for more insurance coverage was the fact that we have these centers,\u201d said Dr. Georges Benjamin, executive director of the American Public Health Association, which advocates for broader health care access.<\/p>\n Benjamin noted that the centers\u2019 importance to rural, mostly Republican communities has heightened their broad-based appeal. He said draining money from them \u201cis not a rational decision.\u201d<\/p>\n \u201cThe administration has a nonsensical and uncoordinated health policy overall,\u201d Benjamin said. \u201cThese important things that keep people alive and keep them healthy are getting caught in this very bad public policy time we\u2019re having.\u201d<\/p>\n But Robert Hayes, president and CEO of the Community Healthcare Network, the largest network of community health centers in New York City, said the centers there are determined to do what they have always done, regardless of the current challenges.<\/p>\n \u201cWe are secure. We\u2019re obeying the law. We\u2019re doing the right thing,\u201d Hayes said. \u201cI don\u2019t mean to dismiss the anxiety that is around health care for the vulnerable these days, but our job is to not let it distract us from what we have to do, which is important and very hard to do: [provide] the most fundamental and primary and preventative health care for people who are basically excluded from the health care system.\u201d<\/p>\n Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org<\/a>.<\/em><\/p>\nWelcoming culture<\/h4>\n
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Bipartisan support<\/h4>\n