NEW YORK — On a busy avenue in Queens, New York, simply across the nook from a halal sizzling hen sandwich restaurant and a barber store, the Lengthy Island Metropolis Well being Middle welcomes its sufferers right into a brightly lit ready room, painted child blue and crammed with tender white and grey seats.
A lady working behind the desk on a latest weekday answered one affected person’s questions in Spanish. Different sufferers got here wearing hijabs, kurtas or different conventional clothes from international locations across the globe. A caseworker assigned to the middle rolled one lady, wheelchair-bound due to a stroke, towards an examination room.
The Lengthy Island Metropolis Well being Middle is a part of a nationwide community of greater than 1,300 group well being facilities, safety-net clinics that served greater than 31 million sufferers in 2023, based on KFF, a well being analysis nonprofit. The clinics are situated in areas the place there aren’t many docs or hospitals, and so they present care to all sufferers, no matter their potential to pay.
Thanks largely to their broad attain, the facilities have lengthy loved bipartisan help. However the federal authorities shutdown, freezes to federal grants, looming cuts to Medicaid and new Trump administration insurance policies barring some immigrants from receiving care on the facilities have put them beneath monetary stress.
Neighborhood well being facilities disproportionately serve low-income individuals, individuals of coloration and rural residents. In 2023, 90% of sufferers had incomes at or under 200% of the federal poverty degree, based on KFF. Forty p.c of sufferers have been Hispanic, 17% have been Black and 31% have been rural residents.
Greater than 80% of sufferers have been insured, and about half of all sufferers have been lined by Medicaid.
The well being facilities are funded by the funds they get from Medicaid, Medicare and personal insurers, plus federal and state grants. Cash is all the time tight, however between 2010 and 2023, common working margins remained within the black. That modified final yr, as the common margin dipped to -2.1%, based on an audit carried out by the Nationwide Affiliation of Neighborhood Well being Facilities.
Half of group well being facilities have fewer than 90 days of money available, and one-quarter function with margins under -4%, based on the audit.
When the Trump administration froze some federal grants in February, it compelled some clinics, notably in rural areas, to cut back hours or shut down. The broad home coverage legislation President Donald Trump signed July 4 is projected to extend the variety of uninsured sufferers looking for care on the well being facilities. And the ranks of the uninsured would develop additional if Inexpensive Care Act insurance policy get rather more costly on the finish of this yr, as would occur if Congress fails to increase tax credit which have stored costs down.
In the meantime, the federal government shutdown has prevented Congress from renewing the Neighborhood Well being Middle Fund, which expired on Sept. 30 and offers about 70% of the facilities’ federal funding. And the facilities fear {that a} new Trump administration coverage barring them from offering care to some immigrants would power them to dedicate scarce sources to verifying sufferers’ authorized standing. A federal choose has briefly blocked the change.
Andrew G. Nixon, director of communications for the U.S. Division of Well being and Human Companies, informed Stateline that the administration is “totally dedicated to defending America’s group well being facilities, which play a significant function in serving hundreds of thousands of households nationwide.”
“The Trump Administration is working to reopen the federal government and restore full funding, whereas additionally guaranteeing that federal sources are prioritized for Americans and lawful residents in accordance with the legislation,” Nixon stated in an emailed assertion.
This yr, some states— together with Connecticut, Illinois and Minnesota — permitted more cash for group well being facilities. However Illinois and Minnesota even have scaled again or ended well being care applications that served low-income individuals no matter their immigration standing, which could immediate extra of these sufferers to hunt care on the facilities. And California Democratic Gov. Gavin Newsom in June signed a state price range that bars immigrants who’re right here illegally from enrolling within the state’s Medicaid program.
“Traditionally, well being facilities have had bipartisan help, however we’re working in a really totally different world now,” Feygele Jacobs, a professor of well being coverage and administration at George Washington College, informed Stateline.
Jacobs stated well being facilities are a goal for the Trump administration as a result of they serve individuals of coloration, low-income residents, immigrants and the uninsured.
“It’s these very communities which might be actually being challenged proper now by the administration,” Jacobs stated. “So I don’t know that the main focus is a lot on well being facilities as entities, however actually extra on an administration whose views are antithetical to most of the folks that well being facilities have traditionally cared for.”
However Chris Pope, a senior fellow on the conservative-leaning Manhattan Institute, questioned whether or not the Medicaid adjustments included in Trump’s One Large Stunning Invoice Act would result in a major enhance within the variety of individuals with out insurance coverage or a dramatic discount in this system’s funds.
Pope additionally famous that the legislation doesn’t take direct intention on the federal funding of group well being facilities.
“There’s no direct lower when it comes to reimbursement for group facilities,” Pope stated. “It’s not the intent of the invoice to slash and assault well being heart revenues.”
Welcoming tradition
The primary group well being facilities have been created in 1965 in Mississippi and Massachusetts as federal demonstration tasks beneath President Lyndon Johnson’s Conflict on Poverty. This system grew to become everlasting in 1975.
Medical doctors on the Lengthy Island Metropolis Well being Middle describe it as a one-stop store for sufferers. Along with offering main care and psychological well being providers, the middle has an in-house pharmacy and offers laboratory assessments, vaccinations, drug therapy, HIV/AIDS therapy, and help for transgender sufferers and their households. Together with its dozen medical residents, the middle has docs who can converse French, Tamil, Kru, Ibo, Yoruba, Spanish, Hindi, Nepali, Russian and Tagalog, amongst different languages.
Dr. Libby Brubaker, an attending doctor on the Lengthy Island Metropolis Well being Middle, informed Stateline that offering a welcoming environment for everyone is on the core of the middle’s mission.
“Our social employees go to bat for our sufferers and assist them get entry to housing. … We write letters to permit our sufferers with bronchial asthma to have the ability to have air conditioners inside their flats,” Brubaker stated.
“Actually what we’re offering for our sufferers is all encompassing, and that units us aside,” she added. “Hospitals don’t do all of these issues. They do some, however having the ability to provide that breadth of providers in an outpatient setting is invaluable.”
Sandra Tapía, a Lengthy Island Metropolis resident from Bogotá, Colombia, walked into the clinic on a Friday to see her nutritionist for the primary time. She’s been within the U.S. for seven years, is a inexperienced card holder and has Medicaid. She stated she likes the middle as a result of “it’s shut and it’s secure.”
Tapía stated she will be able to’t think about not having the ability to have entry to well being care, and values having the ability to converse to her supplier in her native Spanish.
“Right here, they provide actually nice providers,” Tapía stated. “I don’t need individuals with out as many sources, like me, to be punished.”
The thought of cuts frightens sufferers reminiscent of Olga Scott, 65, who stated she has been coming to Lengthy Island Metropolis Well being Middle for years. Scott lives within the Bronx, however takes an hourlong subway trip to the middle so she will be able to see her favourite physician.
“These group well being providers round the entire group of those 5 boroughs are wanted — it’s actually wanted,” she stated. “I simply hope that they don’t do an excessive amount of cutbacks, as a result of we’d like each service we will get.”
Dr. Sindhura Manubolu, director of the household drugs program on the heart, stated she’s sensing “plenty of nervousness” from her sufferers, particularly those that depend on Medicaid.
“A lot of the questions from our sufferers have been round, ‘Oh, will we lose protection?’” stated Manubolu, who’s an immigrant from India. “For somebody to be right here in a complicated nation like America, after which not having the ability to entry the well being care that in all probability is even out there to an individual in a much less developed nation will not be acceptable.”
Bipartisan help
On Capitol Hill, group well being facilities are an more and more uncommon instance of bipartisan settlement.
In Could, Republican U.S. Sen. Roger Wicker of Mississippi and Democratic U.S. Sen. Jack Reed of Rhode Island wrote a joint letter to the chairperson and rating member of the Senate well being appropriations subcommittee, urging them “to supply sturdy funding” for group well being facilities, describing them as “a bipartisan answer to maintaining People wholesome and saving taxpayer {dollars}.”
Wicker and Reed argued within the letter that the facilities save the general well being care system billions of {dollars} by lowering the burden of continual illness via prevention and early intervention, and decrease long-term Medicaid and Medicare spending by curbing costly emergency division visits, hospital admissions and invasive procedures. The senators additionally famous that the facilities make use of greater than 310,000 individuals and generate greater than $118 billion in financial exercise.
“Republicans specifically have all the time argued that one of many causes for not pushing for extra insurance coverage protection was the truth that we have now these facilities,” stated Dr. Georges Benjamin, govt director of the American Public Well being Affiliation, which advocates for broader well being care entry.
Benjamin famous that the facilities’ significance to rural, principally Republican communities has heightened their broad-based attraction. He stated draining cash from them “will not be a rational resolution.”
“The administration has a nonsensical and uncoordinated well being coverage general,” Benjamin stated. “These vital issues that preserve individuals alive and preserve them wholesome are getting caught on this very unhealthy public coverage time we’re having.”
However Robert Hayes, president and CEO of the Neighborhood Healthcare Community, the biggest community of group well being facilities in New York Metropolis, stated the facilities there are decided to do what they’ve all the time completed, whatever the present challenges.
“We’re safe. We’re obeying the legislation. We’re doing the best factor,” Hayes stated. “I don’t imply to dismiss the nervousness that’s round well being take care of the susceptible nowadays, however our job is to not let it distract us from what we have now to do, which is vital and really exhausting to do: [provide] probably the most elementary and first and preventative well being take care of people who find themselves mainly excluded from the well being care system.”
Stateline reporter Shalina Chatlani will be reached at schatlani@stateline.org.
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