We need to rescue public health in America. Here’s something worth trying.

November 1st, 2023 by Tom Lynch

Over the last few decades, America’s public health system has become woebegone, fragmented, uncoordinated, and overly complicated. But there is one light in the vast dark, a more than 50-year functioning network that could point the way forward to better days.

Federally Qualified Health Centers (FQHCs) are primary care clinics first established in 1965 as part of President Lyndon Johnson’s War on Poverty. They provide primary care services in underserved areas. They are community-based and receive funding from the Health Center Program of the Health Resources and Services Administration. FQHCs, also known as Community Health Centers (CHCs), must meet stringent requirements, including providing care on a sliding scale fee structure based on a patient’s ability to pay and operating under a governing board that includes patients. Specifically, at least 51% of their Boards must be patients.

By law, FQHCs must treat anyone, regardless of the ability to pay.

This nation-wide program has expanded over the years, and between 2007 and 2014 grew by 82%. Yet, in the last ten years funding has stalled, and a number of clinics have had to close due to lack of funding, which is a shame.

There are 1,368 FQHCs in the country. Most have a number of locations, called Service Sites, bringing the total health care locations to 14,200. They welcome people with insurance, but their main targets are poor people who could otherwise not afford health care. Currently, their patients number about 30 million.

In addition to Community Health Centers, the Health Center Program also funds Rural Health Centers, whose mission is to increase access to primary care services for patients in rural communities. This challenging mission is made more difficult by significant shortages of staffing in rural areas.

Federally Qualified Health Centers and Rural Health Centers are funded annually by congressional approval, and lately the funding has become contentious as Republicans strive to cut back on governmental costs. Additionally, Section 330 of the Public Health Service Act provides grant awards to eligible health centers and outlines the requirements the centers must meet to be eligible.

Don’t feel bad if you’ve never heard of Federally Qualified Health Centers. They give meaning to the cliché, “flying under the radar,” but these health care providers are critically important to people who have nothing else, the people whose Primary Care Physician is the local hospital Emergency Department, the most costly place to get health care in the universe.

Right now, Congress is once again debating future funding for Federally Qualified Health Centers and Rural Health Centers. More than 500 local, state and national health-care organizations are urging congressional leaders to ramp up federal funding, which is set to expire when the recently passed Continuing Resolution, the one that got Kevin McCarthy fired, expires on 17 November. Yesterday, the group sent a letter to key lawmakers arguing for $5.8 billion for each of the next three years, which is about a billion more than originally contemplated by the House of Representatives.

Congress should cough up the money. In 2021, community health centers were estimated to save a total of $25.3 billion for the Medicaid and Medicare programs.¹ In 2019, community health centers generated $63.4 billion in economic activity, with $32 billion of that coming from supporting local businesses.² Clearly, in addition to strengthening health care for our neediest population, these health centers are a good investment for the nation.

Community health Centers are ubiquitous throughout the country. For example, in my home state of Massachusetts, there are 52 community health center organizations providing high quality health care to some one million state residents through more than 300 sites statewide. For perspective, there are 351 cities and towns in Massachusetts.

Given the woeful state of our nation’s public health system, as was amply demonstrated by our response to COVID-19, you would think it might be a good  idea to consider a Community Health Center model as we attempt to make health care better and more equitable for all.

Just a thought.


¹ Robert Nocon (Kaiser Permanente Bernard J. Tyson School of Medicine). “Testimony on Community Health Centers: Saving Lives, Saving Money before the United States Senate Committee on Health, Education, Labor and Pensions Committee.” (2 March 2023)

² “Community Health Centers Are Economic Engines” (National Association of Community Health Centers, October 2020)