The CBO projects the One Big Beautiful Bill Act (HR1) will increase the number of uninsured by at least 10 million in 2034. When combined with the scheduled expiration of the Affordable Care Act’s enhanced premium tax credits, the total increase in the uninsured population is expected to reach 14.2 million.
Community Health Centers (CHCs), which serve over 6 million uninsured patients, representing at least 1 in 5 uninsured nationally, will be on the front lines of absorbing this coverage loss. Using state-level projections from KFF and data from 2024 CHC and Census data, we estimate CHCs will see an increase of at least 1.9 million uninsured patients under KFF’s lower-bound projection and as many as 4.2 million under its higher-bound projection by 2034. Most of this increase is expected to come from individuals losing Medicaid coverage.
This range reflects the application of state-specific uninsured projections to the proportion of uninsured currently served by CHCs. These additional patients reflect both currently insured CHCs patients who are expected to become uninsured and new patients who may turn to CHCs after losing coverage. These estimates provide a picture of potential added demand and do not reflect CHCs’ actual capacity to serve this many additional patients.
If realized, these shifts could bring CHCs’ total uninsured patient load to 8-10 million annually by 2034. CHCs are already under strain, managing a growing uninsured population while contending with persistent workforce shortages and constrained funding. This pressure is compounded by the fact that CHCs are currently operating at an average margin of -2% (2024 CHC data), with one quarter of CHCs operating below -5% (unpublished audited 2024 financial CHC data).
Taken together, this analysis underscores the urgent need for both state and federal policy responses to ensure CHCs can continue providing high-quality, comprehensive primary care, including behavioral and oral health, to the communities that rely on them most.
State-specific Projections of Additional Uninsured Patients at CHCs by 2034
| CHC uninsured (2024) | Pct state uninsured served by CHCs (2024) | Lower-bound Additional CHC Uninsured (2034) | Higher-bound Additional CHC Uninsured (2034) | |
| AL | 86,000 | 21% | 8,000 | 39,000 |
| AK | 18,000 | 24% | 5,000 | 9,000 |
| AZ | 149,000 | 19% | 49,000 | 101,000 |
| AR | 62,000 | 22% | 17,000 | 37,000 |
| CA | 606,000 | 26% | 314,000 | 550,000 |
| CO | 164,000 | 35% | 39,000 | 85,000 |
| CT | 69,000 | 33% | 33,000 | 59,000 |
| DE | 14,000 | 19% | 5,000 | 11,000 |
| DC | 30,000 | 96% | 23,000 | 38,000 |
| FL | 481,000 | 19% | 84,000 | 364,000 |
| GA | 193,000 | 15% | 18,000 | 91,000 |
| HI | 14,000 | 30% | 9,000 | 16,000 |
| ID | 51,000 | 28% | 8,000 | 17,000 |
| IL | 283,000 | 33% | 115,000 | 214,000 |
| IN | 111,000 | 22% | 35,000 | 78,000 |
| IA | 52,000 | 30% | 18,000 | 39,000 |
| KS | 86,000 | 35% | 7,000 | 27,000 |
| KY | 90,000 | 29% | 47,000 | 79,000 |
| LA | 79,000 | 23% | 43,000 | 93,000 |
| ME | 18,000 | 24% | 6,000 | 10,000 |
| MD | 77,000 | 20% | 27,000 | 51,000 |
| MA | 131,000 | 66% | 92,000 | 171,000 |
| MI | 94,000 | 18% | 42,000 | 90,000 |
| MN | 52,000 | 18% | 23,000 | 41,000 |
| MS | 89,000 | 32% | 9,000 | 44,000 |
| MO | 115,000 | 24% | 29,000 | 68,000 |
| MT | 21,000 | 22% | 6,000 | 14,000 |
| NE | 40,000 | 29% | 9,000 | 20,000 |
| NV | 38,000 | 10% | 8,000 | 15,000 |
| NH | 14,000 | 23% | 4,000 | 9,000 |
| NJ | 171,000 | 23% | 54,000 | 115,000 |
| NM | 75,000 | 35% | 24,000 | 43,000 |
| NY | 315,000 | 32% | 207,000 | 347,000 |
| NC | 225,000 | 24% | 53,000 | 136,000 |
| ND | 7,000 | 16% | 2,000 | 5,000 |
| OH | 134,000 | 17% | 43,000 | 100,000 |
| OK | 61,000 | 13% | 13,000 | 30,000 |
| OR | 39,000 | 18% | 28,000 | 46,000 |
| PA | 174,000 | 23% | 67,000 | 130,000 |
| RI | 22,000 | 44% | 13,000 | 23,000 |
| SC | 110,000 | 23% | 10,000 | 55,000 |
| SD | 20,000 | 27% | 2,000 | 7,000 |
| TN | 142,000 | 21% | 11,000 | 54,000 |
| TX | 636,000 | 12% | 44,000 | 222,000 |
| UT | 62,000 | 22% | 13,000 | 41,000 |
| VT | 23,000 | 86% | 10,000 | 19,000 |
| VA | 87,000 | 15% | 34,000 | 63,000 |
| WA | 173,000 | 34% | 101,000 | 179,000 |
| WV | 55,000 | 55% | 25,000 | 51,000 |
| WI | 50,000 | 16% | 9,000 | 22,000 |
| WY | 6,000 | 11% | 200 | 1,000 |
Source: 2024 UDS, KFF state uninsured projections based on CBO estimates of 10 million and 14.2 million additional uninsured by 2034. Excludes US territories served by CHCs due to lack of comparable projections.