Community Health Centers (CHCs) remain a critical lifeline for underserved communities. However, the capacity to meet growing demand is increasingly strained. In 2024, CHCs served over 1 million more patients than in 2023, even as operating margins decreased to an average of -2%. (Figure) Although their growth demonstrates CHCs’ resilience, underlying pressures threaten patients’ ability to access care, maintain continuity, and receive high quality care.
Access at Risk Despite Growth
In 2024, CHCs expanded visits for primary care, behavioral health, and oral health services. Philanthropic and private grants, targeted federal support, and operational efficiencies enabled them to reach more patients even while running at a financial loss. Increased visits from patients with private insurance and Medicare provided crucial financial stability, helping CHCs continue delivering comprehensive primary care to all patients.
But vulnerabilities are accumulating. According to 2024 CHC audit data, half of CHCs have fewer than 90 days cash on hand, and one quarter operate with margins below -4%. These fragile conditions limit their ability to sustain service hours, expand capacity, or invest in innovative care delivery models. The freeze in federal funding that took place in February 2025 has forced some CHCs, particularly in rural areas, to close sites and reduce hours, leaving patients temporarily without care. Such disruptions highlight how quickly access can be affected when reserves are low. With federal CHC funding set to expire this year, such disruptions can happen again.
CHCs in the Path of a Rising Uninsured Wave
Even as CHCs expand, new policy changes threaten to stretch capacity further. The One Big Beautiful Bill Act (HR.1) is projected to increase the number of uninsured patients seeking care. CHCs are a cost-saving alternative to emergency departments, and they are likely to see an increasing number of uninsured patients seeking accessible primary care, preventive services, and chronic disease management. If CHCs cannot absorb this surge, uninsured patients will turn to emergency departments or delay care, leading to higher costs for the health system and greater risk of complications.
CHCs also continue to be leaders in quality of care, delivering outcomes that outperform many other primary care settings, including high patient satisfaction. A surge in demand without support threatens not only access but also the quality and effectiveness of care that millions rely on.
The Stakes Could Not Be Higher
CHCs serve at least 34 million patients nationwide, including at least one in five rural Americans and one in five Medicaid enrollees. If CHCs are forced to scale back services, rural communities, low-income families, and urban underserved populations will be the hardest hit. Research shows that when CHCs close, mortality rises. The cost of inaction is measured in lives.
Resilience Requires Resources
CHCs demonstrated remarkable resilience in 2024 but growth without structural support cannot guarantee continued patient access or maintain the high quality of care they provide. Thin margins, declining reserves, and the anticipated wave of uninsured all jeopardize the ability of CHCs to meet demand.
To secure the future of CHCs, core funding and reimbursement must reflect the true cost of providing comprehensive primary care and enabling services that support patient health. Dedicated resources are essential to offset the surge of uninsured patients. Policymakers face a clear choice: stabilize CHCs now or risk unraveling access to primary care for millions of Americans. To preserve timely, comprehensive, and high-quality care for millions of Americans, policymakers must act to support CHCs before patient access and outcomes erode.