For residents of rural North Carolina, quality health care can seem nonexistent. Let alone affordable. Now, one of the only options for low-cost, low-barrier medical care is under threat: community health centers.
Rural residents with chronic conditions like hypertension, heart disease and diabetes — on Medicaid or without insurance entirely — can’t afford regular trips to the emergency room. And rural hospitals can’t afford to treat them.
That’s where community health centers have a vital role.
These federally-qualified facilities — of which there are 39 across North Carolina and 1,370 in the country — are designed to serve low-income, rural residents.
But they may struggle to keep their doors open in the coming years.
Potential Medicaid slashes are looming and $230 million in federal health funding to North Carolina has already been lost from cuts made by the Trump administration.
As things stand, the state’s community health centers have to cobble together funding to keep the lights on. Medicaid is their biggest customer. The rest comes from the federal Health Center Program and a number of grants.
Their margins are razor thin. They often operate in the red.
Now they may fade to black.
The doctor is in
There are 1.1 million people without health insurance in North Carolina — one of the highest rates of any state in the nation. And rural residents are 40% more likely to be uninsured than those living in metropolitan areas.
Community health centers are designed to help people who can’t afford treatment, combining services that would usually be spread out over multiple facilities under one roof. All of it priced on a sliding scale.
In the city, there are tons of options for medical care, keeping residents out of the hospital for routine checkups, exams or specialty needs.
But out in the county, not so much. Having an option like a community health center is crucial, medical experts say. The MedNorth center in Wilmington, for example, provides primary care, OB-GYN and pediatric services, an on-site pharmacy and behavioral health services.
In other words, a place that has something for everybody.
“I see these centers as those nets at the very bottom of a construction site,” said Fabrice Julien, a health science professor at UNC-Asheville. “God forbid someone falls. That would be the last thing to catch someone. If you remove it, it’s going to create some really deleterious effects. We will see mortality rates rise.”
Community health centers and ‘war on poverty’
The first community health center opened in 1965 as part of President Lyndon B. Johnson’s “war on poverty.”
Now, the state’s centers treat 762,000 people, who may be at risk while future funding remains uncertain.
Under the Trump administration, $230 million in health funding for North Carolina is gone. Attorney General Jeff Jackson filed a lawsuit against the federal government, calling the cut “unlawful — and dangerous.”
The move gutted programs that would have supported North Carolina’s community health centers to, among other things, expand access to immunizations in isolated communities and provide support to high-risk patients, including those with behavior or substance-use disorders.
If the $880 million cut to Medicaid currently being discussed by Republicans in Congress comes to pass, the blow might be enough to knock community health centers out — or at least make them less effective.
And the state’s Department of Health and Human Services can’t bail them out. As part of the health funding cut, the agency lost $100 million and 80 jobs.
“We’re not in a position to compensate for losses to programs like community health centers,” said Deborah Farrington, a DHHS deputy secretary. “We won’t be in a situation where loss on the federal side can be shifted to the state side. If we experience budget cuts at the state level as well, these centers will be in a really difficult position.
“The resources won’t be there.”
The sick getting sicker
The impact of funding cuts to community health centers may be felt most by rural North Carolinians with chronic conditions.
Like those with hypertension, where 206,000 are treated each year.
Or diabetes. There are 107,000 that typically need care.
Or heart disease. That’s 42,000 patients.
Without these centers, many low-income patients would have nowhere else to turn except emergency rooms.
“That’s putting a Band-Aid on a fatal wound,” Julien said. “That’s only going to get you so far.”
But as the reality of funding cuts sets in, rural residents may increasingly have to make do with the Band-Aid.
“We are working with our partners to mitigate any impact of the federal funding reductions,” said Kelly Kimple, the state health director and DHHS chief medical officer. “But losing this funding and this investment in North Carolina from the federal government is going to impact people and services. It’s going to be real. It’s going to jeopardize their ability to do their work and to hire doctors and nurses.”
The centers have long enjoyed bipartisan support at the state and federal level, and those in the field hope that not all critical funding will be thrown out.
But the existing threat to community health centers is enough to make administrators think twice.
“Cuts like this, and the wider environment in which cuts come abruptly without notice, makes it very challenging to plan,” said Brendan Riley, vice president of the North Carolina Community Health Center Association. “It is hard to plan for the future or to enhance staffing. Anything you come to depend on might be pulled out from under you.”
This article first appeared on Carolina Public Press and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
