Community health centers (CHCs) already provide medical care, dental care, mental health counseling, pharmacy services, and enabling services to 32.4 million people, or one in ten US residents.¹ Today, there are more than 16,300 CHC service sites operating across virtually every congressional district.² These are funded by a mandatory funding stream, the Community Health Center Fund, which was created by the Affordable Care Act.³

These are critical sites for climate resilience since the climate crisis is increasing the rates of extreme weather events, new vector-borne diseases, unhealthy air and water quality, and chronic stress and trauma—all of which exacerbate morbidity and mortality. With the Community Health Center Fund’s current budget—$4.6 billion—CHCs simply cannot rise to this challenge. Congress should use the budget reconciliation process to increase its funding to $9.2 billion with the following conditions:

CCI calculates that this package would cost roughly $50 billion over ten years, or roughly 5 cents for every dollar the One Big Beautiful Bill Act (OBBBA) cut from Medicaid.⁴

The Congressional Budget Office (CBO) projects that the OBBBA will add 10 million people to the ranks of the uninsured by 2034.⁵ It will also have an outsized impact on CHCs. An estimated 5.6 million CHC patients could lose their Medicaid cards, draining as much as $32 billion from health centers over five years and adding roughly $7 billion per year in non-reimbursable care.⁶ Many of these cuts are expected to go into effect in 2027, which means people will feel the pain soon. CHCs were already running a negative operating margin before the OBBBA, with some experts projecting the network to shrink from more than 15,000 sites to around 9,000.⁷

As the climate crisis continues, rural communities, where CHCs are largely located, are particularly prone to climate-related health impacts.⁸ For instance, people working in agriculture, forestry, and fishing have some of the highest vulnerabilities to heat-related deaths because they work outside.

Medicaid cuts will decimate the healthcare workforce and state economies in states already facing disproportionate climate impacts. Researchers at George Washington University project that the OBBBA will eliminate 1.22 million jobs by 2029 and shrink state economies by $154 billion, with effects focused in southern and southwestern states that face high heat impacts and have some of the largest poverty rates.⁹

CHCs are also where people turn for help when outages or disasters hit, but these centers often rely on unreliable diesel backups. When New Orleans lost power due to Hurricane Ida in 2021, 19 residents died of heat, carbon monoxide poisoning, and failed oxygen equipment.¹⁰ The local CrescentCare Health Center’s gas generators also failed, wasting $250,000 in vaccines and medicine.¹¹ Overall, health facilities average 52-hour outages after disasters and yet—unlike hospitals or nursing homes—CHCs are not required by federal law to have backup power.¹² Before private philanthropy began filling the gap, fewer than 40 percent of California’s safety net clinics—most of which are CHCs—had backup power.¹³

With an expanded budget, CHCs would provide free medical and dental care to the poorest US residents starting the year it goes into effect. A total of 90 percent of CHC patients already fall below 200 percent of the poverty line, so expanding free care would mean CHCs are free for nearly everyone who walks in.¹⁴

Doubling the Community Health Centers Fund might sound expensive, but it would actually save the government money. Dollars spent on preventative care at CHCs go much farther than spending at the hospital or emergency room. An average emergency room visit costs $2,032, versus $167 for a primary care visit.¹⁵ Researchers at the University of Chicago and Johns Hopkins found that patients who got their care at CHCs cost Medicaid $2,371 less per year—24 percent less than comparable Medicaid patients treated by primary care physician offices or hospital outpatient clinics.¹⁶ Even the CBO, which is typically allergic to claims that spending will pay for itself, has in the past scored CHC expansion as offsetting $11.4 billion in other federal health spending.¹⁷

At the same time, the budget expansion could ensure that CHCs in areas prone to intense storms and wildfires are able to keep running, while improving community resilience overall. Most clinics with backup power rely on diesel generators, which produce nothing the majority of the time and rely on fuel deliveries at exactly the moment when natural disasters strike and roads become impassable. Meanwhile, solar and storage can run day after day without resupply and will cut a CHC’s electric bill on ordinary days. In fact, a recently completed California site is projected to cut energy costs by about $40,000 a year.¹⁸ If more CHCs had solar power sources, not only could they continue to administer healthcare in extreme weather events, but they could provide a safe space to the surrounding community to shelter.

There is plenty of precedent for expanding CHCs via budgetary measures consistent with reconciliation, including the Health Care and Education Reconciliation Act of 2010, which set the CHC Fund’s appropriations, and the House-passed Build Back Better Act, which included $2 billion in health center capital funding.¹⁹ To ensure compliance with the Senate’s Byrd rule, any new rules should be attached as conditions for receipt of new money, rather than rewriting the CHC program’s rules themselves.

This expansion would drastically cut the US working class’ reliance on insurance companies, medical bills, and private hospitals. Since a majority of every CHCs’ board must be people who get care there, this proposal would route money to the only health care institutions in the United States that are legally required to be governed by their own patients.²⁰ By increasing energy resilience, this expansion would also reduce CHCs’ dependence on the grid and/or fuel deliveries during emergency events.

By expanding the care workforce, this program would grow employment in one of the lowest-carbon and fastest-growing sectors of the economy. CHC expansion would create a jobs program aimed at some of the poorest and most rural parts of the United States (30 percent of CHC patients are rural).²¹ CHCs already support more than 500,000 jobs and nearly $85 billion in economic output nationwide, with jobs and activity spread across virtually every congressional district and county.²² Funds would go overwhelmingly to wages rather than equipment or imports, and new jobs would be anchored in communities where clinics sit. Moreover, the medical bills that patients no longer pay would be spent in local economies, further aiding circulation.

By standardizing and procuring essentially identical solar-and-storage packages for thousands of clinic sites, the program would collapse engineering and permitting costs that currently make most CHC retrofits a bespoke, half-a-million-dollar undertaking.²³ Mirroring how the New York City Housing Authority (NYCHA) created the modern window heat pump as a product category simply by aggregating demand, these procurement programs would create an off-the-shelf product that could be shared by similar community institutions like schools, fire stations, churches, or post offices.²⁴ And domestic content requirements would cost little and ensure the continued growth of US battery plants in states like Tennessee, Georgia, Indiana, and Michigan.²⁵

Finally, since they operate across virtually every congressional district, CHCs have proven highly resilient to the political winds. CHCs were first founded under President Lyndon Johnson, were doubled under President George W. Bush, and had every funding extension signed by President Trump.²⁶