The Ammonoosuc Community Health Services clinic in Franconia, N.H., closed last month after leaders said Medicaid funding reductions and other federal policy changes squeezed the network’s budget. Roughly 1,400 patients, many older or medically fragile, must now drive at least 10 miles (16 kilometers) to the nearest clinic, with a second option about twice that distance. The closure reflects wider strain on community health centers, which rely on federal funding; the National Association of Community Health Centers reports centers are losing money and nearly half have less than 90 days’ cash on hand. Local leaders, the clinic’s CEO and U.S. Sen. Maggie Hassan called on lawmakers to restore funding, extend ACA tax credits and consider short-term supports such as transportation assistance as decisions in Washington unfold.
For more than two decades, Susan Bushby, a 70-year-old housekeeper from a rural ski town in New Hampshire’s White Mountains, relied on a short drive to the Ammonoosuc Community Health Services clinic in Franconia. The lodge-like building became a second home where staff knew patients’ names and stored decades of medical records. That familiarity ended when the Franconia site closed last month, a decision officials attributed to reductions in Medicaid funding and other federal policy changes.
The closure immediately reshaped access for about 1,400 patients who used the Franconia location. Officials said almost half of those patients are older and some face serious health challenges such as cancer and early-stage dementia. The nearest health center is at least 10 miles (16 kilometers) away along rural roads, and a second option is roughly twice that distance.
The clinic’s CEO framed the decision in budgetary terms. Ed Shanshala, who runs the Ammonoosuc network of five New Hampshire centers, projected a roughly $500,000 shortfall after a federal bill passed this summer and said his network relies on more than $2 million in federal funding within a $12 million budget. He identified the leased Franconia building as the easiest place to cut and said closing it would save $250,000. Shanshala warned that further cuts could force patients into emergency rooms or lead them to “stop engaging in health care period.”
State and national officials put the clinic’s fate in the context of wider policy decisions. New Hampshire Sen. Maggie Hassan said Medicaid cuts will “hit rural hospitals, in particular, hard” and added that “the failure to extend the ACA tax credits right now is going to compound the problem.” The story of Franconia followed a similar announcement that a branch of the HealthFirst Family Care Center in Canaan would close at the end of October, citing “changes in Medicaid reimbursement and federal funding.”
National data cited in reporting underscore the systemic risk. Federally funded community health centers treat about 1 in 10 Americans and 1 in 5 rural Americans, according to the National Association of Community Health Centers. The association finds centers are on average losing money, relying on cash reserves, and making service changes to stay afloat. Nearly half of centers have less than 90 days’ cash on hand. Peter Shin, the association’s chief science officer, said, “There’s nothing left to trim without cutting into care itself.”
Patients and local leaders described a palpable sense of loss. Bushby said she was “very disturbed” and “downright angry” and wept discussing the prospect of starting over at a new site. Marsha Luce and her husband, a 72-year-old former volunteer firefighter who has undergone cancer surgery and has heart and memory problems, face longer waits and more difficult trips to care. Jill Brewer, chair of the Franconia Board of Selectmen, asked whether the clinic’s closure was “the first domino to fall,” pointing to other recent reductions in local services.
Health-center leaders described limited short-term options to ease the transition. Shanshala emphasized continuity: “People still have access to health care. We’ll help them with transportation, but it’s clearly a grieving process.” The nearest clinic’s proximity to a regional hospital was identified as a mitigating factor, but officials acknowledged that distance and the fragility of patients’ conditions create real risks for missed care and worse health outcomes.
Policy levers cited in the reporting include restoring or replacing Medicaid reimbursements, reversing elements of the federal legislation that reduced funding this summer, addressing proposed work requirements, and extending Affordable Care Act tax credits to prevent an influx of uninsured patients. Sen. Hassan warned that without action, providers “are going to see more and more uninsured patients,” forcing more painful decisions about services.
Advocates and association officials said longer-term stability will require federal policy changes and more reliable funding models for the nation’s primary care safety net. The National Association of Community Health Centers projects that at least 2 million community health center patients could lose Medicaid coverage by 2034 while 2 million newly uninsured patients may turn to centers for care. The projection frames the closure in Franconia as part of a broader national stress on rural and safety-net care.
Local leaders and patients said they will press lawmakers for relief even as they cope with the immediate disruption. Staff packed the reception office and moved exam tables on the clinic’s final day, and patients hugged patient access specialists, saying goodbye to relationships built over decades. The coming months will test whether short-term mitigation such as transportation assistance and transfers to nearby centers can prevent avoidable breaks in care while policymakers consider whether to restore funding and extend insurance supports that advocates say contributed to the financial squeeze.
Lawmakers in Washington face choices on ACA tax credits and Medicaid reimbursement that advocates say could alter the trajectory for centers like Ammonoosuc. The association’s warnings and projections through 2034 create a timeline for oversight and decision-making that will shape whether similar closures spread in rural America.
Susan Carter serves as a Senior Correspondent for Just Right News, where she leads the network’s comprehensive coverage of Health, Medicine, and Public Policy. With a career dedicated to dissecting the complexities of the American healthcare system, Susan brings a principled perspective to the most pressing debates of the day. Her reporting is characterized by a commitment to individual liberty, fiscal responsibility, and a healthy skepticism of government overreach, making her a vital voice for audiences seeking clarity in an increasingly regulated landscape.
Raised in Minneapolis, Minnesota, Susan’s professional outlook is deeply informed by the values of the American heartland. Growing up in the Twin Cities, she witnessed firsthand the importance of community-driven solutions and the resilience of the individual. This Midwestern foundation instilled in her a firm belief that the best answers to public policy challenges often come from local innovation and personal responsibility rather than top-down federal mandates. Her background allows her to translate complex legislative jargon into stories that resonate with families who value common sense and local autonomy.
Now based in Baltimore, Maryland, Susan operates from a unique vantage point at the intersection of medical innovation and urban policy. Living and working in a city renowned for its world-class medical institutions and significant public health challenges, she has a front-row seat to the realities of the modern healthcare landscape. Her proximity to these hubs of research and policy allows her to scrutinize how government intervention affects the quality of care and the freedom of medical professionals. In Baltimore, she sees the tangible results of policy decisions, using the city as a lens through which to examine the broader national health debate and the impact of federal spending on local communities.
As the lead for the acclaimed feature series “The Cost of Care,” Susan dives deep into the economic realities facing patients and providers alike. Her work focuses on the necessity of price transparency, the benefits of market competition, and the preservation of the sacred doctor-patient relationship. She is a staunch advocate for the idea that a well-informed public is the best defense against bureaucratic inefficiency. Through this series, she has exposed the hidden drivers of rising medical expenses, always seeking to empower the individual consumer over the massive institution.
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