Federally qualified health clinics brace for untenable patient surge | Opinion

Outside a federally qualified health center in Oakland, I used to make calls with patients as they stood in lines that stretched down the block. I spent a year supporting unhoused and uninsured patients in the Bay Area, coordinating care and scheduling appointments with our physicians whose calendars were often already full. We often overbooked appointments, despite struggling with reimbursement.

Why? By law, federally qualified health centers must see every patient — regardless of an individual’s ability to pay.

Now, as a future physician, I can see an emerging threat to our health care system: Republican lawmakers in Congress are refusing to extend the Affordable Care Act’s enhanced premium tax credits, which are set to expire at the end of the year — a move that could deprive 20 million Americans of health insurance, including up to 2 million Californians.

However, these patients won’t simply disappear. Rather, they’ll turn to the only places left that cannot turn them away: federally qualified health centers. But those centers — especially ones in California — are already struggling.

In 2024, the Federal Bureau of Primary Health Care estimated that federal qualified health centers served over 25.1 million uninsured, Medicaid and Medicare patients. Ninety percent of these patients lived below 200% of the federal poverty line. These health centers are already overwhelmed, and 70% of their funding comes from the Community Health Center Fund, which expired at the end of September.

If the premium tax credits are also discontinued, millions of Americans who may no longer afford their insurance may turn to seeking care at federally qualified health centers, forcing providers to see more patients with even more limited resources. In California — where high housing costs, income inequality and Medi-Cal gaps already drive patients into the safety net — any surge would be devastating.

I’ve seen what that pressure looks like up close: A year after starting medical school, I went back to visit the health center where I worked. I barely recognized anyone. Many staff had left — burned out or forced to find other jobs. Nearly 30% of federally qualified health center physicians report burnout, and turnover makes it even harder to maintain consistent care.

This strain doesn’t just impact current providers — it also discourages future ones. Family medicine is one of the primary care specialties that has consistently ranked the least competitive among medical students, often due to lower pay, less prestige and increasing administrative burden. According to the National Resident Matching Program, almost 15% of family medicine residency spots went unfilled in 2025 — an increase from previous years. If working in federally qualified health centers becomes even more overwhelming, it will be even harder to attract passionate young doctors to serve these communities.

If Congress allows subsidies to lapse, these health centers will face more patients, with fewer resources and even fewer clinicians.

And this pressure won’t be limited to safety-net clinics either. If premium tax credits are cut, major hospitals and health systems lose out on a source of revenue as well. If severe enough, hospitals may be forced to cut staff or curtail services, impacting patients nationwide regardless of access to care or insurance status.

The ripple effects of ending premium tax credits will be widespread, but the first and hardest-hit will be the clinics on the front lines — federally qualified health centers in California and nationwide — and the patients who depend on them.

This is a threat to the foundation of our primary care system. If we allow the ACA subsidies to expire, we will trigger a chain reaction: a spike in the number of uninsured, a crushing demand on health centers, fewer primary care doctors and, ultimately, worse outcomes for the very people our health care system is supposed to protect.

The federal government is now shut down over this issue as Democrats refuse to allow continued spending until this health care issue is resolved. We need a bipartisan solution and for Congress to act now to restore the Community Health Center Fund and extend the ACA premium tax credits. Anything less would be a betrayal of the clinics holding our safety net together — and to the millions of Americans they care for every day.

Lee Dason Lam is a second-year medical student and co-chair of organized medicine at the UC Davis School of Medicine. He currently holds positions on the medical student sections of the American Medical Association and California Medical Association.