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George Washington University Milken Institute School of Public Health Geiger Gibson/RCHN Community Health Foundation Research Collaborative


Policy Research Brief # 42


Affordable Care Act; Community Health Centers; Health Policy


Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show the ACA’s major national impact on both medically underserved communities and community health centers. Between 2013 and 2014, the number of health center patients with health insurance rose by more than 2.3 million (a 17 percent increase), the number of uninsured patients declined by 1.2 million (a 16 percent decrease), and the total number of patients served rose by over 1.1 million (a 5 percent increase). Since 1996, the total number of patients served at federally funded health centers has nearly trebled, from slightly more than 8 million to almost 22.9 million patients served by 2014.

Consistent with the fact that over 70 percent of health center patients have household incomes at or below 100 percent of the federal poverty level, of the 2.3 million increase in insured patients, approximately 79 percent is the result of an increase of 1.8 million in the number of patients covered by Medicaid. Between 2013 and 2014, the number of privately insured health center patients also rose, from 3.1 to 3.6 million, an increase of 16 percent and by far the greatest increase in private insurance coverage over the 1996-2014 time period.

These findings point to the importance of the ACA in the nation’s poorest communities, while also emphasizing the vital role played by Medicaid. The UDS results also underscore the major expansion trajectory for community health centers as a result of insurance expansions and direct Congressional investment in continued health center growth. These findings also reveal that as patients gain coverage, they remain with their health centers, even as health centers continue to reach more community residents.

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