February 26th, 2025

Health care’s fragile foundation: What happens when we ignore the underserved?

Mimi Gardner

Imagine two neighborhoods just a few miles apart. One is a picture of prosperity, with lush parks, fresh produce and top-notch healthcare, where residents benefit from an environment that promotes well-being and longevity. The other is a stark contrast, grappling with economic hardship, food deserts, and a lack of medical facilities — a place where limited resources and structural inequalities have tangible effects on health outcomes. This is the harsh reality of health care in America, where your ZIP Code can determine your life expectancy. Ignoring these differences has taken a toll on our health care system — we must act now if we want the future to look different.

For all its global reputation as a health care and academic powerhouse, Boston reflects these inequities clearly. In Back Bay, the average life expectancy is 90 years, while in Roxbury, it is 67 — a staggering 23-year gap. This gap represents more than years lost; it is a cascade of preventable and harmful health conditions, particularly for Black and immigrant communities navigating systemic barriers to care.

Our strained health care system is balancing on a razor’s edge. Community health centers (CHCs), the bedrock of primary care for the state’s MassHealth population, have been operating under capacity-strained and cost-inflated conditions for years. Yet now, these vital institutions face an even more significant existential threat: potential cuts to Medicaid funding.

Proposals advancing in Congress, such as block-granting Medicaid or capping federal contributions, could slash federal funding by $1.5 trillion over the next decade. For Massachusetts, this would mean losing billions in Medicaid funding, forcing the state to cut services, reduce eligibility, or both. Today, almost half of Massachusetts children and nearly one-third of adults under the age of 65 are MassHealth members.

Any cuts in Medicaid would dramatically affect maternal health for minorities. Minorities already experience disproportionately higher rates of maternal death and severe health complications after childbirth in Massachusetts. Lack of access to quality care, including prenatal checkups, postpartum support, and treatment for potential complications, would worsen these disparities. Inadequate prenatal care can lead to low birth weight, premature birth, and other health problems for newborns. These issues can have long-term consequences for a child’s development and overall health.

Seniors’ well-being will suffer reduced access to care, which can lead to declines in physical and mental health, increased social isolation and a lower quality of life for many seniors. Loss of independence and dignity could have a significant emotional impact.

Over 75% of these MassHealth members under 65 come from hard-working families in food services, transportation, sales and other industries. The result? Working families in vulnerable communities, including children, seniors, and people with disabilities, would be left without a safety net. The impact of these cuts would be felt deeply, and our state’s already overburdened healthcare infrastructure would teeter on the brink of collapse.

Without preventive care, chronic conditions such as diabetes and hypertension could escalate into emergencies, drastically increasing health care costs, heavily burdening MassHealth and threatening financial sustainability. CHCs have long been one of the most cost-effective solutions in our health care system. Every dollar invested in CHCs generates significant cost savings by reducing unnecessary health care spending and improving health outcomes for the most at-risk populations. By using a team-based preventive care model that leverages less costly staff to achieve the same patient results, CHCs keep people healthy and out of costly emergency rooms and hospitals — saving the health care system billions each year.

The loss of funding for mental health services in Boston would have severe and far-reaching consequences. There will be increased rates of untreated mental illness, leading to potential worsening of conditions and increased risk of suicide. Additionally, there will be increased homelessness and involvement with the criminal justice system for those with untreated mental illness.

Cuts to Medicaid would not just affect CHCs; they would destabilize the entire health care ecosystem. Overcrowded emergency departments, longer wait times, and provider burnout are already the norm. Hospitals would buckle under the demand to manage the influx of patients, and the strain on public health resources would leave all residents, regardless of income or ZIP Code, at greater risk.

For the most disadvantaged populations — those already losing 23 years of their lives — the stakes could not be higher. These cuts would not just deepen the divide between the haves and have-nots; they would turn that divide into a chasm, one measured in Black and immigrant lives lost.

CHCs remain our most effective defense against these cascading crises. Their integrated care model — spanning behavioral health, chronic disease management, and preventive services —saves lives and money. Nationally, CHCs reduce health care costs by $24 billion annually by preventing unnecessary hospital visits. Their role is crucial, but they cannot do it alone.

The time for action is now. Policymakers must preserve and prioritize Medicaid funding for CHCs and ensure equitable reimbursement for critical services like behavioral health care. We must address social determinants of health — housing, food security, and education — to build a resilient and equitable healthcare system from the ground up.

It is not just a matter of policy; it is a matter of survival. CHCs are more than medical facilities. They are symbols of hope and justice in a system too often marked by inequity. By investing in their sustainability, we choose a future where every community, regardless of its ZIP Code, has the chance to thrive.

The choice is clear: We can watch as these inequities deepen or act to ensure that everyone, no matter where they live, has access to a longer, healthier and fairer life.

Mimi Gardner is a LICSW, MPH, NeighborHealth vice president and chief equity officer.