Amid a widespread surge in chronic diseases, the third Primary Care Scorecard highlights how systemic disinvestment in U.S. primary care is posing a grave threat to the wellbeing of communities nationwide. By increasing investment in Community Health Centers (CHCs), the nation’s largest network of primary care providers, policymakers will help to improve health outcomes for Americans while also saving healthcare dollars.
Developed by researchers at the Robert Graham Center for Policy Studies in Primary Care and co-funded by the Milbank Memorial Fund and The Physicians Foundation, The Health of U.S. Primary Care: 2025 Scorecard, tracks key metrics of primary care performance, underscoring critical gaps at the national and state level.
The bottom line is that the U.S. invests less than 5% in primary care.1 This underfunding weakens preventive care, drives healthcare costs higher, and increases Americans’ reliance on expensive emergency departments, hospitals, and specialty care. In contrast, states that allocate a greater share of their healthcare spending to primary care experience decreased hospital and emergency department visits.2
A case in point is Oregon, where every dollar spent on primary care generated $13 in savings. Even elderly patients on Medicare and dually enrolled beneficiaries (people enrolled in both Medicaid and Medicare) – who often experience complex, high-cost conditions like diabetes and heart disease – experience fewer hospitalizations when they have easier access to primary care.3
Lack of investment in primary care has led to workforce shortages
One in three people struggle to find a primary care doctor. An estimated 100 million Americans lack access to primary care, particularly in rural and low-income communities. 4 The Bureau of Health Workforce projects a shortage of 87,150 primary care physicians by 2037,5 and a national survey found that 45% of primary care physicians report burnout – 39% of whom plan to stop seeing patients.6
As the U.S. struggles with rising healthcare costs and primary care shortages, Community Health Centers (CHCs) stand out as a proven, cost-effective solution. These nonprofit, primary care organizations governed by a patient majority board are legally required to provide care to all patients, regardless of their ability to pay. In 2023, nearly 1,500 CHCs provided comprehensive care, including behavioral health and substance use disorder services, to 32.5 million patients across nearly 16,000 communities. Nine in 10 patients have incomes less than 200% of the federal poverty level, and CHCs deliver care through a team-based approach – about 51% of medical visits are provided by a nurse practitioner, physician assistant, or certified nurse midwife.
CHCs are a bright spot in the healthcare system
CHCs expand primary care access and reduce costs. The Congressional Budget Office⁷ has documented that investing CHCs saves taxpayer dollars, while additional studies show CHC patients have lower hospital admission rates and emergency department visits, cutting annual Medicaid expenses by 24%.⁸ CHCs consistently exceed key quality benchmarks in diabetes control, blood pressure management, and cancer screenings, delivering higher-quality care⁹ at lower costs with improved patient outcomes. The Primary Care Scorecard highlights the critical need for increased primary care investment, but CHCs represent more than just another option—they embody a fundamentally different model. Their patient-majority governance, mission-driven approach, integrated service delivery, and proven cost effectiveness set them apart.
“The Primary Care Scorecard underscores the need to expand the Community Health Center program, which is successfully providing access to primary care with a team-based care model that meets patients’ needs in a comprehensive and cost-effective manner,” said Christopher Koller, president of the Milbank Memorial Fund.
“The Primary Care Scorecard underscores the need to expand the Community Health Center program, which is successfully providing access to primary care with a team-based care model that meets patients’ needs in a comprehensive and cost-effective manner.”
The uncertain road ahead
The recent congressional Continuing Resolution (CR) offers temporary financial relief for CHCs, which now serve 1 in 10 Americans. However, ongoing financial uncertainty limits their ability to expand access, hire staff, and plan. At the same time, Medicaid’s uncertain future threatens coverage for half of all CHC patients (16 million patients) who rely on the program for their care.
As the Primary Care Scorecard notes, strengthening primary care is essential to improving health outcomes and controlling costs. CHCs are a key part of this solution, delivering affordable, high-quality, and comprehensive primary care to millions of people who would otherwise go without. However, without stable funding and a strong Medicaid program, CHCs face significant challenges in meeting the needs of their communities. Ensuring long-term financial support will allow them to expand services, strengthen the primary care workforce, and improve access to care for those who need it most.
Endnotes:
- The Primary Care Scorecard
- Investing in Primary Care
- The association between primary care use and potentially-preventable hospitalization among dual eligibles age 65 and over.
- Closing the Primary Care Gap
- Health Workforce Projections—HRSA
- A Poor Prognosis: More Than One-Third of Burned-Out U.S. Primary Care Physicians Plan to Stop Seeing Patients
- 2840, Bipartisan Primary Care and Health Workforce Act
- Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings
- Community Health Centers: Providers, Partners and Employers of Choice — 2024 Chartbook—NACHC; By the Numbers: Health Care Use and Spending—HRSA