A health center closure in New England town reveals toll of federal cuts
on rural communities
[November 20, 2025]
By MICHAEL CASEY, AMANDA SWINHART and DEVI SHASTRI
FRANCONIA, N.H. (AP) — For more than two decades, Susan Bushby, a
70-year-old housekeeper from a rural ski town in New Hampshire's White
Mountains, took comfort in knowing she only had a short drive to reach
the community health center.
The lodge-like medical building, which sits on a hill overlooking town,
was like a second home for Bushby and many other patients. The front
desk staff knew their names and never missed a chance to celebrate a
birthday or anniversary. Staff photos of the wilderness that makes the
place such a draw hung on the walls, and bumping into a neighbor in the
waiting room was routine.
But last month, the Ammonoosuc Community Health Services location in
Franconia, a town of around 1,000 people, closed for good.
Closure raises concerns
Officials blamed cuts in Medicaid, the federal program that millions of
low-income Americans rely on for health care. The 1,400 patients, almost
half of them older and some facing serious health challenges like cancer
and early-stage dementia, must now drive at least 10 miles (16
kilometers) along rural roads to reach the nearest health center, which
also is near a regional hospital. A second center is twice as far.
“I was very disturbed. I was downright angry,” said Bushby, who was
brought to tears as she discussed the challenges of starting over at a
new health center. “I just really like it there. I don’t know, I’m just
really going to miss it. It’s really hard for me to explain, but it’s
going to be sad.”
The closure of the Franconia center reflects the financial struggles
facing community health centers and rural health care systems more
broadly amid Medicaid cuts and a feared spike in health insurance rates.
The government shutdown, which ended last week, was driven by a
Democratic demand to extend tax credits, which ensure low- and
middle-income people can afford health insurance through the Affordable
Care Act, or ACA.
Patients rattled by closure
Marsha Luce, whose family moved from the Washington, D.C., area in 2000,
is especially concerned about the impact on her 72-year-old husband, a
former volunteer firefighter who has had his left ear and part of his
jaw removed due to cancer. He also has heart and memory issues.
She worries about longer waits to see his doctor and the loss of
relationships built up over decades in Franconia.
“It’s going to be hard,” she said. “But it’s a relationship that’s going
to be missed. It’s a relationship that you can talk to people and you
tell them something and you go, yeah, well, I’ve had cancer. Oh, let’s
see. Oh, yeah. There it is in your chart. Do you know what I mean?”
Demise of rural health care
More than 100 hospitals closed over the past decade, according to the
Center for Healthcare Quality and Payment Reform, a policy and advocacy
group, and more than 700 more hospitals are at risk of closure. A branch
of the HealthFirst Family Care Center, a facility in Canaan, New
Hampshire, also announced it was closing at the end of October due in
part to “changes in Medicaid reimbursement and federal funding” for
these facilities.
“Because of these Medicaid cuts, we’re going to see rural hospitals, in
particular, hit hard,” New Hampshire Sen. Maggie Hassan, a Democrat,
told The Associated Press. “And obviously, the failure to extend the ACA
tax credits right now is going to compound the problem. … These
providers are going to see more and more uninsured patients. And that
means they’re going to have to make really difficult decisions.”
The sustainability of the centers is critical because they serve as the
nation’s primary care safety net, treating patients regardless of
insurance coverage or ability to pay.
Though federally-funded community health centers like the one in
Franconia have expanded their reach in recent years, treating 1 in 10
Americans and 1 in 5 rural Americans, they’ve often done so in the face
of major financial constraints, according to data from the National
Association of Community Health Centers.
On average, the centers are losing money — relying heavily on cash
reserves, making service changes and sometimes closing locations to stay
afloat, NACHC found. Nearly half have less than 90 days' cash on hand,
according to the association. The future is even more bleak, with at
least 2 million community health center patients expected to lose
Medicaid coverage by 2034 and 2 million more who are newly uninsured
turning to the centers for care.
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Fall foliage colors the scene near the Community Church, Tuesday,
Oct. 21, 2025, in Sugar Hill, N.H., a rural area where the closure
of a community health center is leaving residents without nearby
medical care. (AP Photo/Robert F. Bukaty)
 “There’s nothing left to trim
without cutting into care itself,” said Peter Shin, the chief
science officer at the association.
Tough choices for Ammonoosuc
When President Donald Trump’s bill passed this summer, Ed Shanshala,
the CEO of Ammonoosuc, knew he was in trouble.
A meticulous planner and strategist, Shanshala projected that his
network of five New Hampshire health centers — which relies on more
than $2 million in federal funding out of a $12 million budget —
would face a $500,000 shortfall partly due to Medicaid funding cuts.
He also expected work requirements in the bill and spikes in health
insurance premiums to have an impact.
Shanshala knew he needed to make cuts to save his centers and zeroed
in on Franconia because the building was leased, whereas Ammonoosuc
owns the other facilities.
“We’re really left with no choice,” Shanshala said, adding the
closure would save $250,000. Finding additional cuts is hard, given
that the centers provide services to anyone under 200% of the
federal poverty line, he said. If he cuts additional services,
Shanshala fears some patients will end up in a hospital emergency
room or “stop engaging in health care period.”
“To have to pull out of a community is devastating on a relational
level,” he said. “People still have access to health care. We’ll
help them with transportation, but it’s clearly a grieving process.
Whenever a business leaves a community, regardless if it’s health
care or something else, there’s an emotional fabric tear.”
Sense of loss
The closure has brought little controversy. Just a lot of grief.
Most of the patients come from the small towns of Franconia, Easton,
Lincoln and Sugar Hill, communities whose economies rely on hikers,
skiers and leaf peepers. Many are older, sicker and more spread out
than the rest of the state.
Luce, who volunteers at the local Head Start program and delivers
food to schools in Franconia, said the closure has her mostly
frustrated with politicians, adding that she wished lawmakers in
Washington could “just live the way regular people live” for a few
months.
“They would have a much different idea of what goes on in the real
world,” she added.
More closures coming?
Patients like Jill Brewer, the chair of the Franconia Board of
Selectmen whose family has been going there for decades, worry about
the future and whether the closure signals the gradual collapse of
the health care system in this part of the state.
“Is this kind of the first domino to fall?” said Brewer, noting how
disbanding the town's volunteer ambulance service in 2023 angered
many residents.
“It definitely leaves you feeling pretty anxious that this is going
to continue to kind of snowball and become an even bigger issue,”
she added.
On the clinic's last day, it was business as usual — no balloons, no
cakes, no farewell speeches. The staff were stoic as they tended to
patients, three of whom came in for their physicals and four for
checkups. Bushby, who had come to have her blood pressure checked,
hugged a staffer as crews dismantled the clinic and wheeled out exam
tables.
“I'll come see you, honey. I will,” Bushby said, hugging Diane
LaDuke, a patient access specialist. “It's been such a joy coming
here.”
___
Shastri reported from Milwaukee, Wisconsin.
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