This is National Health Center Week, and medical groups point to the growing demand for affordable healthcare services at a time when over 100 million Americans struggle to access primary care. Officials say the nation's community health centers are often the last line of care for America's uninsured or underinsured families.

Jana Eubanks, CEO of the Texas Association of Community Health Care Centers, said that because Texas did not expand Medicaid under the Affordable Care Act, local clinics have learned to be "scrappy" when it comes to funding.

"Health centers have to get really creative, and it kind of depends on the community because we can't keep up with the need. We have so much need, particularly in a state like Texas. We're always looking for additional support to be able to meet growing need, and we are seeing growing need," she explained.

Eubanks said Community Health Centers serve more than 1.8 million Texans, but only the poorest receive Medicaid assistance, leaving the rest mostly uninsured. According to Health Insurance-dot-org, Texas is leaving $12 billion on the table by not expanding Medicaid.

Eubank added Texas receives federal grants that help subsidize care, but these are only about 20% of Texas health centers' revenue, which means they also have to "cobble together" state and local resources. She added that finding doctors and other professionals to staff clinics is a perpetual challenge.

"We're playing the long game here. We're doing all types of training, whether it's a residency program to create more primary care physicians that want to work in a medically underserved area, or it's nursing staff, or it's community health workers or medical assistants," she continued.

Kyu Rhee, CEO of the National Association of Community Health Centers, pointed out that millions of Americans get health care from community clinics daily.

"Community health centers have served as the employer, provider and partner of choice across our nation since 1965 and so nearly six decades, and now serve one in 10 people across our nation, or over 32.5 million people," Rhee said.

It is National Rural Health Day and experts are flagging research showing increasing health disparities between urban and rural places, including in South Dakota.

A new advisory from the American Heart Association shows between 2010 and 2022, cardiovascular death rates increased a whopping 21% among young adults in rural areas, especially after the onset of COVID-19. In urban areas, the rate increased only 3%.

Dr. Karen Joynt-Maddox, associate professor of medicine at Washington University, chairs the association's presidential advisory committee and said the change is due to a mixed bag of increased risk factors in rural areas.

"If you put that on top of a real problem with health care infrastructure and access in rural areas, you sort of have a perfect storm for worsening cardiovascular health."

Joynt-Maddox noted traditional risk factors include high blood pressure, diabetes and obesity, which have been increasing in rural areas over the last few decades. Other contributing factors, she said, include poverty, food insecurity, depression and substance use disorder.

Tim Nikolai, Midwest senior rural health director for the American Heart Association, said rural communities have less access to resources like health care and grocery stores with fresh produce. Even access to high speed internet contributes to health outcomes. Health care providers are stretched thin, Nikolai added.

"It stretched hospitals and health care providers to try to serve the needs of their community the best way they can," Nikolai observed. "And that's something we're trying to collaborate with them on, is how can they meet people where they are?"

Nikolai listed some work happening in South Dakota including offering blood pressure monitoring at local libraries, installing four new Public Health AmeriCorps members across the state and the town of Spearfish prioritizing public CPR training and AED access.

More than 38 million Americans live with diabetes, including nearly 1 million Georgians.

The Georgia Department of Public Health estimates another 230,000 people in the state may have diabetes but don't know it.

During National Diabetes Month, Dr. Griffin Rodgers - director of the National Institute of Diabetes, Digestive, and Kidney Diseases at the National Institutes of Health - emphasized the importance of managing diabetes early to prevent serious health complications.

"Diabetes can damage blood vessels and nerves," said Rodgers, "so the patients that have it have a higher risk of developing conditions like a heart attack or a stroke, diseases of the kidneys and the eyes and the teeth, as well as the lower extremities."

Between 2014 and 2018, diabetes led to over 100,000 hospitalizations and 154,000 emergency-room visits in Georgia.

But Rodgers said diabetes is preventable and manageable. He added that regular wellness visits - where blood sugar, blood pressure, and cholesterol are checked - are key to staying healthy.

Rodgers said a healthy diet is a major part of managing or preventing diabetes.

He suggested eating plenty of fresh produce, whole grains, and lean proteins like fish - and cutting back on sugary drinks by choosing water instead.

Regular exercise and seven to eight hours of sleep each night are also important.

"On the physical activity side, 30 minutes a day, five days a week for most adults is what's
generally recommended," said Rodgers. "Just walking. And if you can't do the 30 minutes all at one time, breaking it into either two 15, or three 10-minute intervals is sufficient."

Early signals that diabetes could be a problem include frequent urination, constant thirst or hunger, fatigue, blurry vision, nausea, unexpected weight loss, or tingling in your hands and feet.

Rodgers said managing diabetes can be as simple as focusing on "the A-B-Cs of care" - checking your A1C, blood pressure and cholesterol levels, and quitting smoking.




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California could be in for some big cuts to health care for low-income families under a second Trump administration, according to health experts.

Policy specialists at the nonprofit KFF said they are bracing for Trump allies in Congress to make major reductions to Medicaid expansion under the Affordable Care Act, in order to pay for big tax cuts promised by the president-elect.

Larry Levitt, executive vice president of health policy at KFF, said it would force states to backfill or raise costs.

"For the ACA, simply letting enhanced financial aid expire after next year would result in big out-of-pocket premium increases, reduced enrollment and more people uninsured," Levitt projected.

Robert F. Kennedy Jr., President-elect Trump's choice for Health and Human Services Secretary, did not say much on the campaign trail about funding for Medicaid or the Affordable Care Act, so his positions are unclear. Kennedy has expressed skepticism about vaccines and has said the U.S. should stop putting fluoride in drinking water.

Jennifer Kates, senior vice president and director of the Global Health and HIV Policy Program for KFF, said the Centers for Disease Control and Prevention cannot require states to follow its recommendations on vaccines and fluoridation.

"That's up to states and local governments," Kates explained. "But CDC can recommend, and if those recommendations are not being made or being watered down or changed, that sends a message to states, to schools, to parents."

Health advocates are also raising concerns DACA recipients could lose access to health plans sold on the state marketplaces created under the Affordable Care Act. Changes to so-called "public charge" rules could make families with mixed immigration status hesitant to use Medicaid benefits.


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