The Paradoxical Politics of Community Health Centers from the Great Society to the COVID-19 Pandemic.

ABSTRACT

CONTEXT Though community health centers (CHCs) arose in the 1960s as part of a Democratic policy push committed to social justice, subsequent support has been shaped by a paradoxical politics wherein Republican and Democratic support for CHCs continually morphed in response to changes in the health policy landscape. METHODS: Drawing on the CHC literature and empirical examples from first-hand accounts and reporting, we explain CHCs' curious historical development from 1965 to present. FINDINGS: Since their inception, CHCs have received differing levels of support due to a paradoxical politics that tell us much about CHC policy history. Though the CHC program began as a Democratic vision, both Republicans and Democrats have calibrated their support for CHCs in response to a broader set of political considerations, from anti-welfare policy commitments to aspirations of establishing a national health care plan. CONCLUSIONS: CHCs have proven to be a politically malleable policy tool within the broader context of American health care policy. While the COVID-19 pandemic raised new questions about CHCs' sustainability and future, CHCs will continue to play a critical role not only providing health care access to underserved populations, but as an attractive bipartisan policy option within the larger framework of U.S. health policy.