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Imagine working multiple jobs at once to provide healthcare access to the most vulnerable residents of your community while operating on razor-thin margins and also saving the overall US healthcare system money.
That’s what it takes to be the CEO of a community health system (CHCs), according to Andrea Schwab-Galindo, chief exec of the Tiburcio Vasquez Health Center in the San Francisco Bay Area.
Tiburcio Vasquez is a nonprofit and federally qualified health center, which means it’s an outpatient clinic that’s eligible for certain types of state and federal funding. The health center was founded in 1971 and now operates 14 sites, treating about 30,000 patients across roughly 113,000 visits annually.
“Unlike other CEOs at other health systems, as a community health center CEO you have to wear multiple hats,” Schwab-Galindo told Healthcare Brew. “I joke around and I tell our staff that if you work at a community clinic you can work anywhere because you really have the opportunity to learn so many things and to do a lot more than you would at a private hospital.”
What it’s like to lead a CHC
Schwab-Galindo took over the reins at Tiburcio Vasquez in 2020 after working her way through various leadership roles starting in 2013. Before starting at Tiburcio Vasquez, Schwab-Galindo spent four years at another community health system, Bay Area Community Health.
At Tiburcio Vasquez, providers care for a “really complex patient population” of mostly children and Medicaid beneficiaries, Schwab-Galindo said.
“They come to us either because their parents don’t have access to healthcare” or because of the quality of care health centers can give patients, she said.
Having a high Medicaid population (70%, or roughly 20,000 patients) means “the total cost of care for us typically exceeds what we get reimbursed for each visit,” according to Schwab-Galindo.
The health center works with foundations and private funders and receives grants that help offset some of the costs, she said, but “funding is the No. 1 challenge that we have.”
And that isn’t unique to Tiburcio Vasquez.
CHCs typically have very thin margins, with roughly 42% having 90 days of cash or less on hand, according to Amy Simmons Farber, communications director for the advocacy group the National Association of Community Health Centers (NACHC). For the last two years, CHCs have relied on extensions of a continuing resolution to provide a large chunk of their funding, which is set to expire on Sept. 30.
Wait…what exactly is a community health center?
CHCs were first established in 1965 as part of President Lyndon B. Johnson’s “war on poverty,” and provide healthcare to everyone regardless of insurance status or ability to pay.
The health centers are typically composed of a group of outpatient clinics that provide primary care services in addition to dental care, mental health care, nutritional care, and more, according to Simmons Farber.
Today, there are roughly 1,500 CHCs serving about 32.5 million people in the US in both urban and rural areas. Of those patients, roughly 90% have low incomes (at or below 200% of the federal poverty level, which in 2025 is $32,150 for a household of four), 18% are uninsured, 64% are people of color, and 62% have public health insurance, according to an NACHC fact sheet.
Additionally, the health centers employ roughly 310,000 providers including physicians, nurses, and advanced practice professionals.
The purpose of the centers, aside from providing greater access to healthcare, is to save the overall healthcare system money by preventing costly emergency room (ER) visits and hospitalizations, according to NACHC. ER visits cost the US $80.3 billion in 2021, according to the most recent data from the Agency for Healthcare Research and Quality, a division of the US Department of Health and Human Services.
In 2023, the Congressional Budget Office estimated that funding CHCs would reduce spending on federally subsidized health insurance by $3.4 billion between 2024 and 2033 because the health centers “could provide more cost-effective patient care.”
How Medicaid cuts would affect CHCs
The financial challenges of running a community health system could become even greater if significant Medicaid cuts being floated by Congress are passed.
While Congressional Republicans have said they don’t intend to cut Medicaid, the House of Representatives in February adopted a budget resolution that calls for $880 billion in budget cuts from the Energy and Commerce Committee, which oversees Medicaid and Medicare.
If the cuts are passed, Schwab-Galindo said she and other CHC leaders would be forced to consider reducing staff and closing clinics, which would jeopardize healthcare access for the thousands of patients she says rely on Tiburcio Vasquez.
And in the long term, Medicaid cuts would likely mean more costs for the overall health system, because inadequate access to primary and preventive care could lead to higher rates of chronic disease, she added.
“Community health centers and clinics could be forced to cut back services,” Schwab-Galindo said. “That’s really jeopardizing the work and access for millions of patients. For us, it’s thousands of patients, and for folks in California, it’s hundreds of thousands of patients that need access to critical care.”