The Role of Community Health Centers in Advancing the Make America Healthy Again Initiative: A Review of Literature on Chronic Disease Management & Prevention
This research was compiled by Adina Rubenstein, Policy Intern at Advocates for Community Health (ACH) and MPH student at the University of Michigan. In addition, ACH has created an Issue Brief on Chronic Disease available to download on its website.
Executive Summary
This literature review examines the role of Community Health Centers (CHCs) in chronic disease management within the United States, with a focus on alignment with the MAHA initiative. Recent studies and reports indicate that CHCs play a critical role in improving outcomes for people with chronic conditions such as diabetes, hypertension, and obesity, while promoting preventive care, health care access, and cost-effective service delivery. CHCs most often serve medically underserved populations, offering preventive screenings, lifestyle counseling, early detection programs, and management of chronic conditions. Current evidence demonstrates that CHCs achieve outcomes that meet or exceed national benchmarks while maintaining low per-capita healthcare costs, resulting in significant national savings.
Additionally, CHCs enhance health care access by providing care regardless of insurance status or income, thereby addressing systemic disparities in chronic disease burden. Despite their successes, challenges for the effective functioning of CHCs remain, including workforce shortages, funding instability, and gaps in preventive service delivery, particularly in rural areas. Research gaps exist regarding the implementation and sustainability of prevention efforts across CHC settings. CHCs are essential to advancing MAHA’s goals of chronic disease prevention, health promotion, and equitable access to care. Future policy efforts should focus on increased funding, workforce development, expanded preventive services, and improved data reporting to optimize CHC contributions to chronic disease management nationwide.
Rationale for Inclusion/Exclusion of the Literature
The literature selected for this review was chosen according to specific criteria to ensure relevance to chronic disease management in Community Health Centers (CHCs). Emphasis was placed on publications within the past 5–10 years to reflect more current trends in CHC funding, service delivery, and patient populations. Studies and data were then organized by theme, and were restricted to materials focusing on the United States to ensure applicability. Only empirical reports, institutional analyses, government or nonprofit publications, and peer-reviewed studies were included; this encompasses documents from the National Association of Community Health Centers (NACHC), The Commonwealth Fund, and other academic medical literature, to ensure methodological thoroughness, credibility, and policy relevance. Included sources specifically address CHC capacity, financing, patient access, and chronic disease outcomes.
Sources were excluded if they fell outside the defined time period, were not U.S.-based, or lacked substantive content on chronic disease management in CHCs. Materials unrelated to chronic disease management and CHCs were also excluded to maintain a focused, relevant, and evidence-based foundation for understanding how CHCs manage chronic diseases.
Introduction
The Trump administration launched the Make America Healthy Again (MAHA) initiative following the appointment of Robert F. Kennedy Jr. as Secretary of Health and Human Services to improve health outcomes in the United States. The articulated goal of MAHA is to address and prevent the root causes of chronic disease in the U.S. through the utilization of public health tactics, including prevention, wellness, and equitable access to care. As depicted below, MAHA’s stated objectives emphasize improving the nation’s overall health by promoting healthy lifestyles, reducing obesity and smoking rates, and enhancing early detection and management of chronic diseases. By addressing these areas, MAHA aims to reduce the rates of chronic diseases in the US, including diabetes, heart disease, and hypertension, ultimately increasing life expectancy and quality of life across communities.
Specifically, MAHA outlines a vision for a healthier, stronger America by tackling the chronic disease epidemic through “a comprehensive, national strategy to address the root causes of America’s chronic disease crisis—poor diets, environmental toxins, and inadequate healthcare systems.” Implicitly central to this vision is a focus on preventive healthcare and equitable access to wellness resources to improve health across the U.S. Currently, approximately 60% of adults in the U.S. have at least one chronic disease, and 40% have two or more, with heart disease, cancer, and diabetes serving as leading drivers of the nation’s $3.8 trillion in annual healthcare costs (MAHA, 2025).
Given this public health landscape, Advocates for Community Health (ACH) and Community Health Centers (CHCs) fully align with and are thus critical stakeholders in advancing the administration’s MAHA chronic disease prevention mission. CHCs serve medically underserved populations, promote health care access, and provide accessible, cost-effective care that directly supports the initiative’s goals. This literature review examines and synthesizes current research on the role of CHCs in improving chronic disease outcomes, expanding preventive services, and promoting equitable access to care across the United States.
Review of Literature
CHCs and Chronic Disease Outcomes
The recent literature strongly suggests that CHCs significantly contribute to the improved management of chronic diseases such as diabetes, hypertension, and obesity. According to the National Association of Community Health Centers (NACHC, 2023), CHCs serve approximately 10% of the U.S. population, yet account for only approximately 1% of total health care spending. This illustrates the efficiency and effectiveness of CHCs in delivering high-quality, cost-effective care. Additional data demonstrate that even though CHC patients often face higher burdens of chronic illness due to socioeconomic and geographic disparities, yet the clinical outcomes for patients served by CHCs across the US consistently meet or exceed national benchmarks (HRSA, 2024).
In 2024 alone, CHCs treated nearly 34 million patients nationwide, including numerous patients with chronic conditions such as diabetes, hypertension, and obesity. Among 3 million patients with diabetes, 70% maintained hemoglobin A1c (HbA1c) levels indicative of good diabetes control, resulting in an estimated $19.6 billion in healthcare cost savings due to reductions in complications of uncontrolled diabetes (KFF, 2025). Similarly, 65% of 5.7 million hypertension patients achieved target blood pressure control, decreasing the risks of heart attacks and strokes for these people and ultimately saving over $7 billion in estimated health care costs (NACHC, 2023). These data suggest that CHCs not only improve disease management but also contribute to reducing the broader national burden of preventable chronic diseases and their complications. However, it is important to note that these outcomes may vary widely as a function of differences in regional funding, staffing, and resource availability (NACHC, 2025). Further research is still needed to determine how differences in CHC capacity across states influence long-term chronic disease outcomes and the sustainability of these cost savings.
Prevention, Early Detection, and Management
Preventive care and early detection are critical components of CHCs’ mission and also directly align with MAHA’s articulated focus on chronic disease prevention. CHCs widely provide health screenings, vaccinations, nutrition counseling, and lifestyle interventions that can help reduce the onset and progression of chronic diseases by emphasizing preventive measures and early interventions. In 2024 alone, care provided by CHCs helped more than 2.2 million patients maintain diabetes control, supported over 3.6 million people manage their hypertension, and provided weight assessment and nutrition counseling to 4.6 million pediatric patients (HRSA, 2024). CHC's preventive efforts also extend to early screening and detection for cancer, performing nearly 2 million breast cancer screenings, 4.4 million cervical cancer screenings, and 3.6 million colorectal cancer screenings in 2024 (NACHC, 2024). These data further underscore the integral role of CHC efforts in promoting population health and reducing the incidence of late-stage chronic disease diagnoses. Studies in the literature further suggest that patients receiving care from CHCs are more likely to receive recommended preventive services than those in non–CHC primary care settings (Hatch, 2022). Even so, disparities in preventive service delivery persist, particularly in rural areas and regions with workforce shortages (KFF, 2025). Future research is necessary to examine how increased MAHA-related funding could close these gaps by expanding preventive infrastructure within CHCs.
Health Care Access and Cost Efficiency
The literature also supports the notion that CHCs are vital contributors to health care access and cost- effectiveness. As depicted above, CHCs deliver care to populations that are disproportionately affected by chronic illness and face significant barriers to accessing care, including individuals with low income, residents of rural areas, children, older adults, and more (NACHC, 2023). By providing affordable and accessible care and services regardless of insurance coverage or immigration status, CHCs help to reduce systemic health disparities and advance the stated MAHA goal of equitable healthcare access.
CHCs also generate substantial economic benefits, or return on investment, through their emphasis on prevention and the management of chronic diseases by reducing avoidable and costly hospitalizations and emergency department visits. This preventative care and management resulted in an estimated $38.6 billion in savings for Medicaid in 2023 (NACHC, 2023), and reflects the CHCs’ capacity to provide high-value care at lower cost. This is clearly a critical consideration for national initiatives like MAHA that seek to lower healthcare expenditures while improving efficiency and outcomes. Still, the literature highlights ongoing challenges, including workforce shortages, funding instability, and limited infrastructure in high-need areas (NACHC, 2023). Addressing these challenges is essential to ensure CHCs can continue to serve as a foundation for accessible and cost-effective healthcare delivery.
Gaps that Exist in the Literature
The literature clearly demonstrates that CHCs play a critical role in chronic disease identification and management, along with providing key preventive services. However, few studies explore how these prevention efforts are implemented or sustained across different CHC settings and populations. Most research focuses on clinical outcomes, leaving less attention to the broader community-level or long-term preventive impact emphasized in MAHA’s goals. As a result, gaps remain in understanding which of the many prevention strategies utilized by CHCs are most effective, how they differ across communities, and what structural factors support or limit their success.
Conclusion and Recommendations
The literature confirms that CHCs play a pivotal role in identifying and improving chronic disease outcomes, advancing prevention, and promoting equitable access to care. CHCs’ ability to provide cost-effective, high-quality services to reduce chronic disease burden aligns directly with MAHA’s articulated initiative to reduce chronic disease and improve overall public health. To advocate for reducing the burden on those with chronic diseases in alignment with MAHA ideals, ACH’s future policy efforts should:
- Advocate for increased federal investment in CHC infrastructure, workforce development and expansion, and preventive health programs.
- Advocate for data/reporting measures to improve transparency into CHC contributions for chronic disease management and outcomes, and evaluating impact while mitigating disproportionate effects on minority populations.
- Advocate for expanded preventive services in rural and underserved communities through the use of telehealth.
References
America’s health centers: By the numbers. (2025, August 16). Retrieved November 18, 2025, from NACHC website: https://www.nachc.org/resource/americas-health-centers-by-the-numbers/
Community health centers: Reducing chronic disease and lowering costs through preventive and primary care. (2025). Retrieved November 18, 2025, from Nachc.org website: https://www.nachc.org/wp- content/uploads/2025/01/chcs-and-chronic-disease_may2025.pdf
The Commonwealth Fund. (2024, August 8). Community Health Centers’ Progress and Challenges in Meeting Patients’ Essential Primary Care Needs. Retrieved November 18, 2025, from Commonwealthfund.org website: https://www.commonwealthfund.org/publications/issue- briefs/2024/aug/community-health-centers-meeting-primary-care-needs-2024-FQHC-survey
Hatch, B., Tillotson, C., Hoopes, M., Huguet, N., Marino, M., &; DeVoe, J. (2022). Patient-level factors associated with receipt of preventive care in the safety net. Preventive Medicine, 158(107024), 107024. doi:10.1016/j.ypmed.2022.107024
Make America healthy again. (n.d.). Retrieved November 18, 2025, from Maha.vote website: https://www.maha.vote/
Mason, B. (2025, September 8). Community Health Centers grew in 2024 but patient access faces a tipping point. Retrieved November 18, 2025, from NACHC website: https://www.nachc.org/community- health-centers-grew-in-2024-but-patient-access-faces-a-tipping-point/
Pillai, A., Corallo, B., &; Tolbert, J. (2025, January 6). Community health center patients, financing, and services. Retrieved November 18, 2025, from KFF website: https://www.kff.org/medicaid/community-health-center-patients-financing-and-services/
The overlooked decline in community health center funding. (2023, July 28). Retrieved November 18, 2025, from NACHC website: https://www.nachc.org/resource/the-overlooked-decline-in-community- health-center-funding/
Williams, N. (2024, June 11). The importance of community health centers and FQHCs. Retrieved November 18, 2025, from Community Health Centers website: https://www.chcfl.org/the-importance-of- community-health-centers/