More than a quarter-million Tennesseans without health insurance could also lose access to primary care, with Community Health Centers across the state now looking down the edge of a looming fiscal cliff. Funding to help the centers expand reach and capacity was part of the Affordable Care Act, but the operating grants are set to expire next year. Mary Bufwack, CEO, of Nashville’s United Neighborhood Health Services, said if the funding is lost, they would likely have to close four of their 11 clinics. Statewide numbers could be even higher. “There are 28 centers and we altogether have 201 clinics,” said Bufwack. “If the impact is about the same in other areas, you’re looking at about 80 clinics out of that 201 closing.” Bufwack added that the closures and elimination of other services would impact about 260,000 CHC patients in Tennessee, which means they’d either have to go without care, or show up at the emergency room when a health issue becomes a crisis. CHCs can also be economic drivers in their areas. Dr. Gary Wiltz, board chairman of the National Association of Community Health Centers, said such areas are often small communities that need jobs as much as they need health care services. “We’re employing 250,000 people nationwide,” said Wiltz. “Fairly good-paying jobs. And by nature, we’re located particularly in the rural areas, like I’m in.” Nationally, research shows the number of CHC patients could drop by 7 million by the year 2020, if federal funding is lost and if more states don’t expand their Medicaid programs. Tennessee hasn’t made any expansion moves yet. But Bufwack said it’s greatly needed, because of the state’s high rates of poverty and uninsured, and low health rankings. “Look at every measure of health status,” said Bufwack. “Whether it’s diabetes, cardiovascular disease, prenatal care, infant mortality. We’re always 48 or 47, competing with Louisiana and Mississippi for the bottom rung of health care.” Currently, it’s estimated that 62 million Americans still do not have regular access to a primary care provider, and the demand is only expected to continue to rise in the years ahead.