Minnesota health centers warn H.R. 1 could put 71,619 patients at risk

The Minnesota Association of Community Health Centers says federal H.R. 1 could drive coverage losses for more than 71,000 Minnesotans and strain the state’s community health center system by 2030. The group is urging state agencies and local partners to move fast on enrollment support, Medicaid protections and safety-net funding.

Why it matters: - MNACHC says federal H.R. 1 could push 71,619 Minnesota health center patients out of coverage by 2030. - The group says the loss of coverage would hit primary care access, raise avoidable emergency room use and threaten the stability of 17 community health centers. - MNACHC projects the changes could also reduce local economic activity and eliminate jobs tied to health centers.

What happened: - The Minnesota Association of Community Health Centers released a statewide analysis on Oct. 19, 2026. - The report says H.R. 1, also known as the One Big Beautiful Bill Act, puts tens of thousands of Minnesotans at risk of losing health coverage. - MNACHC says the law threatens the financial viability of Minnesota’s community health centers. - The analysis was prepared by Facktor and Capital Link.

The details: - The report projects 71,619 patients could lose coverage because of the expiration of enhanced ACA Marketplace tax credits, twice-yearly Medicaid redeterminations and work requirements. - MNACHC projects a cumulative net loss of $100.3 million for health centers from lower patient revenue and higher uncompensated care. - The analysis says local economic contributions could fall from $41 million to $25 million. - The report says 78 jobs could be lost statewide. - Minnesota’s uninsured rate has risen from 3.8% in 2023 to 5.8% in 2025. - New federal immigrant eligibility restrictions took effect Oct. 1, 2026. - MNACHC says administrative barriers are also putting coverage at risk for low-income families, immigrants and rural Minnesotans. - MNACHC thanked state leaders for using state funds to preserve the three-month retroactive Medicaid coverage period through 2027. - Jonathan Watson, MNACHC CEO, said H.R. 1 imposes administrative hurdles and eligibility rollbacks that would strip access from more than 71,000 health center patients and threaten clinic sustainability.

Between the lines: - The analysis frames H.R. 1 as both a coverage issue and a financing threat for Minnesota’s safety net. - The group is signaling that state-level action can offset some federal changes, but not all of them. - MNACHC’s recommendations suggest enrollment friction, not just benefit cuts, could drive a large share of the projected coverage losses.

What's next: - MNACHC is urging state agencies, counties, managed care organizations and health systems to strengthen eligibility processes, fund in-person enrollment navigators, protect safety-net revenue and build cross-sector coalitions. - The group wants agencies to maximize data matching, automate ex parte renewals, issue clear notices and streamline exemptions. - MNACHC also wants more funding for MinnesotaCare and state and county primary care. - The organization is pushing for navigators to focus on rural and non-English-speaking communities. - Watson said state leaders need to act now to prevent thousands of Minnesotans from falling through the cracks. - MNACHC directs patients to the full report and updates and to find care or insurance help.

The bottom line: - MNACHC says H.R. 1 could trigger a sharp coverage drop, weaken clinic finances and spread pressure across Minnesota’s health care safety net unless state leaders move quickly.