When Dr. Marketta Blue steps into an exam room, her vibrant energy is infectious. Dressed in her signature leopard-print Crocs, she greets each patient like an old friend, often with a warm, “Tell me what’s up!”
Dr. Blue serves as a family physician at the Delta Health Center, a foundational institution in rural American healthcare and the nation’s oldest federally funded community health center. Located in the heart of the Mississippi Delta, it stands at the entry to Mound Bayou, a historic all-Black town established in 1887. This area faces significant economic challenges, with over half its children living below the poverty line. Last year alone, the center provided care to more than 14,000 individuals, with Medicaid covering 36% of those patients.
Having grown up in the very same region, 38-year-old Dr. Blue vividly remembers her grandmother’s struggles to take time off work for medical visits. Back then, seeing a doctor was reserved for dire emergencies, a reality that deeply shaped Dr. Blue’s understanding of her patients’ obstacles today. She knows all too well the many barriers they face: the cost of gas, the lack of childcare, or the sudden loss of health insurance.
The topic of insurance was heavy on the mind of 64-year-old Johnie Williams when Dr. Blue entered his exam room that September. He shifted uneasily in his wheelchair, his wife Carolyn nearby, holding their granddaughter. He confided in Dr. Blue about his sleepless nights, describing his lungs as feeling like cement, unable to draw air. Persistent nausea made eating a struggle.
“Medicaid cut me off,” he stated, a deep concern in his voice. He’d received a notice in July, explaining the change in his coverage. While he still retained Medicare, which he’d had alongside Medicaid, the letter cited his and his wife’s combined household income as just “a few dollars over the limit” for Medicaid eligibility.
Dr. Blue’s expression immediately conveyed alarm. “Oh my gosh,” she responded, her concern evident.
This exchange is likely just the beginning of countless similar conversations across the country. Healthcare policies enacted in the recent federal tax and domestic bill, passed in July by the Trump administration, project that an additional 10 million Americans will lose their health insurance by 2034, according to the Congressional Budget Office. This legislation includes a staggering reduction of over $1 trillion in federal Medicaid spending, marking the most significant cut to the program since its inception in 1965.
A key component of this bill introduces stringent work requirements. Beginning in 2027, individuals receiving Medicaid expansion will be mandated to provide proof of employment or qualify for an exemption to maintain their health insurance. Many experts warn this requirement could lead to a significant number of recipients losing coverage and facing increased difficulty in re-enrollment. This shift is expected to burden the nation’s 1,512 community health centers with an estimated $7.3 billion annually in uncompensated care costs, as they absorb new patients who are suddenly uninsured.
Supporters of the legislation contend that these measures will curb federal Medicaid expenditures, projecting savings of $326 billion over a decade due to the new work requirements. The White House has stated that the bill aims to tackle “improper payments” within Medicaid, thereby “protecting Medicaid for the truly vulnerable” population.
Michael Cannon, director of health policy studies at the libertarian Cato Institute, commented that those losing coverage will either be genuinely ineligible or simply unable to navigate the complex process of certifying their eligibility. He framed aspects of the policy as a means to combat fraud.
Within the Delta Health Center, staff members are deeply concerned that without Medicaid, many patients will delay or skip necessary medical treatments. Studies from KFF, a leading health research group, indicate that uninsured individuals are three times more likely than insured ones to forgo essential care.
Moreover, federally funded clinics anticipate a surge in newly uninsured patients, many of whom may be turned away from other healthcare facilities once their Medicaid coverage ends. Delta Health Center, for instance, operates on a sliding-scale fee system, enabling patients to pay as little as $25 per visit, with the option to waive this fee entirely if a patient cannot afford it.
Gerard Anderson, a professor of health policy at Johns Hopkins Bloomberg School of Public Health, warned that “federally qualified health centers are going to experience a dramatic increase in patient volume. They’ll be stretched even thinner than before. It’s going to be a nightmare.”
Compounding these pressures are ongoing federal funding cuts and freezes. Last April, the Delta Health Center’s $250,000 Title X grant was temporarily suspended, impacting access to certain contraceptive services for some patients, though these funds have since been restored. More recently, a grant supporting women, infants, and children was halted due to the federal government shutdown, forcing the center to quickly secure replacement funding.
Amy Simmons Farber, a spokesperson for the National Association of Community Health Centers, emphasized the impossibility of delivering consistent services amidst such unpredictable funding. “Their resilience has been severely tested, not solely by federal funding issues, but also by potential reforms to Medicaid itself. They are facing immense challenges from multiple directions.”
The weight of these challenges is clearly felt by Dr. Blue. “I just hope we’re able to carry the load,” she admitted.
“We Serve as the Essential Safety Net”
Traveling along Highway 61 through the Mississippi Delta, past vast cotton fields and the small towns that birthed legendary blues musicians, one eventually arrives at Mound Bayou. This town, established during the Jim Crow era, once thrived with its own bank, train station, library, and newspaper. However, with agricultural mechanization and a decline in local jobs, businesses shuttered, including the town’s sole grocery store. Today, like many communities in the region, Mound Bayou is characterized by a modest grid of single-story homes, a post office, and a cemetery. The average household income here is just over $23,000 annually.
The origins of the Delta Health Center are rooted in the civil rights movement of the 1960s, when activists flocked to the South to register Black voters. During that period, Black patients were frequently denied care at hospitals. Even white civil rights workers, suffering from heatstroke or dehydration in the scorching Southern summers, were sometimes refused treatment by local white doctors. In response, a group of physicians journeyed to the region, providing care and initiating a movement to establish a dedicated health center in Mound Bayou.
From its very beginning, the Delta Health Center faced strong opposition from local officials. A display within the center features old editorials criticizing its establishment. In 1965, The Bolivar Commercial, a local newspaper, controversially claimed: “There has never been an occasion in our memory when a person could not receive medical attention in Bolivar County.” The editorial concluded, “We feel that a federally financed and controlled clinic or hospital is not needed and especially so in Bolivar County.”
The last two decades saw significant expansion for the health center, including the opening of 17 satellite clinics across six neighboring counties and the deployment of mobile treatment vans. However, healthcare professionals now fear that this hard-won progress is at risk of stalling.
John Fairman, the center’s chief executive, expressed his concern: “The worst-case scenario would involve us having to scale back, perhaps even closing some of our outlying clinics, but I truly hope it doesn’t come to that. We serve as the essential safety net for this community.”
In early September, Tracy Price, a 66-year-old Mound Bayou resident, arrived at the center’s waiting area, visibly anxious. She held tightly to the hand of her 19-year-old granddaughter, whose face was streaked with tears. “I will tear this hospital down before I leave without getting her seen,” Ms. Price declared upon entering, her determination palpable.
As clinic staff rushed to assist, Ms. Price explained, “She is on psychiatric medication, and she’s been without it for a couple of weeks. This is an emergency.”
Ms. Price elaborated that her granddaughter, who has bipolar disorder, had been covered by Medicaid in Nevada until moving to Mississippi last summer. The move resulted in the loss of her insurance and her crucial supply of lorazepam. In a desperate letter to the Nevada Department of Human Services, shared with the article’s author, the young woman wrote, “I have been unable to reach Medicaid for two months. Please expedite.”
Dr. Blue’s Unwavering Commitment
Dr. Blue’s schedule was packed, and she winced at the daunting patient list. Yet, she made sure to connect with each person, sharing jokes and putting them at ease. In one room, 68-year-old Wesley Tribune, who lives with diabetes, proudly informed Dr. Blue he was cutting back on spaghetti and junk food. “My wife doesn’t cook any for me,” he added with a chuckle.
“She’s looking out for you,” Dr. Blue affirmed warmly.
“She’s starving me!” Mr. Tribune playfully retorted.
Back with Mr. Williams, Dr. Blue listened intently as he expressed his deep concerns about affording necessary medical care now that Medicaid had cut him off.
He admitted he was considering skipping some appointments to save money. “It’s about to get to that point,” he said with resignation.
Dr. Blue gently shook her head. “We need to do an X-ray on your stomach,” she informed him. “I’m also going to check your urine and your electrolytes.”
Her worried expression momentarily softened into a broad smile as she noted his hemoglobin A1c — a measure of average blood sugar over three months — had dropped to 7.4. “When you first started seeing me, it was 13!” Dr. Blue exclaimed, clapping her hands in delight.
Turning to Ms. Williams, she announced with confidence, “He’s going to be OK!”
Research for this report was contributed by Sheelagh McNeill.