A health center closure in New England town reveals toll of federal cuts on rural communities

FRANCONIA, N.H. (AP) — For more than two decades, Susan Bushby, a 70-year-old housekeeper from a rural ski town in New Hampshire's White Mountains, took comfort in knowing she only had a short drive to reach the community health center.

The lodge-like medical building, which sits on a hill overlooking town, was like a second home for Bushby and many other patients. The front desk staff knew their names and never missed a chance to celebrate a birthday or anniversary. Staff photos of the wilderness that makes the place such a draw hung on the walls, and bumping into a neighbor in the waiting room was routine.

But last month, the Ammonoosuc Community Health Services location in Franconia, a town of around 1,000 people, closed for good.

Officials blamed cuts in Medicaid, the federal program that millions of low-income Americans rely on for health care. The 1,400 patients, almost half of them older and some facing serious health challenges like cancer and early-stage dementia, must now drive at least 10 miles (16 kilometers) along rural roads to reach the nearest health center, which also is near a regional hospital. A second center is twice as far.

“I was very disturbed. I was downright angry,” said Bushby, who was brought to tears as she discussed the challenges of starting over at a new health center. “I just really like it there. I don’t know, I’m just really going to miss it. It’s really hard for me to explain, but it’s going to be sad.”

The closure of the Franconia center reflects the financial struggles facing community health centers and rural health care systems more broadly amid Medicaid cuts and a feared spike in health insurance rates. The government shutdown, which ended last week, was driven by a Democratic demand to extend tax credits, which ensure low- and middle-income people can afford health insurance through the Affordable Care Act, or ACA.

Marsha Luce, whose family moved from the Washington, D.C., area in 2000, is especially concerned about the impact on her 72-year-old husband, a former volunteer firefighter who has had his left ear and part of his jaw removed due to cancer. He also has heart and memory issues.

She worries about longer waits to see his doctor and the loss of relationships built up over decades in Franconia.

“It’s going to be hard,” she said. “But it’s a relationship that’s going to be missed. It’s a relationship that you can talk to people and you tell them something and you go, yeah, well, I’ve had cancer. Oh, let’s see. Oh, yeah. There it is in your chart. Do you know what I mean?”

More than 100 hospitals closed over the past decade, according to the Center for Healthcare Quality and Payment Reform, a policy and advocacy group, and more than 700 more hospitals are at risk of closure. A branch of the HealthFirst Family Care Center, a facility in Canaan, New Hampshire, also announced it was closing at the end of October due in part to “changes in Medicaid reimbursement and federal funding” for these facilities.

“Because of these Medicaid cuts, we’re going to see rural hospitals, in particular, hit hard,” New Hampshire Sen. Maggie Hassan, a Democrat, told The Associated Press. “And obviously, the failure to extend the ACA tax credits right now is going to compound the problem. … These providers are going to see more and more uninsured patients. And that means they’re going to have to make really difficult decisions.”

The sustainability of the centers is critical because they serve as the nation’s primary care safety net, treating patients regardless of insurance coverage or ability to pay.

Though federally-funded community health centers like the one in Franconia have expanded their reach in recent years, treating 1 in 10 Americans and 1 in 5 rural Americans, they’ve often done so in the face of major financial constraints, according to data from the National Association of Community Health Centers.

On average, the centers are losing money — relying heavily on cash reserves, making service changes and sometimes closing locations to stay afloat, NACHC found. Nearly half have less than 90 days' cash on hand, according to the association. The future is even more bleak, with at least 2 million community health center patients expected to lose Medicaid coverage by 2034 and 2 million more who are newly uninsured turning to the centers for care.

“There’s nothing left to trim without cutting into care itself,” said Peter Shin, the chief science officer at the association.

When President Donald Trump’s bill passed this summer, Ed Shanshala, the CEO of Ammonoosuc, knew he was in trouble.

A meticulous planner and strategist, Shanshala projected that his network of five New Hampshire health centers — which relies on more than $2 million in federal funding out of a $12 million budget — would face a $500,000 shortfall partly due to Medicaid funding cuts. He also expected work requirements in the bill and spikes in health insurance premiums to have an impact.

Shanshala knew he needed to make cuts to save his centers and zeroed in on Franconia because the building was leased, whereas Ammonoosuc owns the other facilities.

“We’re really left with no choice,” Shanshala said, adding the closure would save $250,000. Finding additional cuts is hard, given that the centers provide services to anyone under 200% of the federal poverty line, he said. If he cuts additional services, Shanshala fears some patients will end up in a hospital emergency room or “stop engaging in health care period.”

“To have to pull out of a community is devastating on a relational level,” he said. “People still have access to health care. We’ll help them with transportation, but it’s clearly a grieving process. Whenever a business leaves a community, regardless if it’s health care or something else, there’s an emotional fabric tear.”

The closure has brought little controversy. Just a lot of grief.

Most of the patients come from the small towns of Franconia, Easton, Lincoln and Sugar Hill, communities whose economies rely on hikers, skiers and leaf peepers. Many are older, sicker and more spread out than the rest of the state.

Luce, who volunteers at the local Head Start program and delivers food to schools in Franconia, said the closure has her mostly frustrated with politicians, adding that she wished lawmakers in Washington could “just live the way regular people live” for a few months.

“They would have a much different idea of what goes on in the real world,” she added.

Patients like Jill Brewer, the chair of the Franconia Board of Selectmen whose family has been going there for decades, worry about the future and whether the closure signals the gradual collapse of the health care system in this part of the state.

“Is this kind of the first domino to fall?” said Brewer, noting how disbanding the town's volunteer ambulance service in 2023 angered many residents.

“It definitely leaves you feeling pretty anxious that this is going to continue to kind of snowball and become an even bigger issue,” she added.

On the clinic's last day, it was business as usual — no balloons, no cakes, no farewell speeches. The staff were stoic as they tended to patients, three of whom came in for their physicals and four for checkups. Bushby, who had come to have her blood pressure checked, hugged a staffer as crews dismantled the clinic and wheeled out exam tables.

“I'll come see you, honey. I will,” Bushby said, hugging Diane LaDuke, a patient access specialist. “It's been such a joy coming here.”

Shastri reported from Milwaukee, Wisconsin.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

An exam table is moved onto a trailer on the final day of operation at Ammonoosuc Community Health Services as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)

Marsha, left, and Kirk Luce, both patients at Ammonoosuc Community Health Services, eat dinner, Thursday, Oct. 23, 2025, at their home in Franconia, N.H. (AP Photo/Robert F. Bukaty)

Fall foliage colors the scene near the Community Church, Tuesday, Oct. 21, 2025, in Sugar Hill, N.H., a rural area where the closure of a community health center is leaving residents without nearby medical care. (AP Photo/Robert F. Bukaty)

Dr. Melissa Buddensee, left, meets with patient Susan Bushby at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H., in the final days before the clinic closes for good. (AP Photo/Robert F. Bukaty)

Employees at Ammonoosuc Community Health Services pack up the reception office as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)

NASA's launch team has loaded more than 700,000 gallons of fuel into the 32-story Space Launch System rocket, setting the stage for the Artemis II mission crew members to board.

The mission is NASA’s planned lunar fly-around by four astronauts that will be the first moon trip in 53 years.

The Space Launch System rocket is poised to blast off Wednesday evening with a two-hour launch window beginning at 6:24 p.m. EDT at Kennedy Space Center in Florida.

Artemis astronauts Reid Wiseman, Victor Glover, Christina Koch and Jeremy Hansen will be on board. They’ll hurtle several thousand miles beyond the moon, hang a U-turn and then come straight back. No circling around the moon, no stopping for a moonwalk — just a quick out-and-back lasting less than 10 days. NASA promises more boot prints in the gray lunar dust, but not before a couple practice missions.

Unlike the Apollo missions that sent astronauts to the moonfrom 1968 through 1972, Artemis’ debut crew includes a woman, a person of color and a Canadian citizen.

Artemis II is the opening shot of NASA’s grand plans for a permanent moon base. The space program is aiming for a moon landing near the lunar south pole in 2028.

The Latest:

Wiseman, Glover, Koch and Hansen have left the Neil Armstrong Operations and Checkout Building and are on their way to launch pad 39B.

Waving to family, colleagues and news photographers, the crew boarded the so-called astrovan for the 9-mile ride to the launch pad and their awaiting SLS rocket.

Before their highly anticipated walkout, commander Reid Wiseman and his crew played a quick card game with NASA’s chief astronaut Scott Tingle. It’s a preflight tradition since the space shuttle era.

Losing is good: It means the astronaut has gotten rid of all bad luck before launching.

The four thanked the suit techs and posed for photos, keeping a safe distance from many of the bystanders to avoid germs. They then went down the elevator at the Neil Armstrong Operations & Checkout Building and walk out to a barrage of cameras and cheers.

They’ll take a custom-designed astrovan for the ride to the launch pad

House Speaker Mike Johnson posted on the social media site X ahead of the planned Artemis II launch.

“Praying for the safety and success of the Artemis II crew and @NASA as they undertake a mission that will carry humanity farther into space than we have gone in over half a century. I had the privilege of hosting these courageous pioneers at the State of the Union earlier this year. Americans are watching proudly as our Golden Age reaches new heights!” Johnson wrote.

Wiseman, 50, a retired Navy captain from Baltimore, was serving as NASA’s chief astronaut when asked three years ago to lead humanity’s first lunar trip since 1972.

His wife Carroll’s death from cancer in 2020 gave him pause.

His two teenage daughters, especially the older one, had “zero interest” in him launching again after a 2014 trip to the International Space Station.

“We talked about it and I said, ’Look, of all the people on planet Earth right now, there are four people that are in a position to go fly around the moon,” he said. “I cannot say no to that opportunity.”

The next day, homemade moon cupcakes awaited him, along with his daughters’ support.

Artemis is the twin sister of Apollo in Greek mythology. They are the children of Zeus and Leto. Artemis has long been associated with the moon.

While the Artemis name builds on the Apollo program and pays homage to it, “there is no way we could be that same mission or ever hope to even be,” said NASA astronaut Christina Koch, part of the Artemis II crew.

The Apollo program was all about beating the Russians to the moon and planting the U.S. flag. NASA sent 24 astronauts to the moon between 1968 and 1972, including 12 moonwalkers. Now China is the competition.

NASA is striving for a long-term lunar presence under Artemis, with Mars to follow.

The Artemis II astronauts are now in their orange Orion spacesuits that they will wear for launch and reentry. Testing these new suits is one of the main goals of the mission.

The four are expected to emerge for their trip to the pad sometime before 2pm.

NASA created bright orange custom spacesuits for launch and reentry. Astronauts will also use them in case of a depressurization or some other emergency.

They can survive up to six days in the suits, inserting a straw into the helmet to sip water or protein shakes and relying on undergarment bags and bladders as a built-in toilet.

Future Artemis crews to the lunar surface will wear white moonwalking suits designed by Axiom Space.

During the Apollo era, astronauts wore the same white bulky spacesuits for launch and return as well as for moonwalks because there wasn’t enough storage on board for different outfits.

“We should have done Artemis 50 years ago,” said John Tribe, a propulsion engineer during the Apollo era.

The launch team has loaded more than 700,000 gallons of fuel into the 32-story Space Launch System rocket, setting the stage for the Artemis II crew to board.

The wind is picking up at Cape Canaveral, more clouds are appearing and rain is expected in about two hours. But there is no lightning threat, NASA says, and there’s still an 80% chance the weather will be good enough to launch.

L-minus tracks the overall time to liftoff, counting down the days, hours and minutes away before the planned blastoff. It doesn’t include built-in holds, or pauses — that’s T-minus time.

The T-minus countdown in the final 10 minutes is where nerves tense up and hearts start pounding. Automated software kicks off a series of highly choreographed milestones. During this period, the clock can be stopped if a problem is spotted and restarted if it’s fixed in time.

T-0 is the moment of liftoff — zero — when the boosters ignite and the rocket begins its journey.

NASA has a narrow time frame each month to fly to the moon.

The Earth and moon must be aligned just so to achieve the proper trajectory for the mission. In any given month, there’s only about a week when Artemis II astronauts can lift off.

The Orion capsule needs to get a check of its life-support and other systems in near-Earth orbit. If that goes well, Orion will fire its main engine to hurtle toward the moon, taking advantage of the moon and Earth’s gravity to get there and back in a slingshot maneuver that requires little if any fuel.

Orion also needs sunlight for power and can’t be in darkness for more than 90 minutes at a time. Plus NASA wants to minimize heating during reentry at flight’s end.

The latest launch window runs through April 6. The next opportunity opens on April 30.

The hydrogen tank of the rocket’s core stage is 100% filled. NASA said no significant leaks have been observed so far in fueling. It was hydrogen leaks that prevented the rocket from flying in February.

The alarm clocks just went off in Kennedy Space Center’s crew quarters.

That means it’s rise and shine for the three Americans and one Canadian who are about to become the first lunar visitors in more than 53 years.

They have a long day ahead of them, whether they launch or not.

After breakfast, they’ll start suiting up. NASA’s launch window opens at 6:24 p.m. and lasts a full two hours.

Launch director Charlie Blackwell-Thompson is wearing green as are many of the controllers alongside her in the firing room.

Green represents “go” for NASA, a color symbolizing good luck.

The team is monitoring the fueling of the 322-foot moon rocket, set to blast off Wednesday evening.

A plush toy named Rise will ride with the Artemis II astronauts around the moon, carrying the names of more than 5.6 million people.

Rise is what’s known as a zero gravity indicator, which gives the astronauts a visual cue of when they reach space.

The design was inspired by the iconic “Earthrise” photo during Apollo 8, showing the planet as a shadowed blue marble from space in 1968.

Rise was selected from more than 2,600 contest submissions. It was designed by Lucas Ye of California.

Commander Reid Wiseman and his crew tucked a small memory card into Rise before the toy was loaded into the Orion capsule. The card bears the names of all those who signed up with NASA to vicariously tag along on the nearly 10-day journey.

“Zipping that little pocket on the bottom of Rise was kind of the moment that put it all together for me,” Wiseman said. “We are going for all and by all. It’s time to fly.”

NASA is fueling the new rocket that will send four astronauts to the moon.

Launch teams have begun pumping more than 700,000 gallons (2.6 million liters) of liquid hydrogen and liquid oxygen into the Space Launch System rocket at Kennedy Space Center in Florida.

It’s the latest milestone in the two-day countdown that kicked off on Monday when launch controllers reported to duty.

It will take at least four hours to fully load the rocket before astronauts climb aboard for humanity’s first flight to the moon since Apollo 17 in 1972.

The two-hour launch window opens at 6:24 p.m. EDT.

▶ Read more about Apollo vs. Artemis

The Americans who blazed the trail to the moon more than half a century ago were white men chosen for their military test pilot experience.

The Artemis II crew includes a woman, a person of color and a Canadian, products of a more diversified astronaut corps.

▶ Read more about Christina Koch, Victor Glover, Jeremy Hansen and Reid Wiseman

NASA's Artermis II moon rocket sits on Launch Pad 39-B at the Kennedy Space Center hours ahead of planned liftoff Wednesday, April 1, 2026, in Cape Canaveral, Fla. (AP Photo/Chris O'Meara)

NASA's Artermis II moon rocket sits on Launch Pad 39-B at the Kennedy Space Center hours ahead of a planned launch attempt Wednesday, April 1, 2026, in Cape Canaveral, Fla. (AP Photo/Chris O'Meara)

Photographers set up remote cameras near NASA's Artermis II moon rocket on Launch Pad 39-B just before sunrise at the Kennedy Space Center Tuesday, March 31, 2026, in Cape Canaveral, Fla. (AP Photo/Chris O'Meara)