FRANCONIA, N.H. (AP) — The closing of a health center in rural New Hampshire has raised concerns that the projected cuts in Medicaid are already taking a toll.
Last month, a site of the Ammonoosuc Community Health Services in Franconia, a town of around 1,000 people, closed for good.
Ammonoosuc officials and a Democratic senator have blamed Medicaid cuts for the closure of the facility that served 1,400 patients from Franconia, Easton, Lincoln and Sugar Hill. These are all tiny communities around the White Mountains, whose patients typically are older and sicker than in other parts of the state.
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.
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.
On average, the federally-funded community health centers like the one in Franconia 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. And 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.
Ed Shanshala, the CEO of Ammonoosuc, said the Medicaid cuts are to blame for the closure of the Franconia center.
Shanshala runs a network of five health centers in New Hampshire which relies more than $2 million in federal funding — out of a $12 million budget. He faced a $500,000 shortfall due to the cuts and realized closing Franconia would save about half that money. It also was the only facility where they leased space.
“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 federal poverty levels, he said. And if he cuts additional services, Shanshala fears some patients will end up in a hospital emergency room or “stop engaging in health care period.”
Susan Bushby, a 70-year-old housekeeper, talked about how much she loved the staff and feared going to a new health center. She wouldn't know her way around a larger facility and wouldn't have the same rapport with the people there.
“I was very disturbed. I was down right 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.”
Marsha Luce, whose family moved from Washington, D.C. area, in 2000, is especially concerned about the impact on her 72-year-old husband, a former volunteer firefighter who has a 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?”
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)
U.S. President Donald Trump says Iran has proposed negotiations after his threat to strike the Islamic Republic as an ongoing crackdown on demonstrators has led to hundreds of deaths.
Trump said late Sunday that his administration was in talks to set up a meeting with Tehran, but cautioned that he may have to act first as reports mount of increasing deaths and the government continues to arrest protesters.
“The meeting is being set up, but we may have to act because of what’s happening before the meeting. But a meeting is being set up. Iran called, they want to negotiate,” Trump told reporters on Air Force One on Sunday night.
Iran did not acknowledge Trump’s comments immediately. It has previously warned the U.S. military and Israel would be “legitimate targets” if America uses force to protect demonstrators.
The U.S.-based Human Rights Activists News Agency, which has accurately reported on past unrest in Iran, gave the death toll. It relies on supporters in Iran crosschecking information. It said at least 544 people have been killed so far, including 496 protesters and 48 people from the security forces. It said more than 10,600 people also have been detained over the two weeks of protests.
With the internet down in Iran and phone lines cut off, gauging the demonstrations from abroad has grown more difficult. Iran’s government has not offered overall casualty figures.
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The semiofficial Fars news agency in Iran, which is close to the paramilitary Revolutionary Guard, on Monday began calling out Iranian celebrities and leaders on social media who have expressed support for the protests over the past two weeks, especially before the internet was shut down.
The threat comes as writers and other cultural leaders were targeted even before protests. The news agency highlighted specific celebrities who posted in solidarity with the protesters and scolded them for not condemning vandalism and destruction to public property or the deaths of security forces killed during clashes. The news agency accused those celebrities and leaders of inciting riots by expressing their support.
Canada said it “stands with the brave people of Iran” in a statement on social media that strongly condemned the killing of protesters during widespread protests that have rocked the country over the past two weeks.
“The Iranian regime must halt its horrific repression and intimidation and respect the human rights of its citizens,” Canada’s government said on Monday.
Iran’s foreign minister claimed Monday that “the situation has come under total control” after a bloody crackdown on nationwide protests in the country.
Abbas Araghchi offered no evidence for his claim.
Araghchi spoke to foreign diplomats in Tehran. The Qatar-funded Al Jazeera satellite news network, which has been allowed to work despite the internet being cut off in the country, carried his remarks.
Associated Press writer Jon Gambrell in Dubai, United Arab Emirates, contributed.
Iran’s foreign minister alleged Monday that nationwide protests in his nation “turned violent and bloody to give an excuse” for U.S. President Donald Trump to intervene.
Abbas Araghchi offered no evidence for his claim, which comes after over 500 have been reported killed by activists -- the vast majority coming from demonstrators.
Araghchi spoke to foreign diplomats in Tehran. The Qatar-funded Al Jazeera satellite news network, which has been allowed to work despite the internet being cut off in the country, carried his remarks.
Associated Press writer Jon Gambrell in Dubai, United Arab Emirates, contributed.
Iran has summoned the British ambassador over protesters twice taking down the Iranian flag at their embassy in London.
Iranian state television also said Monday that it complained about “certain terrorist organization that, under the guise of media, spread lies and promote violence and terrorism.” The United Kingdom is home to offices of the BBC’s Persian service and Iran International, both which long have been targeted by Iran.
Associated Press writer Jon Gambrell in Dubai, United Arab Emirates, contributed.
A huge crowd of demonstrators, some waving the flag of Iran, gathered Sunday afternoon along Veteran Avenue in LA’s Westwood neighborhood to protest against the Iranian government. Police eventually issued a dispersal order, and by early evening only about a hundred protesters were still in the area, ABC7 reported.
Los Angeles is home to the largest Iranian community outside of Iran.
Los Angeles police responded Sunday after somebody drove a U-Haul box truck down a street crowded with the the demonstrators, causing protesters to scramble out of the way and then run after the speeding vehicle to try to attack the driver. A police statement said one person was hit by the truck but nobody was seriously hurt.
The driver, a man who was not identified, was detained “pending further investigation,” police said in a statement Sunday evening.
Protesters burn the Iranian national flag during a rally in support of the nationwide mass demonstrations in Iran against the government in Paris, Sunday, Jan. 11, 2026. (AP Photo/Michel Euler)
