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 lodgelike 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 this place such a draw hung on the walls, and bumping into a neighbor in the waiting room was routine.

But last month, this site of the Ammonoosuc Community Health Services 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 along rural roads to reach the nearest health center, which also is near a regional hospital. A second center is twice as far.

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 Wednesday, 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 an 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.

"I know specifically for Kirk, it’s, it's going to be a harder one because he, he likes dealing with Dr. Buddensee himself.”

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 federally funded facility in Canaan, also announced it was closing at the end of October due in part to “changes in Medicaid reimbursement and federal funding" for these facilities.

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. 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.

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 delivering food for 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.