Navigating Federal Pressure: Community Health Organizations’ Adaptation and Resistance to Policy Shifts

• In Event: Student Forum Special Topic Paper Session

Abstract

Since January 2025, executive orders have removed or significantly reduced funding for community health organizations that provide gender-affirming care and services considered to support diversity, equity, and inclusion (DEI). Community health organizations (CHO’s) depend on federal grants to provide affordable care to underserved populations and are thus especially vulnerable to these changes. Drawing on Michel Foucault’s concept of biopolitics, this study examines how the federal administration exercises power through funding mechanisms to shape which communities are deserving of healthcare access and formalize exclusion for the undeserving. Through 15 semi-structured, in-depth interviews with staff members at Boston-area community health organizations, this study explores how organizations manage this biopolitical pressure. After obtaining Institutional Review Board approval, the recruitment process began with purposive sampling, followed by snowball sampling until data saturation was reached. The four health centers included in this study differ in their organizational structure and patient populations. One organization provides primary care to low-income families, two organizations offer sexual health services for LGBTQ+ youth, and the last combines LGBTQ+ services and syringe access programs. Thematic analysis revealed that community health organizations responded to recent policy shifts through multiple strategies, including removing politically targeted language from publicly facing materials, downsizing or restructuring programs, and proactively addressing patient concerns. These themes illustrate both compliance with and resistance to federal pressure, highlighting how frontline health organizations balance state governance and a commitment to their patients. By investigating how CHOs mediate biopolitical influence through these strategies, this project contributes to a deeper theoretical understanding of governance and political resistance in community-based healthcare and offers practical insights on how institutions adapt, protect, and sustain care in the face of political repression.

Author

• Zoe Solberg, Boston University