The 2030 Census Proposed Rule Could Adversely Affect Free and Charitable Clinics
The U.S. Census provides a consistent source of population data that allows us to understand and compare communities at the city, county, state, and national levels. Proposed changes to who is counted and how Census data are collected and used could make it more difficult to compare community demographics over time and across geographic areas, limiting our ability to identify changing needs and demonstrate whom we serve.
Why I Commented
Free and Charitable Clinics and Charitable Pharmacies exist because communities choose to fill the gaps in healthcare left by the private sector and government. Local donors, faith-based organizations, hospitals, and foundations provide the financial support that keeps their doors open. Making the case for this support requires demonstrating who lives in the community and what they need. One of our most important resources for building this picture is one we may take for granted: Census data.
The proposed changes to the 2030 Decennial Census could have adverse effects on Free and Charitable Clinics, Charitable Pharmacies, and the populations we serve. I acted on my concern by submitting a public comment to the Federal Register. This post describes why. I ask you to consider also submitting a comment by the November 2, 2026 deadline.
Why Census Data Matter to Free and Charitable Clinics
Changing community demographics influence who walks through our doors and what services they need. Census indicators related to race, ethnicity, language, housing, employment, income, and health insurance help us understand the populations within a clinic’s service area and how those populations are changing. Income and insurance data can help estimate the number of people who may be eligible for or benefit from our services, while language data can inform decisions about language access and the services needed to reach the community effectively.
Funders routinely ask applicants to describe the communities they serve, as well as the demographics of their staff, boards, and volunteers. Census data can help clinics answer these questions with evidence and demonstrate their reach and relevance to the populations they serve.
For example, while preparing a grant application for a member of the National Association of Free & Charitable Clinics (NAFC), I compared the clinic’s patient demographics with Census data showing that 8% of the county’s population was Black, while 40% of the clinic’s patients were Black. This comparison helped us make three important points to the funder:
Community need: Black residents represented a substantial share of the clinic’s patient population, demonstrating the clinic’s role in meeting their healthcare needs.
Community trust and reach: The clinic was reaching a population that represented a much smaller share of the county’s overall population, illustrating its connection to that community.
A baseline for measuring change: Comparing clinic and county demographics established a baseline for tracking changes in the populations served over time and potentially informing future program evaluation.
This example illustrates how Census data can strengthen a clinic’s case for funding, demonstrate its role in the community, and support planning and evaluation. Consistent, comparable population data are essential to making that case effectively.
The Problems with the Proposed Changes
The stakes extend beyond data collection. The U.S. Constitution requires a decennial Census to count the population, and that count serves two essential purposes: determining each state’s representation in the U.S. House of Representatives and informing the distribution of trillions of dollars in federal funding to communities.
On September 10, the U.S. Department of Commerce and the Census Bureau published a proposed rule that could significantly change how the 2030 Census counts and categorizes the population. As the National Council of Nonprofits (NCN) explains, these changes could result in communities being undercounted, underfunded, and underrepresented. Among the concerns is the proposed elimination of questions on race and ethnicity and of banning sexual orientation questions. Without consistent demographic data, it could become more difficult to identify disparities in measures such as health insurance coverage among different populations within the same geographic area.
For Free and Charitable Clinics, the consequences would be tangible. The comparison described above, which showed that Black residents made up 40% of a clinic’s patients but only 8% of the county’s population, could become more difficult or impossible to make using comparable Census data. Clinics could lose an important tool for demonstrating whom they serve, documenting differences between their patient populations and the broader community, and establishing baselines for future evaluation. These limitations could weaken both grant applications and efforts to measure whether services are reaching the populations that need them.
The effects would extend throughout the healthcare safety net and beyond. Food banks, domestic violence shelters, housing organizations, opioid-related coalitions, mammography referral programs, and other community partners also rely on demographic data to understand whom they serve and where needs exist. If Census methods make certain populations less visible or less comparable over time, these organizations could face similar challenges in documenting community needs, planning services, and securing funding. Communities that include international students, visa holders, refugees, and undocumented residents also risk being inaccurately represented in population counts, potentially affecting how resources are allocated to the places where they live and work.
The American Public Health Association (APHA) raises an additional concern: changes that result in people being missed or inadequately represented in the Census can diminish their political representation and voice. Those at risk include not only racial, ethnic, and sexual minorities, but also people experiencing homelessness or staying in emergency and domestic violence shelters, recently divorced or separated women, hospitalized and institutionalized individuals, and others whose living situations can make them harder to count.
For Free and Charitable Clinics, reliable Census data help us understand our communities, demonstrate our value to funders, plan services, and advocate for the people we serve. Changes that compromise the consistency or completeness of those data could make all of that work more difficult.
Why Action Is Necessary
Public comments become part of the official record that the Census Bureau must consider before finalizing a rule. Comments from organizations that see the effects of data and funding decisions in every patient visit carry real weight. More than 73,300 comments had been submitted when I submitted mine. The deadline has been extended to November 2, 2026, so there is still time to add your voice.
Your comment does not need to be long or technical. Describe how Census data support your work, what a less complete count would mean for your patients, and what you ask the Census Bureau to do. My request was simple: keep the existing demographic questions and keep counting all residents.
Here are the resources I used:
Use the National Council of Nonprofit’s comment guide, which includes talking points, a comment template, and submission instructions.
Sign NCN’s national letter opposing the proposed changes.
Please take a few minutes before November 2 to make your voice part of the record.
Related news articles:
Comments