Abstract
As health centers celebrate their 40th anniversary, the larger American healthcare system faces challenges as daunting as any in its history. These include rising, unchecked costs of care, deteriorating access to care-especially among low-income, uninsured, and minority Americans-and unsettled quality of care for many. The authors argue that, as policymakers face the challenge of health system reform, the health centers program serves as a potential model for improving the cost-effectiveness and appropriateness of healthcare, setting the course for primary healthcare. At the same time, the program's very future depends on matters that extend into the broadest reaches of US health policy, in the areas of coverage, finance, workforce, quality improvement, and population health.