“We don’t know,” is a phrase you never want to hear in the doctor’s office, but over the last few weeks Dr. John Carlo has found himself saying it often.
Carlo is the CEO of Prism Health North Texas, a conglomerate of community clinics, dental offices and pharmacies founded in the 1980s in response to North Texas’ HIV and AIDS crisis. While Prism’s services have since expanded, catering to marginalized communities by offering specialized care remains the company’s mission.
But changes to the healthcare industry initiated by President Donald Trump could pose long-term challenges to organizations like Prism.
One month into his second term, Trump has released a flurry of executive orders targeting diversity, equity and inclusion initiatives across the federal government, which has resulted in some specialized healthcare getting caught in the crossfire.
“In a community health center environment, virtually every patient we see is going to have some representation to being disenfranchised,” Carlo told the Observer. “Our real concern is how this is going to affect [our patients] and where we see some big challenges in particular is anything that's going to inhibit access to services. While we haven't seen anything yet that is 100% going to be the case, I think the fear alone is something that we're really having to work with.”
Carlo said patients across North Texas are expressing a variety of fears in response to the noise coming out of Washington. As U.S. immigration enforcement agents carry out raids on those believed to be in the country illegally, patients have told Carlo they are worried their immigration status will be documented in their health records.
Prism does not ask patients for their immigration status, Carlo told us. While Texas Gov. Greg Abbott did issue an executive order last year requiring hospitals to document patients’ immigration status, the order has not been expanded to cover clinics like Prism.
Other patients have expressed concern surrounding their gender identity being documented, and whether or not federal funding that supports HIV care for low-income patients will be continued, Carlo said. According to Prism Health's website, around 30% of North Texans living with HIV receive care from one of Prism's four clinics.
"It does feel a little different today because everything has happened so suddenly and quickly. But one of the things we are being careful about is to not overreact because I think the situation is very fluid at this point.” — Dr. John Carlo, CEO Prism Health North Texas
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For now, the answers are few and far between. Even if the doctor doesn't have many answers, he hasn't started to panic.
“As a nonprofit community health center that's been doing this a long time, we're not strangers to disruption and uncertainty,” Carlo said. “This is a lot like a government shutdown, which has happened in other years in the past. We're not strangers to seeing funding cuts or suddenly things change in terms of grants and resources. It does feel a little different today because everything has happened so suddenly and quickly. But one of the things we are being careful about is to not overreact because I think the situation is very fluid at this point.”
Carlo does acknowledge that there have been “threats” in the direction of funding cuts or halting certain types of care.
Last month, Trump ended federal support for gender-affirming care for minors, care that major medical groups such as the American Medical Association and the American Academy of Pediatrics support. (Gender affirming care for minors was outlawed in Texas in 2023.)
Following an executive order ruling that the federal government only recognizes the male and female genders, the Trump administration directed federal health agencies to scrub their websites of what was once publicly available data on a variety of topics.
In a memo sent to federal workers last week, employees at the Centers for Disease Control and Prevention were instructed to remove any content related to gender identity from the organizations’ websites within just a few days. As a result, webpages like Health Disparities Among LQBTQ Youth, and Fast Facts: HIV and Transgender People have been scrubbed.
The centers’ HIV webpage was also taken down temporarily, although at least some of the content was restored as of Wednesday. A note at the top of the webpage reads “CDC’s website is being modified to comply with President Trump’s Executive Orders.”
The Federal Health and Human Services Department and the National Institutes of Health have also removed a number of webpages since Trump’s order.
Many of those webpages, Carlo said, have been used by medical professionals for decades as sources for information or research on topics that affect their patients’ lives. Ensuring that the publication of scientific studies or journals remains public is something he believes the medical community needs to remain “very vigilant” about.
“It's certainly concerning the degree of information that has been taken off of government-level websites,” Carlo said. “We're essentially dealing with a lot of links that don't go anywhere anymore. So there is some concern about that. I don't know at this point how large or great of scale it is. I don't think anybody knows right now.”
With information from the Trump administration still vague, Prism has begun identifying programs that receive federal funding that could be at risk and creating contingency plans.
The organization has been funded by federal grants “virtually since its inception,” Carlo added, but securing private sector or community funding could be a future step in ensuring Dallas’ most at-risk residents have a continuation in care.
“As a health center in Dallas, we're invested in doing the work that we do. We don't really want to get into the politics of things,” Carlo said. “We do think that the patient-level services is not really the battle being fought here, and I think everybody agrees that having health centers like us on the ground, in the trenches in the communities addressing health care and making people healthy, is a valuable part of our community.”
