Ask anyone living in the Ironbound neighborhood of Newark, and they’ll tell you this tight-knit community in the northeast corner of the city has a small-town feel. 

“So you can see it's five minutes to three; schools going to be out in a few minutes. Lots of parents are here waiting for their kids,” says Maria Irizarry. “It’s a very sort of family oriented neighborhood.” 

Irizarry grew up here, just a few blocks from the elementary school on Lafayette Street. The firehouse is located around the corner on Prospect. Saint James Hospital was just up the block. 

When Saint James shuttered its doors in 2008, it left the community’s high number of uninsured residents without access to any primary care services.

Then, last summer, Irizarry and a team of partners got approval to fill the void by opening a Federally Qualified Health Center. They decided to call it Saint James Health.

FQHCs have been a staple of low-income communities across the country for over 30 years now. Their mission is to serve Medicaid and uninsured patients that other doctors won't see.

But at the same time the effects of another change in health care rippled through the neighborhood: the Affordable Care Act dramatically increased the number of people covered by Medicaid. This has put the federal centers in a tough financial spot. Not only are there fewer uninsured to serve but also more primary care doctors have stepped in to compete with centers for new Medicaid patients.

“I’ve been in practice 35 years, and only in the last few years did I start to take Medicaid,” says Dr. Lawrence Armenti, a self-described old-school physician in the Ironbound. He still makes house calls.

“Especially some of my patients who were paying me cash before, and now they have insurance. And so I felt compelled to say ‘Ok, I’ll take your insurance,’” he said.

With another well-funded competitor, Newark Community Health Centers, planning to move in, it’s an uphill battle for a new FQHC like Saint James Health to survive in a post-Obamacare world.

Still, Irizarry remained confident. To offset a dip in their once-traditional patients, she's looking to attract those with commercial insurance. 

“We created a five-star facility. It’s a beautiful place. We give healthcare to anybody that needs it,” she said.