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December 21, 2023 | Volume 27, No. 10 | Archives
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The Power of Love — The HCH Community's Greatest Advocacy Tool
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| In This Issue:
- Homeless Persons' Memorial Day 2023
- FY 2024 Budget Update and Legislative Bright Spots
- The Administration issued Human Rights Proclamation, guidance and advisories in December
- ICYMI: HUD Announcements
- Medicaid Unwinding: New Rule Pressures States to Comply as 12.5 Million Kicked off the Rolls
- A Closer Look: The Power of Love — The HCH Community’s Greatest Advocacy Tool
- Highlight: 600,000 North Carolinians added to Medicaid Rolls
- Confronting Racist Roots in Health Care
- What We’re Reading (and Watching)
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| Homeless Persons' Memorial Day 2023
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NHCHC CEO Bobby Watts and NCH Executive Director Donald Whitehead will speak, along with Reverend Dr. Elizabeth Theoharis from the Poor People's Campaign; Warren Magee, NCAB Steering Committee member and Chair of the Consumer Advisory Board at Boston Health Care for the Homeless; Dr. Catherine Crosland, Director of Homeless Outreach Development at Unity Health Care in Washington, D.C.; and Madalyn Karban, Bhavana Akula, and Ishaan Akula from NCH's National Youth Division, Bring America Home NOW.
The program will also feature art by artist and advocate Tammy De Grouchy Grubbs and an original spoken word performance from Charlotte A. Garner, Regional Representative, NCAB Board Steering Committee, Chair of the Ellen Dailey Advocacy Committee, and Chair of the Healthcare for the Homeless Houston Change Committee.
If your community is hosting a memorial, please register your event here.
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| FY2024 Budget and Legislative Bright Spots
Congress has recessed for the holidays, leaving uncertainty about the full-year appropriation bills funding, as the first government spending deadline approaches on Jan. 19. The stopgap continuing resolution Congress passed in November, funded some government agencies and programs through Jan. 19 and Feb. 2. Republicans and Democrats have reached a stalemate over the FY2024 overall spending differing widely on funding levels for each appropriation bill. House Republicans have been unwilling to stick to the debt ceiling agreement for FY 2024 funding and instead are demanding 9.4% more cuts across the board for domestic programs. Meanwhile, Democrats have been clear that Congress needs to negotiate based on the topline numbers agreed to in the $1.59 trillion debt agreement, including the $59 billion additional funding for non-discretionary programs.
This is not the only stalemate that has advocates concerned. Much of the focus in the last few weeks, has been on advancing immigration border policy in exchange for Ukraine-Israel funding. House Republicans are holding Israel-Ukraine funding hostage in return for stringent border security policy for asylum seekers. It is unclear what kind of concessions Democrats and President Biden might make to secure funding for Ukraine and Israel.
What happens next: With little time between their return from recess and the first government funding deadline, and no agreement on spending limits, Congress might be heading toward another shutdown. Speaker Johnson wrote in a dear colleague letter that he intends to introduce a change-date full-year continuing resolution (CR) if no agreement is reached on the full-year appropriations bills. This prompted U.S. Senator Patty Murray (D-WA) to criticize Speaker Johnson’s proposal. In a fact sheet outlining the consequences of this approach, Senator Murray pointed out that a full-year CR will cut off access to primary healthcare services for millions of Americans, including funding for Community Health Centers where 30 million people receive care, cut federal housing assistance for nearly 700,000 households — pushing many of them toward homelessness, and produce nearly 3,000 fewer units of new affordable housing.
Legislative Bright Spots: Congress advances the SUPPORT ACT, the Lower Costs, More Transparency ACT, and Modernizing Opioid Treatment Access Act (MOTAA). While foreign funding, border security policy, and negotiations over government funding have all stalled, there is some movement on important health care legislation.
- SUPPORT ACT (H.R. 5431 and S. 3393): The Senate’s Committee on Health, Education, Labor, and Pensions (HELP) re-authorized the SUPPORT ACT in a bipartisan agreement. The bill addresses the national opioid crisis and authorizes funding for programs that provide for opioid disorder, prevention, and treatment. Explore more in NHCHC's factsheet about how the opioid epidemic affects the homeless population.
- Lower Costs, More Transparency ACT (H.R. 5378). The House of Representatives advanced H.R. 5378 with significant bipartisan support authorizing $4.4 Billion per year through 2025 for Community Health Centers. Now the bill heads to bicameral negotiations for a final vote before funding expires on Jan. 19. Note that the Senate version of the bill, the Bipartisan Primary Care and Workforce Act (S. 2840), set funding levels at $5.8 Billion per year over three years. We will be watching closely what the final numbers look like, after the two bills are reconciled. Follow the National Association for Community Health Center’s advocacy actions at the Health Center Advocacy Network to continue pushing for maximum funding to be included in the final bill.
- Modernizing Opioid Treatment Access Act (MOTAA) (H.R. 1359 and S. 644) passed the Senate on Dec. 12. MOTAA would expand access to methadone to treat opioid use disorder (OUD). Important to the HCH community, licensed doctors can electronically prescribe methadone for unsupervised use by patients, and patients can pick up methadone at pharmacies. Here is a good primer on how this legislation would improve access to treatment and fact-check those opposing the bill.
Related reading:
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| Take Action on Congress
Even though Congress is on recess during the holiday break, returning Jan. 8, this is a great time to reach out to your representatives' offices and build a stronger relationship with them. Here are some things you can advocate for during your meetings:
- Schedule site visits for your program so your representative learns first-hand how your programs support their constituents and your patients.
- Talk to your representative about the importance of preserving and increasing funding for opioid disorder, prevention, and treatment programs.
- Do you have any patient stories you can share? Share them. Bring your client stories and their humanity into the conversation.
- If your patients are willing, offer them the opportunity to share their stories about how these programs have supported them.
- Urge your representative to negotiate the highest multi-year funding for Community Health Centers. You, better than anyone, know how critical this funding is to saving lives.
- Ask your representative to fund housing vouchers for people experiencing homelessness.
- Thank your representative for taking time to meet with you and learn about your program. Offer to be a resource for them.
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| Biden Administration Issues Human Rights Proclamation, Guidance, Advisories
Naloxone access: U.S. Department of Health and Human Services (HHS), the U.S. Department of Housing and Urban Development (HUD), and the White House Office of National Drug Control Policy (ONDCP) issued a joint letter calling on public health departments and health care systems to partner with the affordable housing community and expand access to Naloxone (also known as Narcan).
Medicaid waivers: The Centers for Medicare and Medicaid Services (CMS) issued guidance on health-related social needs, clarifying which Medicaid authorities are eligible to cover the wide range of supportive services (e.g., medical respite care, tenancy support services, etc.) This helpful chart serves as a supplementary guide. Importantly, medical respite care is clearly identified as appropriate for inclusion in state 1115 demonstration waivers.
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| ICYMI: HUD Announcements
2023 Point in Time Count report released: HUD released the 2023 Annual Homelessness Assessment Report (AHAR) Point In Time (PIT) Estimates of Homelessness in the U.S. On a single night in 2023, 643,100 people were counted as experiencing homelessness. This represents a 12% increase in homelessness broadly, and a 48% increase in unsheltered people specifically. Increases are largely due to ending federal eviction protection and pandemic-related funding as well as rising costs of housing. While those who identify as Black continue to experience homelessness at three times the rate of their proportion in the general population (37% v. 13%), those who identify as Asian saw a 40% increase in homelessness and those who identify as Hispanic/Latin(a)(o)(x) saw a 28% increase. The injustice of racial disparities among communities overrepresented persists in alarming numbers.
Read the joint statement by the National Alliance to End Homelessness (NAEH), the National Low Income Housing Coalition (NLIHC) and the Center on Budget Policy Priorities (CBPP).
Additional Resources:
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| Medicaid Unwinding: New Rule Pressures States to Comply as 12.5 Million Kicked Off Rolls
The Centers for Medicare and Medicaid Services issued a new rule (effective Dec. 6) that would take federal funding away for states that fail to comply with federal Medicaid policies. Under the Consolidated Appropriations Act of 2023 (CAA), Congress gave CMS authority to ensure states complied with federal requirements and monthly reporting. As of Dec. 20, states have disenrolled 12.5 million people amid chaos and confusion. CMS is aiming to bring the unwinding process under control and penalize non-compliant states, even as they proceed with Medicaid disenrollments. Under the new rule states must create and follow corrective action plans (CAPs), may be ordered to pause some or all procedural enrollments and will be subject to cuts in their federal share of Medicaid budgets, up to 1 percentage point.
Additional reading:
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| The Power of Love — The HCH Community's Greatest Advocacy Tool
By Barbara DiPietro, PhD, Senior Director of Policy
“If all public policy was created in the spirit of love, we would not have to worry about unemployment, homelessness, schools failing to teach children, or addiction.”
— bell hooks, All About Love (2001)
Especially challenging times are upon us. Next year will be a difficult one for public policy due to the super-charged political environment and the upcoming elections in a polarized society coupled with the high levels of burnout and moral injury experienced by many providing health and human services to people experiencing homelessness.
Advocacy counters burnout. Advocacy may be what saves us! A recent study on burnout found that advocacy serves as a counterbalance to burnout. The conclusion states: “Policy-level interventions which increase funding to safety-net healthcare systems to bolster existing resources and staffing, create peer-support and wellness programs, and support advocacy efforts may mitigate burnout.” When we advocate, we tell our truth and we share our power. We engage with policymakers so they do their job to advance structural solutions to our problems. Not only is this a fundamental aspect of democracy, it’s also a matter of justice. If we are not advocating for our public policies to reflect our values, who will? Our voice has never been more important.
“Never forget that justice is what love looks like in public.”
— Dr. Cornel West
HCH is Love. The capacity for love in the HCH Community is boundless. The act of providing health care enables some of the most intimate—and sacred—connections to other human beings. But our love goes beyond simply providing care: One of the core tenants to this work is the belief in the inherent dignity and value of human beings. Our community experiences burn out and moral injury because we care, because we love—and because we know it doesn’t have to be like this. We see how homelessness and suffering are preventable, yet our policymakers continue to advance policies that increase poverty, illness, and homelessness over constructive solutions. Yes, our heart and our spirit aches with the wrongness of it all. However, the genuine love among us in the HCH community—people experiencing homelessness, clinicians and other service providers, administrators, advocates – keeps us strong and determined.
Love is our community’s greatest advocacy tool. Our love for each other and our sense of justice are strongly intertwined. Advancing human rights and demanding respect and dignity for others are core values—rooted in love—that drive our direct care services as well as our commitment to advocacy. It is also our love that uniquely positions us to engage policymakers (even those directly opposed to our values) and facilitate transformative change. Our love bonds us as a community and becomes our key strength—as well as our greatest advocacy tool. There is no backing down from love.
“Love is the only force capable of transforming an enemy into a friend.”
— Dr. Martin Luther King, Jr.
For this holiday season, I hope you are able to rest and rejuvenate—and prepare to put Love into Action in 2024 with your advocacy.
Best wishes for a healthy holiday,
Barbara
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| Highlight: 600,000 North Carolinians Added to Medicaid Rolls
North Carolina became the 40th state (41 with District of Colombia) to opt in to the expanded Medicaid program, enabling 600,000 eligible Carolinians to receive health care and 300,000 with limited health care to automatically receive full health care coverage. Efforts are underway for Medicaid advocates and community health centers to hit the ground running to register eligible North Carolinians. It has not been easy for North Carolina to get to this point. After Gov. Roy Cooper signed the Medicaid Expansion program into law, the program had to wait for implementation until a budget deal was passed. Governor Cooper celebrated what the change means for North Carolinians: “After years of fighting for high-quality health care for every person in our state, today’s launch of Medicaid expansion means more than 600,000 North Carolinians can now access the care they need to stay healthier, treat sickness earlier, and have the peace of mind knowing health care is within their reach."
Yes, But: While North Carolina’s low-income households now have access to life-saving health care, 10 non-expansion states continue to deny their residents the health and economic benefits of Medicaid Expansion—leaving 2 million people to be uninsured in the coverage gap and sacrificing billions of dollars.
Additional Reading:
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| Confronting Racist Roots in Health Care
In our November Mobilizer issue, we highlighted the Race And Racial Perceptions Shape Burden Tolerance For Medicaid And SNAP study. Racist attitudes and practices across institutions, including in health care, are rooted in the legacy of systemic racism. These practices determine who receives care and directly shapes the quality of services. In an effort to dismantle racial health inequities, some institutions are confronting their racist past and acknowledging the role racism played in perpetuating anti-Blackness and white supremacist thinking. In a recently published essay, the New England Journal of Medicine (NEJM), the world’s oldest published medical journal, acknowledged its ties to and complicity with slavery. NEJM recognized that it gave a platform to white supremacist thought perpetuating and fueling the health disparities Black Americans face today. While the journal did not announce specific steps to address racial biases, it has plans to publish additional essays on Indigenous Americans, the eugenics movement, Nazi-era medicine, civil rights area articles, and gender bias.
Related reading:
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What We're Reading (and Watching)
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This publication and all HCH advocacy are funded by dues from Organizational Members of the Council and by private donations. Consider joining the Council to support this work.
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