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November 30, 2023 | Volume 27, No. 9| Archives
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'Pray for the Dead and Fight Like Hell for the Living!'
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| In This Issue:
- FY 2024 Budget: Where We Stand
- Administration Announcements
- Medicaid Redeterminations: 11 Million Kicked Off
- A Closer Look: “Pray for the Dead and Fight Like Hell for the Living!”
- New Studies Highlight Known Problems in American Health Care
- Single-Payer In the News
- Immigration in the News
- Substance Use Disorder In the News
- Member Advocacy Highlight: WA Governor Inslee Promotes Housing and Health Care in Yakima
- What We’re Reading (and Watching)
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| FY2024 Budget — Where We Stand
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The U.S. House of Representatives elected conservative Republican Michael Johnson (of Louisiana) as the new House Speaker, who then ushered forward a temporary stop-gap budget bill that would prevent a government shutdown. House Speaker Johnson’s short-term “laddered” continuing resolution, which splits the federal budget into two phases of authorization, was signed into law by President Biden.
The first phase extends funding for the Departments of Agriculture, Veterans Affairs, and Transportation-Housing and Urban Development (T-HUD) through Jan. 19, which includes housing vouchers, SNAP, and the Women Infants and Children (WIC) program.
The second phase extends funding for the Departments of Health and Human Services, Defense, and Justice through Feb. 2, which includes funding for community health centers and public health programs.
What happens next? The House of Representatives is working to pass all 12 annual appropriation bills. Come January, the House and the Senate will need to agree on spending levels for Fiscal Year 2024 amid intense differences in approaches to the budget process, before they begin deliberations for the FY 2025 budget. Both chambers will fight over President Biden’s supplemental budget request to supply aid to Ukraine, Israel, and Taiwan, funding for the U.S-Mexico border, and immigration border policy.
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Take Action on Congress: Reach out to your representatives and ask that Congress preserve and increase funding for domestic priorities such as Community Health Centers and public health programs, nutrition services, safety-net programs like SNAP and Medicaid, and housing programs for people experiencing homelessness.
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| Administration Announcements
The Administration announced policy initiatives and funding opportunities in the last month:
President Biden signed two Executive Orders:
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| Medicaid Redeterminations — 11 Million Kicked Off
Since our October Mobilizer, 2 million more people have been disenrolled from Medicaid — now totaling 11 million people nationwide. Unwinding has been chaotic for people across states, terminating insurance for sick and disabled people, kicking kids off health insurance, and forcing people into hourlong waits on the phone to verify eligibility. The number of people disenrolled and the percentage of people dropped off due to procedural enrollments varies widely across states. Across the nation, 75% of all disenrolled people had their coverage terminated due to procedural reasons (e.g., not responding to mailed letters), while only 30% of renewals were done through automatic renewal. Texas tops the list of states with the highest disenrollment at 65%. On the low end, Illinois has managed to keep disenrollment at 11%.
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New Civil Rights Study on Medicaid Unwinding: A new report from the NAACP (and others) highlights Medicaid Unwinding’s impact on communities of color and asks for “decisive action” to dramatically reduce procedural enrollments through two strategies:
1. States should maximize the number of people whose administrative burdens are eliminated by renewing eligibility based on matches with reliable data sources.
2. States must shift administrative burdens from families to trained staff who can do the work needed for renewal.
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| 'Pray for the Dead and Fight Like Hell for the Living'
By Barbara DiPietro, PhD, Senior Director of Policy
When Mother Jones — a fierce labor and union organizer — said this in 1902 she was fighting to improve the lives of miners and silk mill workers. Now, more than 120 years later, I borrow her words for our current struggle to end homelessness.
Pray for the Dead...
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| "Let us remember those who suffered and died on the streets this year. Remembering they had hopes, dreams, and stories. They were our brothers and sisters in the community. They were not voiceless but a voice without a home. Let us honor their memory on this day." — Deidre Young, Chair, NCAB
"Folks experiencing homelessness are often not acknowledged as members of society or the community, and when we formally gather in memory of someone who had been homeless, it shows those who are living that they are, indeed, valued members of our community.” — Lynea Seiberlich-Wheeler, LCSW; Chair, Clinicians Network Steering Committee
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| ... And Fight Like Hell for the Living
Housing can be the difference between life and death, but housing remains out of reach for many. Health care continues to be inaccessible, wages are deplorably low, disability benefits aren’t sufficient, and many communities have invested in criminalizing homelessness instead of ending it. Hence, there is no shortage of news articles on homeless deaths like these from Anchorage and Maricopa County. Even TIME Magazine wrote about homeless mortality in West Virginia.
However, no one knows how many people experiencing homelessness die each year in the U.S. — the richest country in the history of the world.
Establishing a national estimate of homeless deaths — and the causes of these deaths — is necessary to understand the magnitude of the problem and invest targeted resources to prevent future deaths (ummm…more housing perhaps?). This is a justice issue, an advocacy issue, and a public health issue.
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| “Without knowing the who, where, when, why, and how people experiencing homelessness are dying, any efforts to prevent illness and promote health cannot truly be evidence-based. Any death among someone experiencing homelessness is the result of intentional, systematic, and structural violence.” — Ashley Meehan, Lead Coordinator, NHCHC Homeless Mortality Working Group
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| This is why we’ve made collecting homeless mortality data one of our policy priorities. More communities now collect this type of data and make it available publicly. Examples include:
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| Homeless Mortality Resources
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| Researchers are also publishing more information about homeless deaths and factors that increase the likelihood of death — like encampment sweeps. Here are a few examples:
I’ve spoken before of Murder #2 — deaths from Indirect Policy Violence. Talking about collecting data sounds dry — but these are LIVES that are being lost and we don’t even have a proper count of them. I’m angry and sad that our society doesn’t do right by those who are still living OR by those who have died. And that ain’t right! Yes, Mother Jones, we’ll continue Praying for the Dead AND Fighting Like Hell for the Living. One piece of that struggle is to at least be able to answer the question: Who died without a home this year?
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| New Studies Highlight Known Problems in Health Care
- Health Care Affordability: Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer study by the Commonwealth Fund found that the health care system is leaving most Americans poor, in debt, or unable to access quality care. Most people on Medicare are choosing to skip or delay health care because of cost and difficulty paying for food, utility, and rent. For patients experiencing homelessness, particularly in BIPOC communities, delayed care can mean the difference between life and death
- Structural Racism in Health: Race And Racial Perceptions Shape Burden Tolerance For Medicaid And SNAP study that evaluated the role that racial attitudes and resentment play in public acceptance of administrative burdens on Medicaid and SNAP (like continuous coverage or work requirements) reveals that: “non-Hispanic White respondents with higher levels of racial resentment were more supportive of policies that would create burden.” Administrative burdens are inherently harmful to BIPOC communities, increasing barriers to access food, health care, and housing.
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| Single Payer in the News
The American Medical Association (AMA) House of Delegates will vote on a resolution to show support for single-payer health care later this month. The resolution in support of single payer is brought forward by the delegation of New England practicing doctors. Even though the passing of the resolution doesn’t mean the end to the AMA’s neutrality stance on single payer, it softens their long-held opposition to this policy.
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| Immigration in the News
The migrant border crisis has re-ignited the debate on responding to the U.S. Mexico border crisis, sheltering migrants, and the impact of immigration on providing health care in immigrant communities. Immigrants, particularly those undocumented, have become targets under border policies, deportation, and family separation. The 2023 Survey of Immigrants highlights disparities in health coverage and access to medical care among immigrants, especially among undocumented immigrants who remain ineligible for most federal programs. Fear of accessing public services, inability to pay for private insurance, and enrollment barriers make accessing affordable health care out of reach for immigrant communities. Importantly, health centers continue to deliver care regardless of documentation status, insurance status, or ability to pay.
Related reading:
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| Substance Use Disorder in the News
- OnPoint Saves Lives: The Overdose Prevention Centers, Crime, and Disorder Report indicates that Overdose Prevention Centers (OPCs) don’t increase crime. The report shows that New York City’s two OPCs and 17 syringe service programs reversed over 1,000 overdose deaths. The study also shows a 8.3% decrease in drug and weapons arrests, 69.5% decrease in calls about homelessness, and 28.5% decrease in crime-related calls.
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- Community Health Center Considerations: Take a look at our Health Centers and Syringe Services Programs issue brief on considerations and best practices for how community health centers can embed syringe service programs (SSPs) under HRSA rules. Communities of color are overrepresented in overdose deaths, even though they experience substance disorder at the same rate as other racial groups.
- Racial and ethnic disparities in buprenorphine users persist: A new study finds persistent racial and ethnic disparities about who is prescribed buprenorphine. The study found that Black Medicare disability beneficiaries had lower rates of prescription than their White counterparts. You may recall our issue brief on the importance of buprenorphine as a critical approach to providing access to Medication Assisted Treatment (MAT) to the HCH community.
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What You Can Do - Share this study with your local/state Department of Public Health, your Town/City Manager, Mayor, and local/state policymakers.
- Ask your local Board of Health to share the public rates of ODs in your community, disaggregated by race and ethnicity.
- Recommend your public health officials learn more about the two NYC programs and dedicate funding to establish OCPs in your community—and the hundreds operating worldwide.
- Support state/local measures to establish a pilot safe consumption program in your community.
- Advocate that any overdose-prevention efforts include the voices and expertise of people in recovery.
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| Member Advocacy Highlight: WA Governor Inslee Promotes Housing and Health Care in Yakima
On Oct. 27, Gov. Jay Inslee toured the Rhonda Hauff Community Resource Center and the Neighborhood Apartments on North Street in Yakima, Wash. Gov. Inslee spoke to a young family living in one of the supportive housing units and promoted the importance of supportive housing and health care and support services.
“This (program) does two things,” Inslee said. “The obvious one is providing housing, safe, hygienic housing. The one that’s just as important is health care; it’s providing those services to these folks so they get back on their feet. That means helping them with their chemical addiction challenges, their mental health challenges, and their vocational challenges."
The Rhonda Hauff Community Center, a 40-unit supportive housing program located in a converted grocery store, now houses residents struggling with addiction and chronic homelessness. The Neighborhood Apartments on North First Street, a former motel, was converted to 54 units of supportive housing, and four units of medical respite care, where people can transition to PSH after recovery.
“Nobody wants to see people living on the streets,” YNHS’s chief executive officer, Rhonda Hauff, said during Inslee’s visit. “We all share that goal, and the solution to homelessness is housing.”
Congratulations, Rhonda and staff, for your amazing work!
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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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