Let's Build Back Gratitude

In this Issue:

Build Back Better (Mediocre?) Delayed…among Other Priorities
Advocacy Continues Around Substance Use Disorder Treatment
New COVID-19 Vaccine Mandates
USICH Strategic Plan Comments
Honor Homeless Persons' Memorial Day on December 21
What We’re Reading
BONUS THANKSGIVING TAKE ACTION: Practice Gratitude
Land Acknowledgement

Build Back Better (Mediocre?) Delayed...Among Other Priorities

In the last month, Congress has re-drafted yet another scaled-back bill modeled off President Biden’s Build Back Better Framework. The bill is expected to come to a vote in the House before lawmakers leave for Thanksgiving and then negotiations will continue in the Senate. Thus, our advocacy continues to include the most robust health care expansions possible (see more below). While this month the long-awaited infrastructure bill (text) was finally signed into law, Congress remains behind on crafting Fiscal Year 2022 budget bills ahead of the December 15th deadline and action on other important issues to the HCH community such as voting rights and mental health/addiction (note this includes the MAT Act—see below) are on the table but have seen no substantive progress. Stay tuned to future Mobilizers for how to Take Action.

The National Health Care for the Homeless Council calls on Congress to pass the Build Back Better health expansion proposals immediately and calls on the HCH community to take action by calling or writing your Representatives and telling them they must include ALL the proposed health care expansions in any final Build Back Better bill! The health and lives of so many are in the hands of our policymakers, and as Congress debates the finer point of incremental changes, our patients continue to die on the streets. Note: These action alerts include easy-to-use templates and scripts, but we suggest customizing them using our messaging below and stories from your locality.

Talking Points on Health Care Expansions in Build Back Better

TOP LINE MESSAGE: Congress can and must do both the expansions of Medicaid and Medicare. All of the proposed health care expansion policies are greatly needed and long overdue. Cutting the health proposals down and pitting them against each other for inclusion in a final bill is unconscionable when so many U.S. families already lack basic care and the U.S. has a globally shameful health care reputation.

1. EXPANDING MEDICARE TO INCLUDE DENTAL, VISION, AND HEARING SERVICES

What it would look like: Current proposals in the U.S House’s initial draft legislation phase in vision, hearing, and dental benefits in 2022, 2023, and 2028 (7 years from now!), respectively. Biden’s latest Build Back Better Framework released last month cuts the expanded benefits down further to just hearing (final legislation has not yet been released).

Why it matters: Low-income people experience many adverse health outcomes because of limited access to dental, vision, and hearing services and insurance coverage. Not only do dental, hearing, and eye issues create significant barriers to daily functioning, employment, and education, but they often lead to intense physical and emotional distress. Additionally, dental and other sensory issues are an expensive and common cause of ER visits for people experiencing homelessness. Access to more comprehensive services under Medicare would avoid adverse health outcomes, improve health and wellness, and reduce health care expenses.

HCH Dentist Testimony: “Tooth decay and gum disease are preventable, and routine dental exams and hygiene visits are an important part of preventive care. Many of our patients have extensive needs because they lack access to care for prolonged periods across their lifespans. Patients often express that there is nowhere to go and no way to pay for their treatment. They feel punted around and that is inexcusable.” – Parita Patel, DMD, MPH, and Dental Director at Health Care for the Homeless Baltimore

2. LOWERING THE MEDICARE ELIGIBILITY AGE TO 60

What it would look like: While this provision is not included in the U.S. House’s latest reconciliation bill (and advocacy for inclusion must continue!), a separate piece of legislation introduced by Rep. Jayapal (D-WA) would lower the eligibility age from 65 to 60 and take effect in 2023. Biden’s latest Build Back Better Framework released last month does not include this provision.

Why it matters: Lowering the age of Medicare eligibility would give more adults critical access to quality and affordable health care, which is proven more cost-effective than other insurers. In the HCH Community, this policy would benefit the nearly 80,000 patients between the ages of 60-64 served at HCH programs in 2020. Access to the high-quality and low-cost Medicare program would also improve mortality rates, an important issue for people experiencing homelessness who die much younger than their housed counterparts.

HCH Physician Testimony: “Because our patients experiencing homelessness often die in their 50s they never get access to the coverage Medicare offers. Lowering the eligibility age will help more of my patients, who are in desperate need of better coverage, live healthier lives—and hopefully longer lives. This can’t wait.” – Jeffrey Norris, MD, Chief Medical Officer at Father Joe’s Village in San Diego

3. PROVIDING A HEALTH INSURANCE OPTION IN STATES THAT DID NOT EXPAND MEDICAID

What it would look like: Current proposals in the U.S House’s initial draft legislation provide tax credits in the marketplace for individuals under the poverty line through 2024 and create a federal lookalike Medicaid program thereafter. Biden’s latest Build Back Better Framework released last month includes the marketplace tax credits through 2025, and nothing thereafter.

Why it matters: Medicaid coverage prevents evictions, improves health, and reduces mortality. This policy would improve access to care for more than 120,000 patients in the HCH community who remain uninsured. Overall, 85% of total HCH patients are under the federal poverty line, so should be eligible for Medicaid.

HCH Consumer Testimony: “It’s fundamentally irresponsible for the government to not provide insurance options for everyone. Here in Florida I see how Medicaid saves lives and also how uninsured folks always end up in the ER and in debt. For me, there is no question that a lack of Medicaid expansion makes poverty and homelessness worse.” – David Peery, JD, NHCHC Board Member and Consumer Advocate in Miami

Advocacy Continues Around Substance Use Disorder Treatment

A roundtable discussion with invited guests and HCH staff and patients to discuss barriers to substance-use treatment.

Last month Health Care for the Homeless in Baltimore hosted a facility tour, a discussion with patients and providers, and a press conference with HHS Secretary Becerra (and other federal officials) to announce the new HHS Overdose Prevention Strategy (see a local news recap). As overdose deaths reach a record high of over 100,000 annually, our advocacy continues for broader changes, such as those included in the MAT Act, which eliminates the X-waiver requirement to prescribe buprenorphine. This legislation recently surpassed the mile-marker of 200 co-sponsors in the House.

Two Ways to Take Action on the MAT Act in under 5 minutes! 1) Organizations and individuals are invited to join the Council in signing on in support of the MAT Act. Thanks to our partners at End Substance Use Disorder for organizing this effort. And 2) check the list of over 200 co-sponsors on the bill in the House and contact us at rreed@nhchc.org if your representative isn’t on the list so we can ask them to join.

New Federal Rules on COVID-19 Vaccine Mandates

On November 4, the Biden Administration issued two rules to provide further guidance on the COVID-19 vaccine mandate announced in early September. One rule outlines the requirements for health care facilities, while the second rule outlines those for private employers with 100+ employees. See the Council’s new resource, The Biden Administration’s COVID-19 Vaccine Mandate: Frequently Asked Questions for the HCH Community. Learn more about these policy developments and emerging issues related to COVID-19 in the biweekly COVID-19 Flash Blast.

USICH Strategic Plan Comments

The U.S. Interagency Council on Homelessness is in the process of creating a new Federal Strategic Plan to Prevent and End Homelessness and they want input from individuals and organizations. Comments can be submitted online through Tuesday, November 30. Use this opportunity to illustrate the need for single-payer health care (or at least universal Medicaid eligibility), the importance of medical respite care, and the critical shortage of substance use treatment. Contact rreed@nhchc.org for templates and suggested talking points to use while crafting your letter.

Honor Homeless Persons' Memorial Day on December 21

On December 21, the first day of winter and the longest night of the year, we take part in Homeless Persons’ Memorial Day events. Unfortunately, 2021 marks 31 years of honoring those without homes who have passed away in our communities. Visit the HPMD landing page to find a social media toolkit and resources on creating a meaningful experience in your community.

What We're Reading

BONUS THANKSGIVING TAKE ACTION: Practice Gratitude

Reflecting on good things is key to improving health and quality of life at work, which allows us to work harder and more productively as advocates. As we approach our final December 2021 “gratitude” edition of the Mobilizer, let us know what you’re grateful for this year so we can feature it.

Share What You're Grateful For

Here are some things NHCHC staff are grateful for this year:

“As someone who has committed to a regular meditation practice, this past year I have been especially grateful for breath. It is so easy to overlook that most happy of exchanges of what I exhale and what the air that surrounds me freely gives in return. COVID brought home how this is one exchange we cannot take for granted.” – David Wunsch, Logistics and Change Management Specialist

“I’m incredibly grateful for vaccines – to keep my family safe, enabling us to be able to see a few more of our loved ones, and protect my community.” – Caitlin Synovec, Medical Respite Manager

“I’m grateful for my colleagues and their brilliance and humor!” – Lily Catalano, Clinical Manager

“I am grateful for a community of incredible, empathetic humans who help me feel sane while the world feels chaotic and confusing.” – Katherine Cavanaugh, Consumer Advocacy Manager

“I am grateful to have the ability to reconnect and play in my local sport leagues with my friends- and icy hot for post games.” – Hugo Aguas, Research Associate

“I am grateful for my son who is 19 months old who keeps me grounded and motivated! When I get discouraged or impatient in the work, he reminds me that I am working to create a more equitable health system for the next generation in hopes no one will experiences homelessness in the future.” – Courtney Pladsen, Director of Clinical and Quality Improvement

Land Acknowledgment:

The Mobilizer is written on the ancestral land of the Pakestikweya people (now known as Baltimore City, Maryland). We humbly offer gratitude and respect to the elders, past and present citizens of the Cedarville Band of the Piscataway Conoy, the Piscataway Indian Nation, and the Piscataway Conoy Tribe, all Algonquian Peoples.

Did you receive Mobilizer as a forwarded email or hear about it via social media? Register now to receive our action alerts each month!

Regina Reed, MPH
Health Policy Manager
National HCH Council
Baltimore, MD
rreed@nhchc.org
(443) 703-1337

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.