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July 25, 2024 | Volume 28, No. 6 | Archives
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The Urgent, Uncomfortable Issue We Need to Talk About
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| In This Issue:
- Scramble for Democratic Party Presidential Nominee
- FY2025 HHS Budget
- A Closer Look: The Urgent, Uncomfortable Issue We Need to Talk About
- Medicaid Unwinding: Over 24 Million Disenrolled
- Medicaid: Work Requirements
- SCOTUS: Overturning the Longstanding “Chevron Deference”
- Biden Administration Actions on Housing
- November 5 Election
- Biden Administration Actions on Worker Protections from Heat
- What (Else) We’re Reading
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| Biden Drops Out; Is Harris the New Nominee?
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| On Sunday, President Biden announced on social media he would step down from seeking re-election, throwing the 2024 presidential election into uncertain terrain. He has endorsed Vice President Kamala Harris and last night he addressed the nation to “pass the torch to a new generation.” These developments put a spotlight on the Democratic National Convention happening in Chicago starting Aug. 19 — just three weeks away — where a new candidate will be nominated.
Obviously this is a rapidly developing situation, so stay tuned to (credible) national news sources to keep up on what’s happening. By the time we send out the August issue of Mobilizer, a new Democratic Party nominee will have been named, and a new round of excitement will begin as we head into the Nov. 5 elections (see below for more information on voter registration).
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| On July 10, the House Appropriations Committee passed the FY25 Labor-HHS budget — cutting $8.5 billion from FY24 HHS levels by eliminating 57 programs and reducing funding for 48 programs. While HRSA’s health center program funding remains flat-funded, other reductions/eliminations are targeted to HRSA’s Ending the HIV Epidemic Initiative and Ryan White program, Title X/Family Planning and Healthy Start programs, as well as broadly barring funding for “divisive ideologies, like Critical Race Theory,” abortion, climate change, gun research, gender-affirming care, and other culture war issues.
- Harm Reduction: The Committee is concerned that SAMHSA has confused the normalization of illegal drug use with its mission to support prevention and recovery in relation to substance use disorder. The Committee continues to support the availability and provision of naloxone to reduce overdose deaths; however, the Committee provides no funding to support harm-reduction activities related to supporting the continued misuse of controlled substances. (p. 125)
- Screening, Brief Intervention, and Referral to Treatment: The Committee provides no funding for the Screening, Brief Intervention, and Referral to Treatment program. The Committee notes that SAMHSA has labeled the program as supporting ‘‘harm reduction’’ activities. The Committee further notes that following the decriminalization of drugs for personal use in Oregon in 2021, overdose deaths increased almost 50 percent. (p. 137)
The full Appropriations Committee is not likely to hear the HHS budget until Aug. 1, but we look to Democratic Senate leadership to counter the harmful cuts and policies the House Committee is likely to advance. Stay tuned for further developments here.
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| Take Action on Congress
If you haven’t already, schedule a site visit with your Congressional representatives during the August recess. This is a great time to show them the value of your work, impact to vulnerable people, and the vital importance of further investments in health care, housing, and support services. Emphasize the practical value of evidence-based harm reduction approaches to engage people in treatment.
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| The Urgent, Uncomfortable Issue We Need to Talk About
By Barbara DiPietro, Senior Director of Policy
There are two words that feel especially uncomfortable right now: Sanctioned Encampments.
This term means different things to different people — and can reference a wide range of approaches — but simply letting large numbers of people live outside is hardly a solution to homelessness, and it's an approach that has a high risk of devolving into actual health and safety hazards (both for the people who live there as well as the surrounding community). And if there’s no commitment to moving people into permanent housing, these spaces can continue to grow. These are genuine concerns, and advocates and service providers must carefully navigate the uncomfortable tension between advancing permanent housing and reducing the actual harms happening to unsheltered people right now.
Is there a way we can stabilize unsheltered people in the short-term, respect their right to dignity, deliver needed care AND continue to move them into permanent housing?
Our new issue brief speaks to just this combination of goals for sanctioned encampments, though we’re calling them Temporary Supported Communities, or TSCs. This term emphasizes the temporary nature of these spaces, the support needed to stabilize and move people to permanent housing, and the community that forms among those living together.
Many advocates have been working tirelessly for decades to increase the supply of affordable/supportive housing and to end the police-based encampment sweeps that cause so much harm to vulnerable people. But here’s the dilemma communities are facing: Absent permanent housing, if you don’t sweep an encampment, what SHOULD you do? Communities are increasingly experimenting with allowing unsheltered people to legally stay in public spaces — hence the term “sanctioned” encampment.
But here we are, and as more people are living in sanctioned encampments, the Health Care for the Homeless community is delivering more services in these spaces and learning what works well to support and stabilize a myriad of health care conditions. This work cannot occur in a vacuum, and it’s important that these spaces do not become permanent fixtures in our communities.
We interviewed health care providers and TSC residents in 13 communities and asked them what works well — and what doesn’t — in order to present a range of strategies communities can consider implementing to respond to immediate needs while continuing to move people into affordable/supportive housing.
The issue brief is organized around three goals, each focusing on vital practices:
- Increasing Safety, Security, and Greater Stability: Sleeping spaces, other basic needs, location, disability access, governance and rules, staff training, perimeter, and referral/entry/exit
- Expanding Connections to Care: Case management and benefit enrollment, health care services, outreach and support services, and harm reduction interventions
- Establishing Stronger Pathways to Permanent Housing: Housing case management and additional housing strategies
This has to be a two-track solution. We must focus on reducing the harms of living unsheltered AND moving people into housing. It is deeply troubling that this is where we are right now because it feels like such an epic failure of our housing policies that we are forced into devising approaches to better support people living outside, rather than in housing. It is also a legitimate criticism that every minute and dollar spent planning, implementing and running a TSC is a minute and dollar NOT spent on permanent housing units.
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| We have to talk about how to meet this urgent, uncomfortable new reality and reduce the harms currently being done to unsheltered people. Our new brief on Temporary Supported Communities attempts to give the HCH Community and other stakeholders options for supporting this conversation and advancing a two-track solution.
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Medicaid Unwinding: Over 24 Million Now Disenrolled
As of July 12, over 24 million people have been disenrolled from Medicaid since the unwinding period started in March 2023, with 69% of all people losing coverage for procedural reasons (such as not returning paperwork). At the highest end, 93% of those losing coverage in Nevada were due to procedural reasons (Utah coming close behind at 92%) — with Maine at the lowest end, with 24% being disenrolled for administrative reasons not related to actual eligibility.
New JAMA research shows disenrollment impacts patients at Community Health Centers, with nearly 17% of patients newly uninsured. Of key concern, however, is the finding that American Indian and Alaska Native, Black or African American, and Hispanic or Latino patients had higher odds of being disenrolled. Further, patients with more frequent prior visits, and diagnoses of HIV/AIDS, mental health needs, or substance use conditions were also more likely to be disenrolled. This points to stark equity problems that need to be addressed at the state level.
Related reading:
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| Take Action
- Advocate with your state’s Medicaid director against procedural disenrollments. Point out the racial disparities that disenrollments are having, as well as disproportionate impact to people with HIV and behavioral health issues.
- Use our policy brief to take further actions, both internal to your program and external in your community.
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| Medicaid: Work Requirements
Yes, one state currently has a work requirement in its Medicaid program — Georgia. While the Biden Administration swiftly repealed most of the work requirements pursued/enacted under the Trump Administration, Georgia won a federal court battle to continue its program. In order to qualify for health care, recipients must work 80 hours a month — with no exceptions.
While it claimed it would cover 25,000 people, it currently has only 4,300 people enrolled. Plagued by the same reasons that work requirements previously were found to be inefficient, expensive, and harmful, Georgia is now doubling down on its one-year-old program rather than just doing a straight Medicaid expansion (like decent states do). Fortunately, a judge just refused to extend the timeframe for this failed experiment and it is slated to end in September 2025.
This is your reminder that the November 5 election will determine whether national work requirements will be added into the Medicaid program (Project 2025, page 468).
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| SCOTUS: Overturning the Longstanding 'Chevron Defense'
On June 28, the Supreme Court overturned 40 years of legal precedent in a case that has significant implications for public health and the role of executive agencies when issuing regulations. Known as the “Chevron deference,” SCOTUS previously required federal courts to defer to reasonable agency decisions where federal law is silent or unclear. Now, after ruling on Loper Bright Enterprises v. Raimondo, courts will not have to accept agency expertise in their review of challenged regulations.
This could have significant implications for public health, and lead to many more legal challenges to rules that the Administration issues that are important for the HCH Community. This could include CMS rules on Medicaid eligibility and waivers, HUD rules on fair housing, or whether HHS can regulate nursing home staffing levels—just to name a few issues.
It will take some time for the effects of this decision to take hold, but experts are anticipating many more lawsuits that will delay (or prohibit) the implementation of laws passed by Congress.
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| Biden Administration Actions on Housing
President Biden is calling on Congress to pass legislation presenting corporate landlords with a basic choice: either cap rent increases on existing units to no more than 5% or lose valuable federal tax breaks (see fact sheet here and a statement from our partners at the National Low Income Housing Coalition). The Administration’s Housing Supply Action Plan would also reform zoning and preserve more housing units. This action comes as new reports show corporate landlords are earning record high profits after raising rents and fees.
Note: This would require an act of Congress, so any significant changes are unlikely in the short term — but it’s a good issue to raise in discussions with Congress members about how they can help prevent/end homelessness.
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| Nov. 5 Election
You might have heard, but there’s a Big Event coming up on November 5 that will determine the direction of many programs and policies vital to the HCH Community, such as:
- Repealing the Medicaid expansion
- Adding a national work requirement to Medicaid
- Privatizing Medicare
- Restrictions to family planning services and abortion care
- Restrictions or prohibitions on gender-affirming care
- Diminished role of public health
- Institutionalizing those who are unhoused, and those with mental health and substance use disorders
- Further restrictions on immigration and immigrant benefits
While President Biden has since stepped down from his re-election campaign, his Administration has advanced very different health care policies than former President Trump. Here’s a great comparison between the two Administrations on health care policy. To better understand Republican policy intentions, here’s a link to Project 2025, the policy agenda affiliated with Trump’s team. For something shorter, here’s the 2024 Republican Party Platform, which promises to “stop woke and weaponized government,” “defend religious liberty,” “end left-wing gender insanity,” and “stop the migrant invasion” (among many other things). Happy reading.
An important note: Violence has no place in a civil society. Political violence has no place in a democracy. The July 13 assassination attempt on former President Trump is horrifying and the National HCH Council condemns this act of violence. We emphasize the critical need for nonviolent dialogue and strong advocacy actions as we advance constructive policy changes that improve the health care system and end the public health crisis of homelessness. We will only achieve our goals through Love, not violence.
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| Take Action
Health centers are encouraged to conduct voter registration activities! Help those you serve get registered to vote, and then plan activities to ensure robust turnout on Election Day. Here are resources to help from our partners:
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Coming Soon: HCH2025 Call for Abstracts
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| The Call for Abstracts for the 2025 National Health Care for the Homeless Conference & Policy Symposium, slated for May 12-15 in Baltimore, will open next week, so be sure to keep an eye on your inbox! The theme for 2025 is Building Communities.
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What (Else) We're Reading
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Did you receive Mobilizer as a forwarded email or hear about it via social media?
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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 or donating to support this work.
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