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August 30, 2024 | Volume 28, No. 7 | Archives
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1 in 10 Unhoused People Vote —
That's a Problem
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| In This Issue:
- Harris-Walz are the Democratic Nominees
- Biden-Harris Administration Announcements
- FY25 Budget/Congress
- A CLOSER LOOK: 1 in 10 Unhoused People Vote — That's a Problem
- 2025 National HCH Conference: Proposals Due September 6!
- Medicaid Unwinding: Nearly 25 Million Now Disenrolled
- SUD in the News: Opioid Settlement Funds
- More on Encampment Sweeps: The Injustice Continues
- Shocking New Research on Incarceration
- What (Else) We’re Reading
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| Harris-Walz Are the Democratic Nominees
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| Since President Biden stepped down from seeking re-election on July 21 and endorsed Vice President Kamala Harris, it has been a whirlwind of activity. A wide range of Democratic leaders quickly coalesced behind her candidacy, she chose Minnesota Governor Tim Walz as her running mate, and both were nominated as the Democratic Party candidates at the Democratic National Convention last week. The trajectory of the election has now turned to make the race for the Presidency much closer than it was a month ago.
On Aug. 16, VP Harris issued a plan for her first 100 days in office, which called for the following:
- Housing: Funding and tax incentives to create 3 million new housing units, lowering rent by preventing price fixing and gouging, and providing downpayment support for first-time homeowners.
- Health care: Lowering the cost of prescription drugs by capping expenses for everyone (not just seniors), fighting price gouging by the pharmaceutical industry, and canceling more medical debt.
- Food: Banning price gouging on food and imposing new penalties on companies that exploit consumers.
- Family support: Restoring the Child Tax Credit by providing middle- and low-income families up to $3,600 per child, creating a new $6,000 tax credit for the first year of a child’s life, reducing taxes for frontline workers and those with premium payments for marketplace insurance plans.
Gov. Walz has previously tackled health care issues in Minnesota. He’s banned medical providers from withholding care due to unpaid debt, set limits on prescription drug pricing, capped insulin prices at $35, expanded health coverage for low-income people, codified abortion rights in state law, and legalized marijuana. These issues align well with VP Harris’s positions — with both candidates viewing health care as a human right. Regrettably — but perhaps pragmatically — Harris has pulled back on her position on Medicare for All, which she strongly supported previously.
Stay tuned for more to come on the race for the Presidency — and see more about voter registration in the Closer Look section!
Related reading:
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| Biden-Harris Administration Announcements
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| The Administration has been busy issuing a flurry of new rules, announcements, and proposals:
Coding for homelessness in hospitals: This month, the Centers for Medicare & Medicaid Services (CMS) issued the final rules for the FY2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). While these are not normally items covered in The Mobilizer, the rules contain a provision to recognize the higher costs that hospitals incur when they provide hospital services for individuals experiencing homelessness. This means hospitals will generally receive higher payments when a patient is experiencing housing insecurity. CMS is also adding new social determinants of health data elements into LTCH quality reporting, requiring LTCHs to report elements on housing, food and utility stability, and access to transportation, which are factors that influence the resources required for their care. Note: this makes coding for homelessness (and other social determinants) even more vital.
Medical debt: In June, the Administration proposed eliminating medical debt from credit reports, which would impact more than 15 million Americans, raise their credit scores by an average of 20 points, and lead to 22,000 additional mortgage approvals every year. He is also calling for states, local governments, and health care providers to take three specific steps to go further in canceling medical debt:
- Leverage public dollars to purchase and eliminate medical debt;
- Prevent accumulation of medical debt and protect patients from aggressive debt collectors by expanding access to charity care; and
- Protect patients and consumers by limiting coercive debt collections practices by health care providers and third-party debt collectors
Since then, North Carolina is offering hospitals enhanced Medicaid funds if they eliminate medical debt, New Jersey is forgiving $100 million, and Ochsner Health System (with hospitals in Louisiana, Mississippi and Alabama) is eliminating $366 million in debt from 193,000 low income people.
Housing: The Administration also announced new actions to lower housing costs in an effort to spur more housing development. They are providing $100 million to HUD for grants to communities to identify and remove barriers to affordable housing production and preservation, changing interest rates to reduce costs for state and local housing finance agencies, accelerating permitting and reviews of federal housing projects, and enabling more types of housing to be built with HUD funding.
Medicare drug pricing: The Inflation Reduction Act, passed in August 2022, allowed Medicare to negotiate the price of 10 drugs in 2024. Now, HHS has reached agreements with drug manufacturers to lower costs for the first set of drugs—many of them diabetes and other chronic illnesses. Note that these prices don’t actually go into effect until 2026 as part of Medicare Part D prescription drug coverage, but are estimated to save Americans $6 billion in the first year ($1.5 billion in out of pocket costs). In 2025, 15 additional drugs will be negotiated, an additional 15 for Part B and D drugs in 2026, and up to 20 drugs every year after that. These are crucial (albeit incremental) steps toward lowering the total cost of prescription drugs, which is a huge barrier to care.
Supreme Court: After a string of concerning ethics issues, the President has called for changing how the Supreme Court operates. On July 29, he proposed term limits and a binding code of conduct, as well as called for a constitutional amendment that does not allow the President to claim immunity for crimes committed while in office.
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| Congress has been on August recess but will return on September 9. The biggest thing on the agenda is to finalize the FY25 budget. As we reported last month, the House has proposed cutting $8.5 billion from FY24 HHS levels by eliminating 57 programs and reducing funding for 48 programs (though funding for health centers remains flat). Early in August, the Senate Appropriations passed its own version of the HHS budget (full document here), which increases funding for substance use and mental health programs and public health, and maintains funding for health centers. Majority Leader Schumer has pledged to block House efforts to cut $1.8 billion from the Centers for Disease Control and Prevention (CDC) (22% of its total budget) and the Senate’s version restores much of the funding/program cuts proposed by the House. However, this sets up a difficult fight to come to agreement before the budget year ends September 30.
Related reading:
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| Take Action on Health Center Funding
Health centers have two lines of funding: base discretionary appropriations (mentioned above), and mandatory Community Health Center Fund appropriations (infographic here). Our partners at Advocates for Community Health are asking health centers and Primary Care Associations to sign on to this letter asking Congressional leadership to reauthorize the Community Health Center Fund at $5.8 billion/year for three years by Dec. 31, 2024, when the fund expires.
Signatures are due here by end of day Sept. 10, 2024. It is critical that Congressional leaders hear from us about how important a meaningful, sustained funding increase is to patients, communities, and our nation’s health.
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| 1 in 10 Unhoused People Vote —
That's a Problem
By Barbara DiPietro, Senior Director of Policy
As the HCH Community prepares its voter registration and voter turnout activities in the run-up to the Tuesday, Nov. 5, elections, three points are important to keep in mind:
1. The System is Working as Designed … by Those Who Voted
Social justice advocates often assert that the “system is broken” — but is it? For just about every issue — voting included — it seems the system is working exactly as it was designed. There’s no right to vote outlined in the Constitution or the Bill of Rights, and for a long time, you had to be a white, male landowner to vote. American history shows that attempts to broaden voting rights to anyone else (especially Black, Brown, female, and/or lower income voters) have brought significant opposition from those white male landowners (a long and shockingly violent history that exceeds this blog space to cover properly).
Now, even though all adult U.S. citizens have a right to vote (in theory), a myriad of laws have been passed—by those who vote—to keep people out and/or make it harder. This includes requirements to have:
- Official state identification
- A mailing address
- Proof of rent, homeownership or utility service at an address
- Evidence of having lived in the community for a period of time
Further, most states prohibit people from voting if they have been incarcerated or been institutionalized. Other communities reduce the number of polling stations—or shift the locations—to create the confusion and long lines that lead people to abandon the effort. Then there’s the not-so-subtle threats of violence and voter intimidation that have always been present but now are becoming more common (in addition to many other underhanded tactics). Finally, a sizable portion of the general public is disillusioned so they don’t even try to vote. This is all part of the plan to disenfranchise American voters— a plan that continues to be advanced by politicians who are voted into office by voters who continue to vote.
2. “Nothing About Us Without Us!”
Members of the Council’s National Consumer Advisory Board have a saying about inclusion in decision-making: “Nothing about us without us!” The outcome of elections in general—and the next one especially—directly impact the lives of those without housing. When folks don’t vote, public policy decisions are then made without their input. Unfortunately, only 1 in 10 homeless folks votes — and that’s a problem.
I talked with two members of the HCH Community who are working on voter registration to increase the number of unhoused people who vote to learn more about their work. Here’s what they said:
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| Joseph Benson, Jr. (aka “Cowboy”), Community Health Worker, Healthcare for the Homeless, Houston; President-elect of NHCHC’s Board of Directors: “Most people think their vote doesn’t count, especially when voting for City Council or Commission members, but those people make the laws that have a direct effect on you right now. Our Consumer Advisory Board members are deputy voter registrars, and we set up a table at a local one-stop shop that serves breakfast and lunch and we do voter registration right there. In Texas, a voter registration card is a second form of ID, so it’s helpful to have. The City of Houston also provides free transportation to the polls, and they advertise that everywhere. There’s 3,300 people homeless downtown—if we want to stop homelessness from being criminalized, we can be a block of voters to change how government looks at us. The people most impacted are the ones who should push the solutions.”
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| Malcolm Williams, Senior Client Relations Manager, Health Care for the Homeless, Baltimore: “People feel left out of society because they’ve been victimized by it so much. They feel their vote doesn’t count and lack trust in the political system. They also may not have this as a priority when they are in survival mode. Right now, I’m organizing registration events with our CAB members at all our program locations and for early voting in October, we’ll be offering transportation to the polls—both here in the City and up in the County. We need more folks voting because this is a way of taking power back. We have to explain that this impacts you and everyone around you—your family, friends, your community and the direction of the country itself.”
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| 3. Voting is an Upstream Solution to Fixing our Democracy
So how do we take back power, especially when so many have been banned, alienated and/or harassed out of civic participation? We must demand the power of the uninhibited vote to create the country we believe we deserve. Just like we demand health care and housing as human rights, we demand the right to vote as a civil right. If we object to unjust disenfranchisement, we need to leverage the power of our democracy and fight for it.
This isn’t just about voter registration — this is about actual turnout to vote. The U.S. ranked 31st among nations in voter turnout — at 63% — even when registration itself was high. This means engaging our entire community in the struggle to educate folks about HOW they are being wronged, WHY voting is important to them and their lives, and WHAT they (and others) can do to re/claim their civil power at the ballot box.
At the very least, one vote by an unhoused person likely cancels the vote of some billionaire!
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| Take Action
Conduct voter registration and turnout activities: Health centers (as well as all nonprofit organizations are encouraged to conduct voter registration and turnout activities! Use these great resources to plan your work:
National Coalition for the Homeless:
National Association of Community Health Centers:
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2025 National HCH Conference: Proposals Due Sept. 6!
The 2025 HCH Conference & Policy Symposium will be held May 12-15 in Baltimore, MD. Proposals for workshops are due by end-of-day, Friday, Sept. 6. There’s an entire Policy & Advocacy track intended to highlight the efforts of the HCH community to create better public policy and achieve solutions to poverty and homelessness that are rooted in equity and justice. This track is distinct from the Program Operations and Innovation track in that it focuses on policy advocacy activities and partnerships external to direct-service organizations. Let us know about the great work you are doing by submitting an abstract!
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Medicaid Unwinding: Nearly 25 Million Now Disenrolled
Nearly 25 million people have now been disenrolled from Medicaid, with 15 million cases still up for determination. While 54 million people have had their coverage renewed, the vast majority of disenrollments—69%—have been for “procedural” reasons not related to eligibility (such as incomplete paperwork). This has been fairly consistent every month since the unwinding began in March 2023 and reflects ongoing problems at the state level to prevent wrongful terminations.
- Concurrent expansions: Amid the unwinding, some states are also expanding Medicaid coverage (making for a confusing time). Arizona, Illinois, Kentucky, Maine, Nevada, New Mexico, North Carolina, Oregon, South Dakota, Tennessee, Utah, Vermont, and Washington are all examples of states newly expanding Medicaid to single adults or expanding coverage to specific populations (e.g., children, those pregnant, incarcerated, and/or undocumented, etc.).
- Work requirements: Georgia continues to be one of 10 states that did not expand Medicaid under the Affordable Care Act, but yet still has the nation’s only work requirement in Medicaid, which is a massively expensive and ineffective policy. It launched in July 2023, has signed up only 4,300 people, and has cost (so far) $26 million. (That’s $6,047 per person in administrative costs BEFORE any care is provided.) Advocates in these 10 states continue to push for expansion, but the cruelty of their politics continues to deny 1.5 million people access to life-saving health insurance.
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| SUD in the News: Opioid Settlement Funds
States and localities are in the process of receiving more than $55 billion from opioid-related lawsuits over the next two decades. Most settlements stipulate that states must spend at least 85% of the money they will receive over the next 15 years on addiction treatment and prevention. Unfortunately, there’s shockingly little oversight on how the money is spent. Kaiser Family Foundation is tracking how much your state is getting and who is controlling the cash.
- Opioid funds MUST be spent on: Proven public health interventions; housing, outreach, and wraparound services; addressing collateral consequences of drug war policies; and supporting small, community-based organizations.
- Opioid funds must NOT be spent on: Further criminalization or incarceration; family separation; dangerous “treatment” programs; unproven youth-focused prevention programs; corporate money-grabs masquerading as harm reduction; general funds or supplantation.
Related reading from STAT News:
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| Action Alert
Use the Road Map to advocate with your state to ensure funds are directed to constructive purposes—ideally to solutions that benefit people experiencing homelessness.
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| More on Encampment Sweeps: The Injustice Continues
On June 28, the Supreme Court said it was okay to punish unhoused people for sleeping outside—even when they had no where else to go. On July 25, California Governor Gavin Newsom issued an Executive Order calling for encampments on state land to be cleared with 48 hours’ notice (or less if officials want). No requirements are made for connecting people to housing or shelter. Now, the Governor is threatening to pull state funding from local county governments if they do NOT sweep encampments. As Mobilizer readers might guess, it’s been pandemonium as local and state officials throughout California double down on sweeping encampments with a disturbing fervor.
- San Francisco: SF Mayor London Breed made clear her stance to arrest people in a recent op-ed: “This is no longer a city where you can stay on the street…Our goal with enforcement is not to punish people, it’s to make clear that when we offer help…that these offers are not an option. They are the option.”
- Los Angeles: LA Mayor Karen Bass is a notable exception and has refused to sweep encampments. In response, the Governor showed up unannounced at a homeless encampment in LA to try and shame the Mayor for her stance. This is a surprising discord among fellow Democratic lawmakers that shows how acrimonious the issue of encampments has become.
While the focus has been on California because of the Governor’s Executive Order, advocates anticipate that other states or cities will issue similar orders to sweep encampments.
Related reading:
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| Shocking New Research on Incarceration
Incarceration is harmful to children’s health: Youth with personal/family justice involvement had 1.5–16.2 times the mental health and physical health diagnoses as those without justice involvement. About two-thirds of behavioral health care and nearly a quarter of all hospital inpatient days were attributed to the 2.2% of youth with personal/family justice system involvement.
Incarcerated people are sick and prison co-pays limit care: Of the 1.4 million people in U.S. prisons, thereis a high prevalence of mental health and chronic physical conditions, as well as poor access to care. High prison co-payments (found in 90% of federal prisons) were associated with worse access (especially those exceeding one week’s prison wage). The results suggest that incarcerated individuals, especially those in prisons that usually require co-payments for visits, often receive inadequate care despite their substantial health needs.
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What (Else) We're Reading
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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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