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The St Louis Contrarian

Providing Independent and Intelligent Insight on St. Louis Public Policy Issues

Archive for the month “June, 2017”

Republican health care bills and housing

The Republican health care bills would be disastrous for most Americans. This article will briefly describe its’ effects on housing. 

The effect is obvious. If people are booted off healthcare or have to pay more they will have less to pay for housing. Many people are already financially strapped for housing, the health care bill makes it worse.  Written by Paul Dribin

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Criminal Justice Ministry

In the list of excellent St Louis organizations we must include The Criminal Justice Ministry. Originally part of St Binvent DePaul and now independent, the organization provides a. Ariety if services forbprisoners and ex-offenders. 

The Release to Rent Program provides assisted housing and extensive supportive services for ex offenders. The recidivism rate for this program is less than 10%, significantly better than the overall rate. I helped this program get started. The founder, Sister Carlene Reck has retired but the great work continues.  Written by Paul Dribin

More Metrolink Problems

More shootings drug dealings etc in and around Metrolink. People are afraid to ride it. I was correct in predicting Metrolink would be an albatross for the region. When are the leaders going to do something?

St. Louis as a Place to Live

I have a very good perspective on St Louis having grown up in Chicago and living here for 21 years.  In spite of itself, St Louis is a great place to live.   The culture and restaurants are first class. It is a great sports town and housing is quite affordable. You can get anywhere fairly quickly.  

Why have things not taken off here. There are several reasons 

1.  Racism.  Most of the other problems, crime, education, jobs, and dysfunctional government come from or racist traditions 

2.  Crime.  People around the country hear about crime in St. Louis and don’t want to move here.

3.  Education.  Many school systems are still a mess 

4. Cronyism. By cronyism I mean the strong tendency of people from St. Louis to pick there high school friends for key jobs and not consider outsiders. 

5. Dysfunctional government. This speaks for itself and is related to the other problems. 

We know what it takes to correct these issues. We have had lots of studies. Do we have the leadership and political will to make the changes?   Written. By Paul Dribin 

St. Louis Housing Authority

Yesterday’s discussion about HOPE VI provides for a natural lead in to today’s discussion about the St. Louis Housing Authority. The authority controls thousands of conventional, section 8, and tax credit projects. Their work has been exceptional. They have been led for many years by Cheryl Lovell who quietly has created a powerhouse organization.

Back before Cheryl took over the housing authority was typically considered trouble and on HUD’s bad list. Negative stories about the authority were common in the media. The reforms started under Tom Costello and continued under Cheryl. They have completed revitalized their older projects, collect more rent, and have contracted out their property management. Written by Paul Dribin

Hope vi

Hope VI is a now discontinued public housing program that completely rehabilitated distressed public housing projects in this country.   The idea behind the program was to combine physical rehabilitation social services and create mixed income communities. I had the opportunity to work on the Darst Webbe program in the near south side.  That program has been successful in creating a mixed income community and has led to improvements in surrounding neighborhoods. 

Recent research has evaluated HOPE VI.  The program has not really transformed lives and it was noted that displaced public housing residents did not readily move back 

I believe the program has provided urban development benefits but has not significantly improved the lives of residents. The cost is quite high and demolition and new construction may have been cheaper. The jury is still out on mixed income housing. I have serious doubts that given a choice anyone would opt for this type of housing 

Beyond Housing

In writing about great organizations in St Louis Beyond Housing is probably the best. They have been in business for years and fully realize that community development must be comprehensive and is hard work. 

They are focused on Pagedale  and the Normandy School District. Their projects include housing development and rehab,homeownership training, foreclosure prevention,and economic development. They have brought a movie theatre, grocery store, and bank  to the area. They have created the 24:1 imitative which is bringing the smaller communities together to meet common goals.

Their leader is Chris Krehmeyer a talented, passionate, and caring individual. I am proud of their work

The Big Idea

I am repeating an idea I have expressed in previous blogs because I believe it is so important. The idea is that low income people would be significantly better served by a guaranteed income rather than construction of affordable housing. I am writing this for the following reasons:

1. Too much of the money spent on affordable housing is siphoned off to third party people and does not directly benefit the low income resident.

2. Construction is just too hard to get right. Studies have shown that very little affordable housing is build outside areas of concentration of poverty. Research again shows that low income people concentrated in poverty stricken areas have much less chance to improve their lives.

3. Income supplements largely eliminate the stigma attached to affordable housing. People could rent where they liked, use funds for a downpayment on a house, or make the normal market choices that other people do.

4. Desegregation would be easier.

5. The program would benefit more people than a construction program.

6. The program would provide benefits to more landlords and developers. Why? Because if implemented on a full scale the funds generated would provide tremendous demand for an increased number of apartment units. Apartment developers could feel confident there units could be leased.

I have a couple qualifiers to go along with the positive points:

1. These funds should not discourage employment. I would see them as a supplement to low wage jobs and not a substitute for employment. Someone who worked would actually be better off.

2. There still need to be construction programs to target special needs populations-persons with disabilities,elderly, and homeless people.

3. There needs to be a strong mortgage program in place to support the increased housing development. The FHA multifamily programs are potentially excellent, they need to be streamlined and simplified.

I am not confident that my concept will be enacted any time soon. I do think it is one of those rare ideas that can unite progressives and conservatives.

Issues Affecting Housing and Healthcare

Here is an article from the Housing Matters website that discusses the positives and negatives of trying to link housing with healthcare services.

The Future of Integrated Health and Housing Programs

June 14, 2017

by Josh Leopold, Brenda C. Spillman, Eva H. Allen

Americans spend more on health care, but have lower life expectancies and worse health outcomes than any other developed country. This disparity arises partly from a lack of attention to social determinants of health, which include income, education, and housing.

States, localities, and organizations throughout the country have taken advantage of opportunities created by the Affordable Care Act (ACA) and other health system delivery and payment reforms to improve health outcomes by integrating housing and health care.

But the prospects of ACA repeal and the president’s proposed budget for fiscal year 2018 threaten to reverse recent progress in collaborations between housing and health care providers. Deep cuts to the US Department of Housing and Urban Development (HUD) and Medicaid could make it harder for states to provide basic care to low-income people and leave fewer resources to improve outcomes through integrated health care and housing.

How can housing support health?

Lack of housing makes it hard for vulnerable people (such as the elderly and those with disabilities or experiencing homelessness) to manage chronic health conditions, leads to reliance on emergency rooms for health care and emergency shelter, and contributes to poor health outcomes and reduced life expectancy.

Supportive housing combines a rental subsidy with case management and has been shown to reduce health care spending and improve health outcomes for people experiencing chronic homelessness. In subsidized housing, health care and social services available on-site can help people stay healthy enough to remain at home and avoid hospitalizations and nursing home admissions.

How can housing and health care providers collaborate?

Several ACA provisions aimed to improve care coordination and shift the health care system to value-based payments, where providers have more flexibility in the services they provide, but also are more accountable for improving patient outcomes. Value-based payments are intended to motivate health care providers to take a “whole-person” approach that includes addressing social determinants of health.

The Urban Institute conducted a review of nearly 40 state and local health and housing initiatives. By encouraging cross-sector collaboration, using community resources strategically, and taking advantage of health reform opportunities, many states and communities integrated health care with housing and other services to improve vulnerable populations’ health and well-being.

Three initiatives were particularly promising:

New York State’s Medicaid Redesign Team used state savings generated by Medicaid system reforms to pay for housing for high-needs populations, including construction of new affordable housing units, rental assistance, and supportive services to residents. The state recently committed an additional $1 billion to develop 6,000 new units of supportive housing in the next five years as part of a larger commitment to build 20,000 supportive units over the next 15 years.
Houston’s Integrated Care for the Chronically Homeless initiative paired housing vouchers from HUD with health care and case management services funded by the Medicaid Delivery System Reform Incentive Payment program to serve people experiencing homelessness who have chronic physical and mental health conditions and are high users of costly medical services. Early program results show reductions in participants’ preventable emergency department use, improved mental health functioning, and reduced depression rates.
Housing with Services in Portland, Oregon, brought together several organizations, from nonprofit service providers to Portland’s housing authority to the largest Medicaid health insurer, to coordinate health care and social services for low-income seniors and people with disabilities living in federally subsidized housing. Evaluation results indicate that program participants were more likely than those not connected to the program to use preventive and mental health services, had better access to long-term services and supports, and experienced less food insecurity.
What are barriers to these collaborations?

Although many health and housing partnerships have developed or been strengthened since the ACA’s passage, several obstacles limit the reach of such partnerships, a problem that budget cuts will only exacerbate. In interviews, local leaders and national experts frequently cited the widespread shortage of affordable housing as an obstacle to creating and sustaining housing and health care collaborations. Federal Medicaid funds can sometimes be used for housing-related services, but cannot pay for room and board. Some state Medicaid agencies, hospital networks, and health insurance plans have invested in rental assistance and affordable housing development, but they remain the exceptions.

Competing priorities, restrictions on the use of health care funding for nonclinical services, and lack of housing-related expertise make it unlikely that the health care sector will become a significant funder of new affordable housing. One policy expert said advocates have been overly focused on “trying to find ways that Medicare and Medicaid should fund housing that we eliminated at the HUD level.”

Proposed budget cuts would hamper efforts to integrate housing and health care

The proposed budget aims to cut HUD by $7.4 billion and eliminate the Housing Production Trust Fund and Community Development Block Grants. In addition, the proposal to cut the corporate tax rate from 35 percent to 15 percent has already made affordable housing development more difficult. The proposed cut has reduced investment in Low-Income Housing Tax Credits, the primary funding source for affordable housing, because investors are less motivated to buy the credits to offset their income taxes.

In this environment, housing providers may focus on stemming losses rather than supporting new collaborations. The vulnerability of housing and health partnerships to changes in federal funding was demonstrated recently, when HUD advised the Houston Housing Authority to stop issuing new vouchers for the remainder of the year because of an anticipated budget shortfall.

The budget also calls for reductions in federal Medicaid spending, that, coupled with reductions proposed in the House-passed health plan, would cut Medicaid spending 47 percent over 10 years.

These proposals could slow or reverse the momentum for housing and health care integration. Given the promise of housing and health collaboration for the nation’s most vulnerable populations, further reducing the stock of affordable housing and supportive services could thwart progress in improving their health care outcomes and quality of life.

An earlier version of this post was published on Urban Wire, the blog for the Urban Institute.

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TAGS: Health, housing, Budget
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Health Care and Housing

More attention is being paid to the relationship between housing and healthcare. There are a couple obvious connections. Someone living in unsafe housing is more likely to suffer from serious Heslth problems. We know asthma increases for children living in substandard housing.

Second, families spending a disproportionate amount of money on housing do not have funds left over for healthcare. 

Third health care reform penalizes hospitals for readmisdion if patients. Hospital Social Workers tell me that they often have trouble finding decent affordable housing for patients. This contributes to readmissions

Work is underway to better mesh housing and healthcare. We need to begin the process in St Louis

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