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The St Louis Contrarian

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

Archive for the tag “healthcare”

States Expanding Medicaid Do Not Regret Their Decisions

www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2018/03/26/do-states-regret-expanding-medicaid/

The above Brookings article actually points out that states have cut costs due to high levels of federal reimbursement

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The Benefits of Good and Affordable Housing to a Community

Here is an article copied from Why Housing Matters. It is a very comprehensive statement of the importance of housing to other endeavors such as health and education. It is well worth taking a look at. The data was originally gathered by the MacArthur Foundation. Written by Paul Drib in

Why Educators, Health Professionals, and Others Focused on Economic Mobility Should Care about Housing

November 30, 2017

Cities striving to improve residents’ lives often focus on such issues as schools, parks, jobs, or health. Often overlooked is something equally fundamental. Trace the lineage of many social welfare issues, and you will likely uncover a history of substandard, unaffordable housing. Research increasingly shows that safe and affordable housing in strong and thriving neighborhoods is a launching pad to upward mobility for families.

For more than a decade, the John D. and Catherine T. MacArthur Foundation has supported research on the role of housing as a platform for opportunity among families. The following summary of findings from more than 20 studies shows that housing shapes our lives in critical and long-lasting ways. Through this and other work, our understanding has expanded, providing greater nuance and insight into the pathways through which housing makes a difference in people’s lives and in communities. These pathways include housing stability, affordability, quality, and location.

The findings are organized for educators, health professionals, and economic development experts who regularly see the direct impact of poor-quality, unaffordable housing but who may not realize housing’s role in those outcomes.

Why educators should care about housing

Safe, stable, and affordable housing during childhood sets the stage for success in school. Children are profoundly affected by their environments during key developmental stages. Chaos in their neighborhood, frequent moves, exposure to pollutants, and unhealthy conditions leave a deep and lasting imprint. When housing consumes too much of a household’s budget, kids may not have enough nutritious food to eat to be ready to learn. Teachers see the ramifications of these conditions in the classroom.

MacArthur Foundation-supported research shows the following:

1 Adolescents living in poor-quality housing have lower math and reading scores and lower math skills in standardized achievement tests, even after adjusting for parenting and other factors.

2 Among young children in high-poverty neighborhoods, substandard housing is the strongest predictor among several housing-related conditions of behavioral or emotional problems.

3 Improving housing stability has long-term benefits for children. Any residential move during childhood is associated with a nearly half-a-year loss in school. Each additional move is associated with small declines in social skills. A majority of US children move at least once during childhood, and a sizable group moves three or more times. The negative effects, however, fade with time.

4 Moving three or more times in childhood is associated with lower earnings, fewer work hours, and less educational attainment later in life.

5 Between ages 6 and 10 is a particularly sensitive time to move. At that age, any move, voluntary or not, is linked to lower educational attainment and lower earnings later in life. (See here for results at other ages.)

6 Families who spend 30 percent of their household income on rent spend more on child enrichment than those who spend either more or less than that on rent.

7 Homelessness is linked to behavioral problems in children, though it is relatively rare and often a one-time experience.

8 Too few families can move to high-performing neighborhood schools, even with housing vouchers to help with rent. One-third of public housing families and one-fourth of families using housing vouchers live near schools that are ranked in the bottom 10th in their state.

9 The Low-Income Housing Tax Credit (LIHTC) does better than housing vouchers in placing families near high-performing schools, though the LIHTC serves slightly better–off families.

Why health care professionals should care about housing

Both neighborhood and health disparities are stark in the United States. One’s zip code is as important as one’s genetic code in determining health status or life expectancy. The disparities are linked because where you live offers access to what makes you healthy or unhealthy, from housing without lead or asthma triggers to grocery stores with fresh vegetables, to parks and sidewalks, and access to jobs. Physicians, nurses, and public health experts recognize this, and they are doing more to ensure that the residents they serve live in homes and neighborhoods that promote their health and well-being.

MacArthur Foundation-supported research shows the following:

1 Substandard housing contributed to children’s poor health at age 6 and developmental delays by age 2. (For insights on why, see here.)

2 Housing affects mothers’ health. Poor housing conditions and overcrowding (even just perceived overcrowding) are associated with more depression and hostility among Latino mothers in the Bronx.

3 Moving to low-poverty neighborhoods can improve physical and mental health for adults, including decreased diabetes and obesity.

4 Neighborhood pollution has clear health consequences. Reducing prenatal exposure to pollutants from traffic congestion alone could mean 8,600 fewer preterm births annually, for an annual savings of at least $444 million.

5 Among Latinos living in public housing in the Bronx, the prevalence of cardiovascular disease is significantly higher than for either Section 8 voucher holders or low-income Latinos in general. Nationwide, public housing residents tend to live in poorer neighborhoods than do voucher holders.

6 Neighborhood social cohesion reduces the risk of depression or hostility among low-income Latinos in New York City.

7 About 10 percent of low-income children in a nationally representative survey of urban families were homeless at one point in their childhoods. These children relied more on emergency rooms for health care and had more behavioral problems.

8 Housing for homeless families and rental assistance for food-insecure families improves health outcomes of vulnerable children and lowers health care spending.

Why people focused on ensuring greater economic security and mobility should care about housing

Housing is a launching pad to successful lives. High-quality housing in strong neighborhoods positions residents to capitalize on opportunities. And investing in communities reaps benefits beyond the neighborhood in lower social, health, and economic costs for the city and region. Cities nationwide are working to reverse entrenched poverty and providing needed opportunities for all residents. The findings below demonstrate the connection between housing, neighborhood, and upward mobility.

MacArthur Foundation-supported research shows the following:

1 Improving neighborhood social cohesion and access to jobs and reducing environmental hazards have a strong effect on health, earnings, and well-being.

2 Housing affordability and stability encourage work. Families using housing vouchers were working more consistently after five years than similar low-income families without vouchers.

3 Policies that focus on moving families to better neighborhoods are not enough to address every problem related to poverty. Families need additional supports to overcome their circumstances.

4 Siblings who lived in public housing as teenagers fared better than their siblings who spent less time in public housing. They earned more as young adults and were less likely to be incarcerated. More room in family budgets to invest in children may be one reason for the better results.

5 Improving housing stability for children has long-term benefits. Moving three or more times in childhood—especially between ages 6 and 10—lowered later earnings nearly 52 percent.

6 In Milwaukee, Wisconsin, 16 households are evicted every day. Poor, black women are especially vulnerable. Evictions disrupt children’s schooling and perpetuate economic disadvantage.

7 Racial segregation and a tight rental market constrain housing choice for low-income families and may be one reason voucher holders live near lower-performing schools.

8 Inclusionary zoning policies expand access to more economically diverse neighborhoods and better-performing schools, though inclusionary zoning is only a small slice of the affordable housing pie.

9 For low-income seniors, reverse mortgages can be a lifeline. The most effective strategy to reduce default rates is escrowing funds for property tax and insurance payments for borrowers with low FICO credit scores.

These findings underscore the need to invest in healthy, affordable housing for all Americans. Opportunities are shaped by a person’s housing, neighborhood, and environment. Policies that address housing and neighborhood’s role in creating and sustaining opportunities or disadvantage may be one of the most effective ways to fight poverty and promote upward economic mobility.

This article was originally published on the MacArthur Foundation’s website, and has been reproduced in a modestly modified form with permission from the Foundation.

Again Healthcare and Housing

Housing and healthcare are one and the same. I don’t need to restate the obvious; people with poor housing options tend to be less healthy, and people who are less healthy tend to live in substandard housing.

I am putting some ideas together to address this. Think of this scenario which often happens. A patient cannot be released from the hospital in a timely manner because they are homeless. The daily cost in the hospital is $3000. Wouldn’t it make sense for hospitals to subsidize the rent for these individuals and get supportive services for them? A second issue. Many readmissions to hospitals could be avoided if people lived in decent housing. As I said, I will be putting a project together to address this. Paul Dribin

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

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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