Debate over Affordable Care Act Strikes Fear in Homeless Population

The homeless population widely relies on the Affordable Care Act for healthcare.


In the debate over the Affordable Care Act, commonly referred to as "Obamacare," one demographic has been largely left out of the conversation.

Many people in the homeless population have received improved medical care for the first time in years under Obamacare, and they are now worried that plans to get rid of the Affordable Care Act could directly affect their health in a negative way. About 15 percent of the homeless population is considered chronically homeless, making it difficult for them to afford or have access to proper healthcare. And years living on the streets or in poor conditions can have a vastly negative impact on a person's health.

Under the Affordable Care Act, 31 states and the District of Columbia have been able to extend Medicaid coverage to non-disabled homeless adults. Health centers that treat the poor and homeless in these states have reported that before Obamacare, around 30 percent of their patients would be covered by insurance. Now, these numbers are closer to 80 or 90 percent through Medicaid or Medicare.

Advocates for the homeless feel the possibility of losing this coverage could be costly. They make the point that having homeless people have access to coverage prohibits issues from becoming chronic, which in turn could lead to trips to the emergency room and more expensive hospital bills in the long run. They also cite how having access to this coverage gets more homeless people in treatment for mental health issues, rather than having people suffering from such problems untreated on the streets.

While the block grants supported by the Trump administration are claimed to be designed to curb wasteful Medicaid spending and benefit the homeless, many think it will have an adverse affect. That affect would be making states make tough decisions on who to cover, with groups like the homeless probably at the bottom of the totem pole due to their inability to afford the costs.

According to a release from the National Health Care for the Homeless Council (HCH) shortly after the election:

"The new Administration and Republicans in Congress have promised to end the expansion and replace Medicaid with either block grants to states or to pay states a fixed price per person. Both of these approaches require Congress to amend the law (or create a new one), would reduce federal funding for Medicaid, and put much more responsibility for designing and funding the program to the state level. States would likely respond to this change by shifting Medicaid beneficiaries into private plans, establishing work (or other) requirements to make it harder to qualify, charging premiums for most adults, using wait lists or capping enrollment, cutting provider payments, or eliminating/restricting benefits."

Although the Trump administration has promised that no one will lose coverage under a new plan, the homeless population is one demographic that could likely be missed, according to Barbara DiPetro, policy director for the HCH.

"So when we talk about no one will lose coverage, that's heartening," she said. "But the details are always very important. What does that coverage look like? The population we serve typically falls through the cracks."

For chronic homeless people, Obamacare provides access to basic care that they haven't received in years. Many supporters of Obamacare worry that getting rid of it will hurt access to basic care for hundreds of thousands of Americans. They worry that the progress that has been made, especially within the homeless and low income populations, could be all for naught if repealed, which in turn could be fatal for some people.

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