Barbara DiPietro is the Senior Director of Policy at the National Health Care for the Homeless Council. She joins us this week to talk about what homelessness looks like in the United States, the wildly disporportionate incidence of COVID-19 in people currently experiencing homelessness, and how the dual crises of rising unemployment and insurance loss are making people more at-risk for becoming homeless. She explains why Medicare for All and the fight to make housing a right are interrelated struggles.

Show Notes

In the United States, both our healthcare and our housing systems have failed to protect us during COVID-19, and the two systems can interact in dangerous ways. To talk specifically about this intersection, we welcome Barbara DiPietro to the program, from the National Healthcare for the Homeless Council.

Stephanie starts by asking what homelessness really looks like, and to address any myths people might have. Barbara says that most Americans when they picture homelessness will conjure to mind a street-homeless man who is a chronic alcoholic, but that description represents only about 10% of the homeless population. In fact, the homeless population is primarily low-income, working families and adults, and 1/3rd to 1/2 of shelter stays are children. Even families that work full-time, earning above minimum wage, often do not earn enough to afford rent in addition to meeting their food needs and other basic expenses.

On any given night in America, there are about 1/2 a million people who we can count as homeless (many more are not counted). Over the course of a year, at least 1.5 million people use the shelter system, and possibly 2 million more are experiencing housing instability or doubling up.

Barbara mentions that health issues and healthcare costs are actually one of the leading causes of homelessness in America. Medical debt and hospital bills can quickly overwhelm income, and leave people without cash to pay rent. However, other important issues can also lead to homelessness: domestic violence, fires, losing your job, etc, can all lead to losing your housing. Right now during COVID-19 we have millions of people losing their jobs, and unemployment benefits running out, along with a very vague national eviction order.

What about the common notion that Medicaid is likely to cover everyone who becomes homeless, or that you can seek care in an emergency room? As Barbara mentions, your ability to access Medicaid depends entirely on the state you're in, as 15 states still have not expanded Medicaid to cover low-income people without meeting other requirements. Even in states that have expanded Medicaid, many people are churned in and out of the program.

While it's technically true you can receive life-saving care at an emergency room, it doesn't mean you won't be billed for that care, or that you'll be treated with dignity. That care also won't be coordinated, and the emergency room is not the right place for providing primary and behavioral health in the community. Barbara would like to see more hospitals advocating for Medicare for All, since it would move these patients out of the ER and into appropriate primary care settings, which could really help with ER volume and capacity for all who need it.

What would a public option do for healthcare access for homeless populations? Barbara says: well, it's better than nothing. We have to be honest though: the public option is primarily about incrementally increasing health insurance coverage. As Stephanie mentions, if an ACA marketplace plan (bronze, silver, or gold) is unaffordable to you, a public option plan will likely be as well.