New Developments, Grabbing This Political Moment
By Thom Amdur
4 min read
It is the eve of Donald Trump’s inauguration as the 45th President of the United States. As expected, he and the Republican-led 115th Congress are already shaking things up across the board and healthcare reform is front and center. The House of Representatives and Senate have taken the first procedural steps to repeal “Obamacare” via the arcane budget reconciliation process. As we go to press, President-elect Trump has indicated that his plan to replace “Obamacare” is all but complete and, perhaps, it will have been theatrically revealed by the time you read this column.
Meanwhile in the Senate, HUD Secretary nominee Dr. Ben Carson received a warm reception in his confirmation hearing before the Senate Banking Committee. Much was discussed (see David Smith’s excellent Guru column for more details) and, as anticipated and hoped for, Dr. Carson clearly made the link between good health and affordable housing.
Much remains unknown about the incoming administration’s, as well as Congress’ specific plans regarding healthcare reform, but this may be an opportunity and a political moment to build on important linkages between the affordable housing and healthcare communities. These are ideas I hope will be considered in the weeks and months to come:
Expansion of Medicaid waiver authority. Many states have already seen success in reducing the ever-escalating healthcare costs by combining Medicaid waiver authority with the LIHTC in an assisted-living context. I hope the program will be expanded further to allow Medicaid dollars to be used to reimburse some direct housing expenses in assisted living and perhaps beyond. For many low-income Americans, the lack of safe, sanitary, affordable housing is the direct cause of otherwise treatable and expensive medical conditions, like asthma. The Housing First model, which has now taken hold in dozens of cities around the country, has proven to dramatically reduce chronic homelessness and the significant costs it incurs upon the healthcare system. For a significant portion of people with expensive chronic health issues, a prescription for affordable housing could be the most cost effective healthcare intervention.
Expansion of resident services coordination. For those already living in affordable housing, an expansion of resources for resident service coordination could reap huge healthcare savings, particularly for the elderly. Vermont’s Support and Services at Homes (SASH) Program, which coordinates resources from social service agencies, community health providers and nonprofit housing organizations, has provided services for approximately 5,000 income-qualified seniors across the state. The results have been striking: significant improvements in quality of life and health metrics, in many cases exceeding national benchmarks, as well as slower growth of Medicare expenditures.
Lead remediation. I hope any infrastructure legislation considered by the next Congress will resolve once and for all the still significant exposure to lead that exists in our built environment. The ongoing tragedy in Flint, Michigan has brought renewed attention to an issue still hiding in many communities around the country. Though we have made great strides, when I attended the National Lead Summit in Washington, DC in November, I was horrified to learn how prevalent an issue childhood exposure to lead still is across the country and its long-term negative impact on healthcare and society. The Green & Health Homes Initiatives reports that, “Impacted children enter school with diminished reading and learning abilities and drop out of school at a rate seven times greater than their peers. Additional effects include hearing loss, speech delays, aggressive, even violent, behavior and long-term health impacts on the kidneys, heart and brain costing the U.S. over $50 billion.” Unlike so many other challenges we face as a nation, this one has a real solution, achievable in just a few years if we marshal the effort and resources. Check out GHHI’s “Strategic Plan to End Childhood Lead Poisoning: A Blueprint for Action” to see how interagency coordination and public-private partnerships could make lead poisoning a relic of the past.
Healthcare reform will not be easy, or without controversy, but there seems to be an appetite for action among the majorities in congress and the president. While affordable housing is certainly not the issue leading the healthcare reform discussion, as acknowledged by Dr. Carson, there are clear linkages. What we need now is to link the resources.
