To the credit of the media, the homeless in the cities of Tampa, FL and Charlotte, NC have gotten some attention during the convention season, (though not from the candidates). (Tampa has the questionable distinction of having the highest homelessness rate in the nation according to Phil Hirschkorn in his 8/26/2012 article, “Tampa area has nation’s highest homelessness rate.”)
Here it is argued that even those against “entitlements” should support the expansion of Medicaid under the Affordable Care Act.
The homeless are used as an example here for two reasons, first because as our campaigners make evident, extreme examples are often the best to illustrate a point, and second because under the Affordable Care Act $11 billion in federal grants is being made available for Community Health Center expansion to serve homeless populations, much as federal grants are available for states to expand their existing Medicaid programs.
If you suddenly became homeless where would you get your medical care? What would you do protect yourself against illness, including ailments you might be exposed to by others in your shelter? Would you worry about the health of those around you, including their mental stability?
In the case of healthcare for the homeless, the implications for our day-to-day society indicate a strong need for states to support policies based on what is likely to happen in their hometowns without the “entitlements” that so many are willing to get rid of.
Medicare is arguably the easier case for us to understand. Entitlements, take them away from our elderly or squeeze them every time our government wastes money on something else, and perhaps the visible costs to our nation are not meaningful for the vast majority of Americans. But the homeless, there’s a different example.
We’re now hearing discussions about welfare and Medicaid as “entitlements” that need to go, or be reduced or, in the case of the Affordable Care Act, kept from expanding. And I ask again, if we jump down from our unicorns and realize that there is not work for everyone seeking work, what are we going to do about healthcare for the poor and homeless?
As of now we have programs in place for the homeless. In 1987, the federal McKinney Homeless Assistance Act, was the source for the Health Care for the Homeless program that exists today in section 330 of the Public Health Services Act. (Read more at nhchc.org). That program provides for the treatment of homeless individuals with both acute and chronic disease, including mental illness through community health centers that receive federal funding.
The Affordable Care Act The Affordable Care Act Title IV (Prevention of Chronic Disease and Improving Public Health) provides for federal funds to be given to states to expand services and access to Health Care for the Homeless centers with $11 billion from the years 2011 to 2015, according to the National Health Care for the Homeless Council in their 5/2011 publication, Health Care for the Homeless Program fact sheet on their website at nhchc.org.
Funding under the Affordable Care Act in the form of grants was also intended to expand Medicaid. Under the Supreme Court’s decision, states will have a choice to expand their Medicaid programs and receive additional federal funding or not.
The expansion of Medicaid under the Affordable Care Act was intended to raise the income threshold of those who are eligible to Medicaid making more of the working poor eligible for Medicaid as well as providing for Medicaid eligibility of single adults, those without children.
This will be decided on a state-by-state basis. Here’s where entitlements will hit home for each of us. And here’s the danger of simply voting for or against a policy because it carries a label such as “entitlement.”
So, as a homeless person where would you go to get treated for chronic or acute disease, including contagious disease and mental illness? Emergency rooms? Perhaps, unless you knew of a Community Health Center in your area (you can find out by going to the US Department of Health and Human Services website and putting in your address).
Before you dismiss expanding Medicaid as an entitlement, or choose to modify welfare or some other such entitlement, remember these entitlements are a little bit different from Medicare. You might not worry about being a senior without Medicare, after all, you might be years away from experiencing the need for such an “entitlement” and you’re probably not involved with that many seniors in your day-to-day living.
But with record levels of poverty (US census data 2010 indicates 15.1 percent, highest in about 50 years), on some level you know this could happen to you if you’re middle class. It could be your children who are among the homeless, in a shelter without the benefit of being away from contagious ailments, outbreaks of flu or even the behavior of those with mental illness. Even now, when you are not homeless, you likely see homeless as you’re out and about going about your everyday life. It is likely that your children attend school with at least one homeless child.
Our President and his counterpart candidate for president made little mention of the homeless in the cities they visited for conventions. But when one or the other of them takes office, and one or the other of them goes back to living his non-middle class life, do we really want to argue against policies that support the poor and homeless in our own states?
As we divide ourselves over broad issues, it’s important to look at how the issues can affect you, including an examination of the “entitlement” of Medicaid. It is legitimate, even for those who are rabidly against government programs, to support entitlements to keep our homeless and working poor populations healthy for the benefit of those individuals, their states and society. It is not Republican or Democratic to support Medicaid expansion in your state but rather a radical new approach to consideration of legislation, realism.
