Health Care, Medicaid, and Homelessness – What’s happening?

written by Steve Berg
January 26, 2017

After several weeks of crisis mode in Congress around preserving Medicaid expansion, it’s time for a deep breath and a recap of what’s happened so far and what’s likely to happen next. The process has changed and slowed, the immediate worst-case scenario has been prevented, but many threats remain.

Where do things stand?

Congressional leaders’ original plan was to pass a bill quickly using a “reconciliation” procedure, meaning the bill would not be subject to a filibuster in the Senate and could pass with only 50 votes. This bill would have repealed the spending portions of the Affordable Care Act, eliminating Medicaid expansion.

This dangerous strategy has fallen apart, thanks in part to a widespread advocacy effort. In the Senate anyway, there has been a strong bipartisan response indicating that they will not vote to repeal health care for their constituents unless there is a replacement passed at the same time. President Trump has come around to say the same thing. Many Senators from both parties, have said that Medicaid expansion should stay in effect as is.

Still, “repeal and replace” remains on the agenda of the Congressional majority. People on the Hill appear to be waiting for the Trump Administration’s proposal, which will likely come after the Senate confirms the nominee for Secretary of the U.S. Department of Health and Human Services.

In the mean time, discussions have turned to whether Congress should convert the entire Medicaid program to a block grant program. This proposal has been around for many years. It is widely understood as a way to cut spending and no longer provide comprehensive health care to everyone who is eligible; leaving states rather than Congress taking the blame.

So what do we say now?

Our advocacy on health care is turning from crisis response to sustained action. Any discussions in Congress about “repeal and replace” will likely be long ones, and we should prepare to keep up our advocacy throughout these discussions.

Here are some talking points that have received a good response on the Hill.

  • Medicaid expansion has given us real hope for solving some of the most vexing problems we face in fighting to end homelessness. Medicaid is an excellent funding source for health care and health-related services for people with severe vulnerabilities, often related to mental illness, who are entering permanent supportive housing. This has been a priority since the Bush Administration.
  • Medicaid is the only practical funding source for Medication-Assisted Treatment for homeless people suffering from addiction to heroin or other opioids.
  • Medicaid makes treatment available for people with mental illness released from jails and prisons, which in turn stabilizes housing.
  • Medicaid should not be block granted. It should continue to provide money to states for comprehensive health care to all low-income people. Medicaid is a 50-year-old program that has survived for 50 years because it solves problems that need solving. Expanding it to cover all poor people was a no-brainer. There are some who will always oppose anything that provides taxpayers’ money to take care of low-income people; but that group is not as prevalent in Congress as people might imagine. For more on block granting, see our earlier blog.
  • Leaders in Congress and the Administration should leave Medicaid alone. If they want to find a way out of the difficulties they’ve made by promising to repeal Obamacare without knowing how to replace it, they don’t need to spend time and political capital “fixing” a problem that doesn’t exist. 

A final note: all of us on the policy team here at the Alliance are completely stoked about the response of the homeless services community on this issue. The calls so far have had a real, tangible impact. Congress has visibly turned around on this issue, and the impact on homelessness has been part of the conversation. We represent the interests of people who are the most marginalized and disconnected people in the country; and yet we manage to have some power.

Thanks to everybody who has participated in that. While we may be out of crisis mode for now, we must be ready to jump back in at any moment and we know you’ll be there with us.