"Get all homeless people on Medicaid." That was goal #1 of our Medicaid Reform Committee in 2001. We've been at this a long time, and finally that goal is within sight.
In 2014, the Affordable Care Act (ACA) will extend Medicaid to most people under 133% of poverty. That will include most of our homeless neighbors. This is a momentous victory worth defending, but it is a fragile and incomplete accomplishment.
The ACA is fragile because the political opposition is fierce. This month, lawyers will contest its constitutionality before the US Supreme Court; the National HCH Council has joined in an amicus brief arguing that the ACA helps the United States to meet our international human rights obligations, particularly the obligation to end racial discrimination and disparities in health care. This year's elections will pose another test for the law; the National HCH Council is actively advancing voter registration efforts among people experiencing homelessness, helping them protect their own rights and interests.
The ACA is incomplete because it does not establish a right to health care or achieve universal coverage - 20 million of us will still be uninsured after full implementation. Undocumented immigrants are explicitly excluded from coverage; it will be up to HCH projects and other safety net providers to provide for them what care we can, and we expect attacks on the funding that we use to do so. Moreover, the ACA leaves for-profit interests in charge of most health care financing (insurance) and care delivery; despite ACA incentives to improve health, improve care and reduce costs, the primary legal obligation of for-profit corporations is still to maximize profit for their shareholders, not to provide the best care possible.
Our obligation to the people we serve is clear. We must make the very most of the opportunity that the ACA provides. We are helping HCH projects comply with the technical requirements of health reform - achieving Primary Care Medical Home recognition, for example. We are shaping rapidly evolving health policy to make the system more accessible and effective for people with intense health care challenges - increasing resources for outreach and Medicaid enrollment, for example, and promoting health care interventions that include housing, a social determinant of health.
Though the goal established eleven years ago is within sight, we still have a long way to go. As we support implementation of the ACA, we must also keep our eyes on the prize - the single payer solution that will finance an equitable health care system, serving everyone.
I am grateful to you who have joined in this work through the National Health Care for the Homeless Council, as members, as donors, as advocates, as providers, as consumers, as friends. I urge your continued participation:
