The homeless are constituents, too

Despite several failed attempts to repeal and replace the Affordable Care Act this year, Republican leaders continue to promise an overhaul — driven in large part by the desire to rescind the ACA's Medicaid expansion and further trim the program. But doing so would leave millions of people, including those experiencing homelessness, without health insurance once again.

I volunteer with Health Care for the Homeless in Baltimore, staffing the help desk and providing clients with information on where they can find food, legal aid and other services. From my experiences, it is clear that Health Care for the Homeless effectively fills a community need. On a recent morning when I was volunteering, an elderly woman entered the building and promptly fainted right in front of me. A physician and nurses raced to her, administered first aid and transported her to an ambulance that would take the woman to a nearby hospital, then they resumed their work, continuing to see patients. Sadly, such an occurrence is common here, as the organization's patients are usually desperately in need of medical care.

In 2016, the agency cared for nearly 10,000 people, offering dental and behavioral health care in addition to primary care and supportive services — including assistance with insurance enrollment, case management and housing services. The only requirement for a person to receive services is that they meet the agency's broad definition of homelessness, or be at risk of doing so.

The agency is a member of the National Health Care for the Homeless Council, along with more than 200 other organizations across the country that collectively cared for 900,000 people experiencing homelessness in 2015, according to the council's 2015-16 annual report. Without such organizations, those who are homeless or on the brink of it would likely have to visit a hospital emergency room for health care.

Health Care for the Homeless' funding comes from three main sources: Medicaid and Medicare reimbursements (60 percent), public and private grants, and donations. Because of Maryland's Medicaid expansion under the Affordable Care Act, the percentage of insured clients at Health Care for the Homeless rose from 30 percent to approximately 90 percent in 2014. The agency's newly expanded ability to bill for reimbursement has enabled it to nearly double its size and reach in the last five years.

But the organization may not be able to sustain that growth under the current administration. An ACA replacement proposal would have rolled back the Medicaid expansion, revoking health insurance for most Health Care for the Homeless clients.

The ACA has major flaws; it is evident that health insurance premiums are rising at an unsustainable rate in some states. But taking health insurance away from groups such as those experiencing homelessness is not the solution. I have seen that those experiencing homelessness need treatment and rehabilitation, access to counseling and preventive care. Otherwise, they are likely to end up in emergency rooms needing urgent aid, and American taxpayers will ultimately have to pay the bills.

Those in Congress should visit organizations like Health Care for the Homeless and speak with the individuals served there, because they are the lawmakers' constituents too. We must hold our representatives to their promise that any health care overhaul will not revoke health insurance from those who currently have it. For the sake of all Americans, it is our duty to ensure that this promise is fulfilled.

Sathvik Namburar is a public health policy student at Johns Hopkins University; his email is snambur1@jhu.edu.

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