The relationship between housing and health care is a logical connection. Of course, having a roof over your head is a matter of well-being.
But a new study illustrates how that relationship means smart money, as well.
That study, conducted by Enterprise Community Partners and the Center for Outcomes and Research Education, documents the relationship between affordable housing for low-income individuals and the cost of health care.
The study tapped 145 low-income housing properties, with more than 10,000 residents, in and near Portland. The study included people who were formerly or chronically homeless, as well as those in various forms of subsidized housing, including families, permanent supportive housing, and housing for seniors and people with disabilities.
The bottom line: Affordable housing reduces Medicaid costs, in part because patients can avoid high-cost emergency room visits for chronic problems. Compared to the previous year, total health care expenditures were 12 percent less the year after an individual moved into affordable housing. The amount averaged $50 per member per month and, when multiplied by the 1,675 participants in the panel, would result in $936,000 less per year. Nearly $1 million in savings in one year, for just this survey group.
It also meant better preventive care: “After moving into affordable housing, clients used more primary care and had fewer emergency department visits than in the year before they moved in,” the report found. “These changes were most dramatic for people moving into permanent supportive housing.”
Dr. Megan T. Sandel, associate professor of pediatrics at Boston University School of Medicine and a trustee with Enterprise Community Partners Inc., calls housing “a critical vaccine that can pave the way to long-term health and well-being.”
The study’s recommendations for Oregon are fundamental:
• The Oregon Health Authority should expand its current Medicaid waiver to include using Medicaid dollars to invest in the development of affordable housing. Permanent supportive housing and housing for seniors and people with disabilities should be prioritized for use of this funding.
• The Oregon Health Authority should provide incentives for coordinated care organizations and Medicaid payers to use flexible-services dollars for rental assistance, eviction prevention, rapid re-housing, services such as health navigation, benefits enrollment, and improved access to primary care, mental health services and dental care and coordination of these services.
• The state should include housing stability as a metric that should be measured by coordinated care organizations and move forward with development of a methodology by which housing stability, as it relates to health care outcomes and related costs, will be measured.
In fact, no conversation about health care spending can disregard the massive correlation it has with affordable, stable and safe housing. Likewise, the investments made in permanent housing for low-income residents has to be seen in multiple lights.
Today, the crisis-level housing shortage for lower- and middle-income families is the dead weight preventing so many progressive efforts from living up to their potential. It is a roadblock in preserving communities of color in gentrified neighborhoods, where everyone could and should benefit. It is unraveling the financial stability of families despite the larger trend in economic recovery. And most visibly, the lack of affordable housing for lower incomes is a driving force in the rise of homelessness, despite a spectrum of approaches to stem the tide.
The barriers created by the lack of suitable housing are undermining hard-fought systemic changes to how the medical and insurance industries provide and finance health care services. The Affordable Care Act has brought tens of millions of Americans back under the protection of health insurance and has restored primary-care access. In Oregon, we’ve restructured the state’s delivery system to focus resources on coordinated care networks that provide a more holistic approach to healing. But neither can overcome the obstacles created by the critical housing shortage experienced by their clients.
None of these policies can thrive in a vacuum.
Every day, we’re reminded of the connection in real life. It’s time policy caught up. Until our governments and private interests adopt practical and essential guidelines for fulfilling our housing supply needs, we will foolishly continue to shoot holes in one half of our lifeboat, confident we’ll float on, safe and dry, in the other.