What the Supreme Court's Decision on Obamacare Means for Homeless People

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By the latest count, some 107,000 people in America have disabling conditions and experience long periods or frequent episodes of homelessness: they are chronically homeless. As politicians and experts sift through the implications of the Supreme Court's ruling on the Affordable Care Act, it is important we not forget these, the most vulnerable among us. Many suffer from severe mental illness, often co-occurring with physical and substance-related conditions, all exacerbated by life on the street or in shelters.

There is widespread consensus in the policy community about the solutions to chronic homelessness. Chronically homeless people need access to permanent housing, then access to the services they need to treat their illnesses and remain stable in housing. Many, though not all, of these services are health-related. Reforms embodied in the ACA address key problems in our health care system that have most hampered local progress toward alleviating chronic homelessness.

There is a popular assumption that virtually all chronically homeless people are already protected by low-income health care programs like Medicaid. This assumption is wrong. Many are not. Currently, the lack of access to health care and related supports is a major contributor to housing instability. For someone living on the street -- often already dealing with mental illness or addiction -- or someone with health-related burdens in subsidized housing, access to health care makes a considerable difference.

Time will tell how much the expanded funding promised by ACA will do to patch holes in the tattered health care net or whether the additional resources will make the health care system any easier to navigate. However, the expansion of Medicaid could mean that millions without essential health care services, many with serious and disabling illnesses, will gain ready access to care for the first time. What's needed next is a comprehensive effort by all stakeholders to enroll homeless people in the most appropriate health care programs.

Under the ACA, all uninsured citizens with incomes under $15,000 per year will be eligible for Medicaid starting in 2014, assuming they reside in states that opt for generous federal subsidies provided under the Act. This could mean health care coverage for 16 million more low-income people, including up to 2 million people with mental illness and another 2 million with substance use disorders. Many chronically homeless people have a combination of these conditions, and may also be burdened by cardiovascular disease, HIV/AIDS, diabetes, and untreated injuries.

With its focuses on community health and Medicaid improvements, the ACA is an attempt to bring about the systemic changes needed to more effectively meet the health care needs of the poor and uninsured. The legislation not only extends health care coverage to virtually all chronically homeless adults who currently lack it, it also funds community health centers to guarantee access to competent health care providers.

Instead of having to resort to costly, haphazard care in busy emergency rooms when their conditions have become too severe to ignore, those who lack coverage will be able to receive ongoing treatment in more appropriate settings. Like anyone with health insurance, they will have ready access to physicians, prescription drugs, lab tests, mental health services, and more.

Already, the legislation has helped many people. In a little more than two years it has made insurance more accessible for people with pre-existing conditions and channeled millions of dollars to community health centers serving millions of people who otherwise would not have had access health care services.

And for some chronically homeless people that will be enough to lift them out of homelessness into appropriate permanent supportive housing. For others, it will ensure they never become homeless in the first place.

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