Where a person lives can determine all kinds of important health outcomes. So it’s significant that doctors within the Trump administration are now uniquely positioned to make an impact on housing and health outcomes for Americans, according to Dr. Prabhjot Singh. If a person’s living situation is not stable, they are at greater risk of becoming ill. Thus, Singh notes, solutions aiming to improve the health care of Americans must go beyond the physical to include the social, as well.
In recent years, research has demonstrated that there’s a strong relationship between safe and affordable housing and improved health. The findings of a 2013 Federal Interagency Working Group further reinforced the conclusion that improving housing conditions can have a dramatic impact on patients’ health. But despite all we know, our health systems do not address patients' housing needs as a matter of course. That's not what they were designed to do.
However, we now have a unique opportunity for change. President Donald Trump has put physicians in charge of both housing and health — Ben Carson at the Department of Housing and Urban Development and Tom Price at the Department of Health and Human Services — and together they are positioned to address this linkage, improving health and lowering the costs of health care at the same time.
Having two doctors in charge of these agencies would indeed be a unique opportunity to capitalize on a humane and holistic approach to treating the whole person and a could be chance to make serious change—if Carson and Price were doctors who were able to advocate for interventions that could make a difference for people who are struggling. But they are not.
They have no record of doing such things. Carson, in fact, doesn’t believe we should make housing for the poor “too cozy,” lest the poor get lazy and wish to stay. Tom Price believes in denying women access to abortion and as a member of the Georgia State Senate, voted for a constitutional amendment banning same-sex marriage and sponsored a bill to create a Confederate history month, without any mention of slavery whatsoever. These views demonstrate the kind of out-of-touch, cruel thinking synonymous with the Trump approach to governing. So these are not exactly two physicians we can trust to have the people’s interests at heart.
Singh says states should be given the flexibility to use Medicaid funds to support non-health spending. This is a wonderful idea—in theory. But it requires Republicans to see the big picture. And that’s not gonna happen anytime soon.
First, give states more flexibility to use Medicaid funds together with non-healthcare spending. Fortunately, states are in the best position to decide how to rebalance healthcare spending through the use of Medicaid waivers, which were created under the Affordable Care Act to accelerate state-led innovations. States can then use Medicaid funds to support housing-related health programs. The federal government should ensure that we’re learning from their success and challenges, by resolving the significant barriers to sharing data between healthcare and social services.
Currently, Republicans are doing things like rejecting Medicaid funds completely in certain states like Iowa in order to do things like put family planning programs in place so women cannot use their state insurance at any providers that offer abortion services. So what would make one think that they might be willing to use Medicaid waivers to support housing-related health programs? Especially when Trump’s housing budget looks to cut a range of programs related to infrastructure and economic development, which could help lift people out of poverty.
Ultimately, the right combination of infrastructure development, programs that bridge the health and housing divide, and supportive policies are best determined at the state and local level. However, Dr. Carson and Dr. Price have a critical role to play in removing the payment, data and policy roadblocks that make addressing health care and housing needs in an integrated fashion nearly impossible.
Without a more comprehensive approach, physicians like myself will continue to watch people needlessly suffer.
Dr. Singh is right. In a country as rich as the United States, where someone lives should not determine health outcomes. And supportive policies that address health care and housing needs are a step in the right direction, but they need smart lawmakers to champion them. Sadly, with this administration, they are unlikely to occur. We deserve better when it comes to health care in this country. It’s too bad the Electoral College didn’t pick a better president.