When I first moved to the San Francisco Bay Area in California, one thing that struck me, aside from the beauty of the Golden Gate Bridge, was the prevalence of homelessness in San Francisco. Interspersed with the quaint Victorian houses, stunning views of the bay, and the various popular tourist spots, was the homeless population that San Francisco, as well as the state of California, has become notorious for.
According to the Legislative Analyst’s Office Report (LAO, 2020), there are an estimated 151,000 homeless people in California. Given these numbers, one would think that California does not have a policy or program that aims to end homelessness, but it actually does. Housing First is a homelessness policy that was implemented in California in 2016. The priority of Housing First is to provide permanent housing to individuals or families who are experiencing homelessness without requiring them to first seek help for the problems that led to their homelessness, including behavioral health issues. There is also no requirement for people to first participate in programs before they can access housing. Through Housing First, individuals or families with chronic illnesses, disabilities, mental health issues, or substance abuse issues are provided long-term rental assistance, and short-term rental assistance is provided to other individuals or families. (National Alliance to End Homelessness, 2016)
Housing First looks promising on paper, and the National Alliance to End Homelessness wrote in 2016 that there was a large and growing evidence that the policy was effective, but the current homeless statistics say otherwise. In 2019, California homelessness went up 16.4%, with homelessness in Los Angeles up by 16%, in San Francisco by 18%, and in Sacramento by 19%. (Flanagan & Steeb, 2020) I believe these numbers because when I am walking on the streets of San Francisco, I can see that the homeless population has grown since I moved here almost 10 years ago.
Flanagan & Steeb (2020) wrote that the reason Housing First is not working is that it separates housing and health services. Housing First does not require that mental health, substance abuse issues, and other underlying causes of homelessness be addressed, so California non-profits that couple housing with participation in health services are not eligible for government funding.
There is also the matter of a lack of affordable housing that can be accessible to households whose incomes are at or below the poverty level. 22% of renter households are considered extremely low income, and the figure for the shortage of affordable rental homes is a dire -998,613. (National Low Income Housing Coalition, 2018)
One obvious policy change that Housing First should adopt is to prioritize health services along with housing. Start by providing funding to non-profit organizations that offer services for homeless people who have mental health or substance abuse problems. About one-third of homeless people have serious mental health problems (Wiener, 2020), so it does not make sense to offer housing alone without expanding access to mental health services.
This leads me to discuss the bigger problem with health care for both medical and mental health issues; it can be quite unaffordable to people without insurance. Insurance, meanwhile, is generally tied to people’s employment status. So, what happens to people who lose their jobs and then consequently lose their homes along with their access to health care services because they no longer have a source of income? According to a report from the Homelessness Policy Research Institute (2020), 46% of homeless adults in Los Angeles county cited unemployment or financial reasons as the cause of their homelessness. Financial reasons include the burden of medical bills. If unemployment leads to homelessness, and homelessness cannot be solved without access to affordable health care that can only be provided if people have employer-subsidized insurance, then how will the vicious cycle end?
I believe that one major policy that not only California but also the entire country should implement is universal health care coverage. It is more controversially referred to as Medicare for All, which I am a big proponent of. This issue has been so heavily debated during the election, and it is unknown whether it will ever come to fruition in this country. Universal health care, national health plan, single-payer system, Medicare for All, or whatever term one may choose to call it, is a system that will offer comprehensive health care that is free at the point of care for everyone in the country, no matter what their employment status and economic status are. The World Health Organization (WHO, 2021) defines universal health care as health care coverage where “All people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.” The cost of Medicare for All is one of the main points of contention about its feasibility, but a study concluded that a single-payer, universal health care system will likely lead to 13% in savings, or more than US$450 billion annually, on health care expenses. (Galvani et al., 2020)
Again, I understand that this is a controversial issue, but I advocate strongly for the adoption of a universal health care policy because I believe that it will go a long way towards helping solve the homeless problem.
Legislative Analyst’s Office. (2020, February 11). The 2020–21 Budget: The Governor’s Homelessness Plan. https://lao.ca.gov/Publications/Report/4152
National Alliance to End Homelessness. (2016). Fact sheet: Housing First. https://endhomelessness.org/wp-content/uploads/2016/04/housing-first-fact-sheet.pdf
Flanagan, D. & Steeb, M. (2020, March 8). California is its own worst enemy when it comes to homelessness. But here’s how the state can start to make real change. Cal Matters. https://calmatters.org/commentary/2020/03/california-homeless-housing-first-policy-is-failing/
National Low Income Housing Coalition. (2018). California. https://nlihc.org/housing-needs-by-state/california
Wiener, J. (2020, February 19). Inside the governor’s bid to fix homelessness: changing how California deals with mental illness. Cal Matters. https://calmatters.org/health/breakdown-mental-health/2020/02/mentally-ill-homeless-force-treatment-california-newsom-state-of-state/
Homelessness Policy Research Institute. (2020, August 24). Homelessness and Employment. https://socialinnovation.usc.edu/wp-content/uploads/2020/08/Homelessness-and-Employment.pdf
World Health Organization. (2021). Universal Health Coverage. https://www.who.int/health-topics/universal-health-coverage#tab=tab_1
Galvani, A.P., Parpia, A.S., Foster, E.M., Singer, B.H., & Fitzpatrick, M.Z. (2020). Improving the prognosis of health care in the USA. The Lancet, 395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3