Homelessness and Urban Sustainability: Implications of Changes to the US Health System on a Vulnerable Population

Homelessness has been found to both cause and exacerbate serious health conditions, including cardiovascular disease, diabetes, and HIV/AIDS. In addition, the prevalence of mental illness and substance use along with co-occurring chronic health conditions is significantly higher in homeless individuals, which has implications for the delivery and cost of services for this population. Individuals who are homeless are more likely to rely on emergency care due to a lack of health coverage and pose a significant cost to the health care system.  Changes to the health care system under the Affordable Care Act (ACA), particularly expansion of Medicaid to uninsured, low-income adults, could significantly benefit this population; however, concerns related to access and the effect on diverse homeless populations must be considered.  On November 12, 2014, the National Academies, in collaboration the National Alliance to End Homelessness and the National Health Care for the Homeless Council, convened a workshop titled Homelessness and Urban Sustainability:  Implications of Changes to the US Health System on a Vulnerable Population.  The workshop focused on the impact of the changing US health care system under the Affordable Care Act (ACA) on the homeless population in urban areas.  The goal of the workshop was to identify models of success as well as challenges in using the ACA as a tool to decrease homelessness, increase health care enrollment, and improve health outcomes and the lives of homeless individuals.  The presentation will summarize discussion at the workshop on actionable opportunities as well as challenges in utilizing the ACA as a tool to address the problem of chronic homelessness.