The Health of the Homeless - Problems In Treating The Homeless

To understand why health care may not be readily available to the homeless population, one must look at American health care in general. In "U.S. Health-Care System Faces Cost and Insurance Crises: Rising Costs, Growing Numbers of Uninsured and Quality Gaps Trouble World's Most Expensive Health-Care System" (The Lancet, August 2, 2003), Michael McCarthy described a system "lurching towards crisis." Costs continue to rise, as do the numbers of people who do not have insurance. The Census Bureau noted in 2004 that the number of Americans living below the poverty line increased by 1.3 million in 2004, and the number of uninsured Americans grew by 1.4 million.

McCarthy noted that while most hospitals by law must provide care for the indigent, in reality an uninsured patient is less likely to receive any care at all and, if hospitalized, is less likely to receive the same quality of care as an insured patient. He cited a 2002 study by the U.S. National Academy of Sciences Institute of Medicine (Care without Coverage: Too Little, Too Late, National Academies Press). That study found that "uninsured patients who are hospitalized for a range of conditions are more likely to die in the hospital, to receive fewer services when admitted, and to experience substandard care and resultant injury than are insured patients."

Medicaid

Medicaid is the federal health insurance program for low-income families with children, among others. In "'I Abhor the Status Quo': HHS Secretary Tommy G. Thompson's Plan to Revamp the Healthcare Industry" (Michael T. McCue, Managed Healthcare Executive, March 2003), Tommy Thompson, Secretary of Health and Human Services, described Medicaid as an outdated system that does not adequately serve the mentally or chronically ill, people with substance abuse problems, or childless adults (who make up a significant portion of the homeless population).

Medicare payments to physicians were cut in the early 2000s. Projections prepared by the Office of the Actuary for the Centers for Medicare and Medicaid Services indicated that Medicare will reduce payment rates to physicians by about 5% each year for seven years, beginning in 2006 ("Johnson Announces Hearing on Medicare Payments to Physicians," Press Release, Committee on Ways and Means, Subcommittee on Health, February 3, 2005). As a result of these cuts, some medical providers turned Medicaid patients away. A survey by the American Medical Association found that the number of physicians who said they planned to participate in the Medicare program in 2003 was down to 83%, 9% lower than the previous year (92%). Almost one-quarter of physicians had scaled back on the number of Medicare patients they would treat (American Medical Association: "Research Brief on Medicare Physician Payment Cut Survey," 2002). As a result, access to health care for many low-income people has been compromised.