U.S. Senate bill: S. 2986, introduced by Senator Todd Young (R-IN) — Social Determinants Accelerator Act
Committees:
Senate Committee on Finance
Status:
No action has been taken on the bill.
Cosponsors:
2 (see all cosponsors)| Cosponsor | Date Cosponsored |
|---|---|
| Sen. Stabenow, Debbie [D-MI]* | 12/05/2019 |
| Sen. Carper, Thomas R. [D-DE] | 02/24/2020 |
U.S. House bill: H.R. 4004, introduced by Representative Cheri Bustos (D-IL-17) — Social Determinants Accelerator Act
Committees:
House Committee on Energy and Commerce
Status:
No action has been taken.
Cosponsors:
43 (see all cosponsors)Impact
What are social determinants of health (SDoH)? The Department of Health and Human Services (HHS) defines SDoH as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”[i] Changes in social determinants can both improve health and reduce the cost of health care. HHS puts SDOH into five categories: economic stability, education, social and community context, health and health care, and neighborhood and built environment. The lattermost category includes access to foods that support healthy eating patterns, crime and violence, environmental conditions, and quality of housing.[ii]
What would H.R. 4004/S. 2986 do? The legislation would create funding and promote opportunities for state Medicaid agencies to address SDoH by helping states and communities to devise strategies to leverage existing programs and authorities to take into account SDoH. States and local governments are increasingly attempting to monitor and influence SDoH in order to manage health care costs and improve health outcomes within their Medicaid programs.
What prevents states from taking SDoH into account? Perhaps the greatest challenge is the fragmentation and complexity of government programs. H.R. 4004/S. 2986 would advance cross-sector collaboration and planning through the:
Establishment of an inter-agency (SDoH) technical advisory board under the Secretary of HHS, which would authorize nearly $25 million in grants for state, local, and Tribal governments to use in the development of Social Determinants Accelerator Plans that would demonstrate how target populations would benefit from accounting for SDoH.
Why is H.R. 4004/S. 2986 relevant to homelessness? Health care services are more effective and less expensive when vulnerable populations are stably housed, and, in turn, being stably housed is more likely if those vulnerable populations have reliable access to health care services. According to the Center for Disease Control (CDC), people who experience homelessness are at greater risk of infectious and chronic illness, poor mental health, and substance abuse.
Moreover, people experiencing homelessness typically have more complex care needs and utilization patterns that result in costly, often uncompensated charges for hospitals and health systems. Compared with housed patients, homeless patients are 4.5 times more likely to use the emergency room (ER), typically have longer lengths of stay, and are at much greater risk for returning to the ER and being readmitted after discharge.[iii]
How would H.R. 4004/S. 2986 help reduce homelessness? While there are many factors that influence health, stable housing is a key SDoH, one that directly impacts health outcomes as well as the cost of health care. Even the best health care for the homeless is undermined if not negated if that vulnerable population’s health is continually compromised because of lives spent on the streets or in shelters.
Communities that invest in affordable housing incur lower public costs, achieve better health outcomes, and reduce homelessness. In helping states to account for SDoH, the factors that determine the quality of our health and the cost of our health care, H.R. 4004/S. 2986 would ultimately promote better health for the homeless and at a lower cost to taxpayers.
A recent op-ed[iv] concisely lays out the case for H.R. 4004/S. 2986 from the housing and homelessness perspective:
“One reason the United States spends more on health care than any other nation — more than 17 percent of gross domestic product, compared with an average of 9 percent for other advanced economies — is that we spend far less on social services like food stamps, free school lunches and public housing…
“(S)afety net programs can lower health care costs by strengthening what medical professionals call the `social determinants of health’: the environment in which people are born, grow, live and work. Effective social programs provide access to good nutrition, clean and safe shelter and a subsistence income, which are critical to avoiding disease…
“Especially important are programs that ameliorate poor housing conditions and prevent disease, including lead abatement, control of mold and dampness and heating-system repairs…
“But the United States continues to spend a relative pittance on such programs. Housing programs, including rental assistance, public housing and homeless-assistance grants, account for one-quarter of 1 percent of G.D.P…”
Housing First, a successful approach to reduce homelessness which focuses on quickly moving people experiencing homelessness into housing as well as providing them with support services without also requiring extraneous preconditions, is an example of how health for a vulnerable population can be improved while ultimately avoiding higher costs for health care and other services simply by accounting for the key SDoH of housing.[v]
[i] Department of Health and Human Services: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
[ii] Ibid.
[iii] Mandelberg JH, Kuhn RE, Kohn MA. Epidemiologic Analysis of an Urban, Public Emergency Department’s Frequent Users. Academic Emergency Medicine. 2000; 7:637-646.
White BM, Ellis C, Simpson KN. Preventable Hospital Admissions among the Homeless in California: A Retrospective Analysis of Care for Ambulatory Care Sensitive Conditions. BMC Health Services Research. 2014; 14:511-517.
Hwang SW, Weaver J, Aubry T, Hoch JS. Hospital Costs and Length of Stay among Homeless Patients Admitted to Medical, Surgical, and Psychiatric Services. Medical Care. 2011;49(4):350-354.
[iv] The New York Times, Robert Rubin (formerly Secretary of the Treasury, and Kenneth L. Davis is the president and chief executive of the Mount Sinai Health System, “A Secret to Better Health Care” (May 27, 2019).
[v] “Housing First permanent supportive housing models result in long-term housing stability, improved physical and behavioral health outcomes, and reduced use of crisis services such as emergency departments, hospitals, and jails.” Department of Housing and Urban Development: https://files.hudexchange.info/resources/documents/Housing-First-Permanent-Supportive-Housing-Brief.pdf
“Without clinical prerequisites like completion of a course of treatment or evidence of sobriety and with a low-threshold for entry, Housing First yields higher housing retention rates, lower returns to homelessness, and significant reductions in the use of crisis service and institutions…Housing First should be adopted across your community’s entire homelessness response system, including outreach and emergency shelter, short-term interventions like rapid re-housing, and longer-term interventions like supportive housing.” https://www.usich.gov/tools-for-action/housing-first-checklist/
Summary
Activists are asked to urge their Representatives to cosponsor H.R. 4004 and Senators to cosponsor S. 2986, which were introduced with bipartisan support.