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Health Reform Will Bring Insurance To Oregon's Homeless

When the Affordable Care Act goes into effect in January, most of Oregon’s homeless people will have health insurance. That means they’ll have access to drug and alcohol treatment, regular doctor visits and counseling. Kristian Foden-Vencil reports.

Jack Alexander takes his medication.

Jack Alexander takes his medication.

Kristian Foden-Vencil/OPB

Jack Alexander used to paint houses.

“I kind of think, that’s what messed my lungs up,” he says. “Because back in the day, we didn’t use respirators or anything like that. You know, spraying stain all over the place.”

Alexander is 51 now. He has a colostomy bag and suffers from emphysema, chronic obstructive pulmonary  disease and a host of other physical and mental health problems. He says he spent about 22 years of his life moving from city to city, chasing painting jobs, drinking and living on the streets.

“There was nowhere for me to hook up my nebulizer. It takes electricity. You can’t get electricity on the streets. Have you ever tried to change a colostomy bag on the streets. Not easy. Not east at all.”

But in 2011, Alexander managed to secure a spot in Bud Clark Commons, an apartment block in Portland for the city’s most vulnerable population. Now he has his own bedroom, kitchen and bathroom. He calls it his “medical home” and he’s happy to give me a tour.

Bud Clark Commons.

Bud Clark Commons.

Kristian Foden-Vencil/OPB

Jack Alexander: “This is my oxygen bottle in case the electrical is off. I turn this on at night when I go to sleep. I put this nodule in my nose so I can breath good. And then over here. I’ll sit here and there’s my nebulizer and my medicines down here and I line them up like soldiers.”

Kristian Foden-Vencil: “You’ve got a box here with maybe 13-14 different bottles and then, on the table, laid out in little piles, maybe 13-14 different pills  — and those are for today.”

Jack Alexander: “This pile I’ll take tonight. This one I’m due to take right now. And this one will be tomorrow morning.”



Kristian Foden-Vencil/OPB

Alexander has both Medicare and Medicaid, because he’s both elderly and poor, and he now feels as if his health is under control. But many homeless people who don’t have insurance will be covered starting in January.

Traci Manning, the director of the Portland Housing Bureau, says that will change things dramatically.

“Having health insurance will prevent some people from becoming homeless in the first place,” Manning says. “Because if you don’t have insurance and you have a serious health care crisis, and perhaps are already struggling to make ends meet, you suddenly have a lot of bills, maybe you start missing a lot of rent. You run through your savings and for some people right now, that may be the cause of their homelessness.”

Manning says that fact that homeless people will have insurance could also free up money for other things. “There is the opportunity for services that are currently provided directly by the public to be paid for directly through Medicaid. Now, quite frankly we don’t know what all of those are yet. That is something that is still being determined.”

Rachel Post of Central City Concern expects the share of the organization’s clientele that has insurance to climb from about 50 percent to more than 90 percent.

“We’re very optimistic,” she says. “The city and county have made statements publicly about repurposing general fund dollars that will be relieved once people are covered by insurance and investing that in perhaps rent assistance, in housing vouchers and support services that aren’t covered by Medicaid.”

Post says the money should be spent on housing, because the relationship between housing and health care cannot be overstated. “Housing is health care. We absolutely have to have people housed in order to address their many health issues.”

Consider the homeless man, she says, who spends days in hospital recuperating from tuberculosis, only to be sent back out to live under a bridge.

Post also believes that having insurance will dramatically change the lives of homeless people.

“What it means is that people with primary addiction disorders will now have access to health care,” she says. “They’ll have access to alcohol and drug treatment programing that previously they didn’t have access to because they just didn’t have enough money for uninsured people to have treatment.”

While it’s the federal government that’s going to be picking up the tab for health insurance, Oregon’s new Coordinated Care Organizations may benefit from a healthier population. In theory, healthier people should cost the health care system less.

Sandra Clark with Health Share — one of those CCOs — says they’re looking at ideas to further help improve the health of the homeless population.

“We’re figuring that out and one of the most important things is to figure that out together and listen, and not pretend like we know,” Clark says.

One idea is to place nurse practitioners at affordable housing projects that see the most 911 calls.

Back at Bud Clark Commons, Jack Alexander takes his afternoon pills and sits down to watch some TV. He’s aware it costs the government about $29 dollars a day to keep a roof over his head. But he was costing the government money when he was living on the streets.

“I was in and out of ER two days a week,” he says. “And now that I’ve been housed here at BCC, I only go to ER maybe once every couple of months, due to my lung disease.”

People like Alexander, who suffer from several chronic aliments, can rack-up thousands of dollars in payments in just one emergency room visit or hospital stay.

The chief of Bud Clark Commons, Rachael Duke, doesn’t know if taking care of Alexander’s housing and health care problems is saving the government any money. But she suspects it is.

“So it costs under $11,000 a year to house someone here at the Bud Clark Commons. If someone reduces their emergency services use by, say, going to the hospital three times in a year, instead of five times in a year, we may have recaptured that cost for public benefit,” Duke says.

Alexander hopes to stay at Bud Clark Commons for a long time. He’s working hard to keep all his doctor appointments and take the right pills at the right time. But he still struggles with smoking.

Providence Health and Services is conducting a study to see whether housing people translates into health care savings. It’s expected to be published early next year.

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