美国国家公共电台 NPR Obamacare Helped The Homeless, Who Now Worry About Coverage Repeal

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DAVID GREENE, HOST:

We do not know yet if Obamacare will be replaced. As NPR's Pam Fessler reports, one community facing uncertainty¹ are the homeless.

PAM FESSLER, BYLINE²: Joseph Funn was homeless for almost 20 years, and his body took quite a beating living outside. He now sees nurse practitioner³ Amber⁴ Richert fairly regularly at the Health Care for the Homeless Clinic in Baltimore.

AMBER RICHERT: And any chest pains now?

JOSEPH FUNN: I've been like probably closer two weeks, two and a half weeks without any, and that's really good. They were really scary, yo.

RICHERT: And when exactly did you quit smoking?

FESSLER: He says in December when he finally got an apartment. That's a big change for the 56 year old. Last winter, he had to trudge⁵ through deep snow for days until his foot began to swell⁶ so much, he could hardly walk.

FUNN: It was frostbite. So I thought when you had frostbite is like when it turn purple and blue. But when I came to see Dr. Amber, she said, no, that's when they have to cut something off. So I was like whoa, you know? Whoa.

FESSLER: He immediately went to the clinic's convalescent center to be treated, and they got him signed up for Medicaid. Under the Affordable⁷ Care Act, Maryland is one of 31 states that expanded the health insurance program for the poor to cover non-disabled childless adults like Funn. Health Care for the Homeless President Kevin Lindamood says before Obamacare, only 30 percent of their patients had health insurance.

KEVIN LINDAMOOD: Now 90 percent of our clients from 30 percent insured to 90 percent insured either through Medicaid or Medicare. That's a transformation⁸.

FESSLER: One, he says, that's allowed them to open new clinics including one for dental care and to double the number of clients they see. They've also hired more staff to go out and encourage people to come in for help. Homeless advocates have argued that better health coverage⁹ could eventually reduce costly¹⁰ emergency room visits, and that it will help people get off and stay off the street. Lindamood says his clients are now worried.

LINDAMOOD: We're working with very vulnerable people who are now coming to us, hearing the news in general and saying wait a minute. I just got access to care. Does this mean I'm going to lose it?

FESSLER: And no one really knows. Republicans have promised to replace Obamacare, but haven't said how. President Trump¹¹ has said no one will lose coverage, but White House counselor¹² Kellyanne Conway has also said they hope to turn Medicaid into a block grant, meaning states get a set amount of money along with more control over how to spend it. Michael Cannon¹³ of the Libertarian Cato Institute thinks that will ultimately benefit the homeless.

MICHAEL CANNON: I think that's a good case to be made that states will have more money to devote to the truly needy¹⁴ folks because states will be more aggressive in reining¹⁵ in wasteful¹⁶ expenditures¹⁷, reining in unnecessary expenditures, reining in fraud.

FESSLER: But others are skeptical¹⁸. Barbara DiPietro is with the national Health Care for the Homeless Council, a network that serves almost 900,000 homeless patients. She says block grants will likely mean less federal funding forcing cash-strapped states to make tough choices about whom to cover.

BARBARA DIPIETRO: So when we talk about no one will lose coverage, that's heartening. But the details are always very important. What does that coverage look like? The population we serve typically falls through the cracks.

FUNN: I think these are the first pictures I took of it.

FESSLER: Back at the Baltimore clinic, Joseph Funn proudly shows pictures of his new apartment.

FUNN: This is the bedroom there. That's the heater unit. This is the - all the windows go from the floor almost to the ceiling.

FESSLER: He loves that it's so peaceful. One of his biggest problems is stress. Funn says losing Medicaid would be a hardship, but he also thinks there are a lot of people on the streets of Baltimore worse off than he is.

FUNN: I can see them cutting me and giving the money to the people that need the most help.

FESSLER: And his plan right now is to get healthy, so he doesn't need as much help. Pam Fessler, NPR News.