The New Debtor's Prison: Homelessness

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    A stable home. A family. A source of income that they love. The American Dream. That’s what everyone does, should, experience in this day and age. Yet that sadly is not the reality for over 7,500 people in the Portland area alone in Oregon according to the federal homelessness count. Long cold nights with very few places to go. Many are forced to set up camps in really any grassy areas they can find. Then there’s the correlation of mental illness and homelessness to think about. According to an ABC news analysis of U.S. Department of Housing and Urban Development data, in 2022 approximately 50% of the homeless struggled with a severe mental illness of some kind. This suite of mental illness often comes from either due to pre-existing conditions or from the trauma of becoming homeless itself. So the question remains, how does this drastic change in lifestyle come about?

The Problem


    Debt is a fairly pervasive part of American culture, and in the medical sector, especially so. Over 530,000 Americans in 2019 alone filed bankruptcy at least in part due to medical debt (Himmelstein et. al, 2019). Half a million people. These are the bankruptcy cases alone, over one third of the American population has some form of medical debt right at this moment (Lopes et. al, 2022). Those that go bankrupt are much more likely to become homeless due to often also having their house mortgages sold and their credit taking a resulting drop from said medical debt. For instance in Seattle, people who had trouble paying medical bills experienced a more recent episode of homelessness 2 years longer than those who did not (Bielenberg et al, 2020). It’s a cruel reality but the existing one. 


How do we take the next step in solving this issue then?


    Well thankfully there are steps that can be taken on the individual level that can be taken for those stuck in that unfortunate situation. The IRS amusingly enough has a few programs in place that can provide not only free help with filing for tax returns that will actively help you even get a bank account as well as provide Economic Impact Payments, or a stimulus payment, of approximately 1400 USD as of 2021. There are also low to 0 interest medical credit cards that can be used to not only pay for treatment but also over time help raise your credit back up. Also a valid course of action on the individual level is to try and find a medical bill advocate to help read through the fine print as well as help negotiate treatment costs as well as help you navigate an income driven hardship payment plan.


Why should you care?


    The average American life expectancy is approximately 80 years. Those who are chronically homeless? That number sinks to approximately 47. For historical context, this is approximately the same life expectancy as in 1916 America, over a century ago (Datanni et. al, 2023). A century of technological advancements away. Before the Internet, the pop-up toaster, Insulin or even before BAND-AIDs had been invented. All inventions that many of us couldn’t live or imagine living without with how ubiquitous they are in American culture. Should we really be allowing a significant portion of our population to live in that bygone age out of no volition of their own and rather with the massive debt forced on them for trying to live?


Resources

If you’re interested in learning more about this issue or contacting someone to make a difference, here are some resources just for doing that:

https://endhomelessness.org

https://www.multco.us/dd/shelter-and-homeless-services

https://portlandrescuemission.org/news/about-homelessness/new-guide-to-homeless-resources-available/

https://www.tprojects.org/resource-center/




References

Bielenberg, J. E., Futrell, M., Stover, B., & Hagopian, A. (2020). Presence of Any Medical Debt Associated With Two Additional Years of Homelessness in a Seattle Sample. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 57, 004695802092353. https://doi.org/10.1177/0046958020923535


Himmelstein, D. U., Lawless, R. M., Thorne, D., Foohey, P., & Woolhandler, S. (2019). Medical Bankruptcy: Still Common Despite the Affordable Care Act. American Journal of Public Health, 109(3), 431–433. https://doi.org/10.2105/ajph.2018.304901


Lopes, L., Kearney, A., Montero, A., Hamel, L., & Published, M. B. (2022, June 16). Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills. KFF. https://www.kff.org/health-costs/report/kff-health-care-debt-survey/view/footnotes/


Saloni Dattani, Lucas Rodés-Guirao, Hannah Ritchie, Esteban Ortiz-Ospina and Max Roser (2023) - “Life Expectancy” Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/life-expectancy' [Online Resource]

‌News, A. B. C. (2023, October 17). Amount of homeless people with mental illness increased slightly in recent years, but experts say they’re more visible: Analysis. ABC News. https://abcnews.go.com/Health/amount-homeless-people-mental-illness-increased-slightly-recent/story?id=103751677

Older Middle Aged Homeless Dying at Higher Rates. (2022, October 11). Penn LDI. https://ldi.upenn.edu/our-work/research-updates/the-older-middle-aged-homeless-population-is-growing-and-dying-at-high-rates/


People experiencing homelessness can get Economic Impact Payments and other tax benefits | Internal Revenue Service. (n.d.). Www.irs.gov. https://www.irs.gov/newsroom/people-experiencing-homelessness-can-get-economic-impact-payments-and-other-tax-benefits


Point In Time Count reports chronic homelessness in Portland down 17%. (2023, May 10). KOIN.com. https://www.koin.com/news/homeless/point-in-time-count-reports-chronic-homelessness-in-portland-down-17/

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