Expanding Medicaid in the United States may help reduce the rate of eviction by lowering the cost of healthcare for low-income people and giving renters a better shot at keeping up with housing costs, according to a new study published in the journal Health Affairs.
Researchers at Columbia University and Boston University analyzed eviction data in 51 California counties before and after the state’s expansion of Medicaid in 2011 and 2012, following the passage of the Affordable Care Act. They compared that data to eviction records in 14 other states that did not expand Medicaid. (By comparing before-and-after records from multiple states, they attempted to control for some of the influence of other factors, like changes in the housing market.) After Medicaid expansion, they found, California counties had “significantly fewer total numbers of evictions” — and “expansion was associated with 24.517 fewer evictions per month in each county, compared to a pre-expansion mean of 224.718 evictions per month.”
“Poor health can be a contributor to eviction when people with limited resources cannot afford both housing and medical care … . Medicaid may mitigate the risk of eviction directly by reducing the cost of medical care and indirectly by protecting earning potential through better health,” the researchers write.
The new research answered a call from the Russell Sage Foundation to study the social, economic and political effects of the ACA, also known as Obamacare, according to lead author Heidi L. Allen, an associate professor at the Columbia School of Social Work. Another study by the same team published in the American Journal of Public Health in September found reductions in nationwide eviction rates that were associated with Medicaid expansion. And some of the same researchers also published a related study in 2017 showing that Medicaid expansion in California was associated with reduced payday borrowing among low-income people. Allen, who began her career as a social worker in a hospital emergency department, was also an investigator with the Oregon Health Insurance Experiment, a series of randomized controlled trials monitoring the impacts of health insurance expansion on low-income people.
“[The reduced eviction rate] wasn’t surprising to me because we knew from prior work — pretty definitively — that Medicaid is good for the finances of low-income people,” says Allen. “And I knew from working with low-income populations and growing up in a low-income family myself how tight the financial margins that low-income families are operating under are.”
The study was published in Health Affairs amid growing national recognition that eviction is a cause of poverty, and not just one of its outcomes, as illustrated by the work of the Eviction Lab and Princeton University sociologist Matthew Desmond. Tenants’ rights movements around the country have focused on limiting evictions in various ways, by pushing for rent control to keep costs down and promoting rules that prevent landlords from evicting tenants without just cause. Some efforts, like the national Homes Guarantee campaign, have started drawing explicit connections between healthcare costs, eviction, housing instability and homelessness.
“Health insurance is fundamentally a financial product,” says Tal Gross, an associate professor in the Department of Markets, Public Policy and Law at Boston University and co-author of the Health Affairs report. “It doesn’t directly affect healthcare so much as who pays for healthcare, and it affects the price of healthcare.”
In other words, the expansion of Medicaid in places like California is primarily a financial benefit to low-income people, Gross says.
“They’re still suffering and getting sick and missing out on work,” Gross says. “But they’re not getting hit with that big bill. So that means they’re less likely to end up not paying rent.”
Healthcare — and, to a lesser degree housing — has become an issue once again in the Democratic presidential primary campaign this year. Some candidates have emphasized the ways that a lack of access to affordable health insurance has been detrimental to low-income people’s lives, either physically or financially or both. After the passage of the ACA, some states declined to expand Medicaid to more people, even though under the law, the federal government would cover 90 percent of the cost. Some of those states, like Florida and South Carolina, are dealing with a range of problems related to the lack of affordable housing for low-income residents.
The report “contributes to an existing body of literature suggesting that one of the principal benefits of Medicaid expansion is related to protection from encumbering medical debt, leading to improved financial well-being,” the authors write. Allen says one limitation of the research that she’d like to know more about is how access to expanded Medicaid impacts the lives of people who actually have gone through eviction.
“I’m interested in economic policies that can improve health, and health policies that can improve the finances of low-income families,” says Allen. “We know that low-income people make really tough choices every month, but losing your housing is a really big deal. So the fact that money saved from spending on healthcare would be used on housing doesn’t surprise me at all.”
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Jared Brey is Next City's housing correspondent, based in Philadelphia. He is a former staff writer at Philadelphia magazine and PlanPhilly, and his work has appeared in Columbia Journalism Review, Landscape Architecture Magazine, U.S. News & World Report, Philadelphia Weekly, and other publications.