Note:
“CalCare for the homeless” refers to the access to healthcare services provided through California’s Medi-Cal program (also known as “CalCare”) specifically designed to support individuals experiencing homelessness, primarily through the “CalAIM” initiative which offers enhanced care management and community supports to address complex needs like housing instability and mental health issues faced by the homeless population in California (AI)
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PUBLIC ADDRESS AT THE FRESNO HOMELESS PERSONS MEMORIAL DAY
by Ron Martin (with Paul Thomas Jackson)
This address advocates passage of AB 2200, to enact Cal Care, single payer health care, important for saving the lives of people experiencing homelessness. It was presented during Homeless Persons Memorial Day at the Eton Park amphitheater on December 21.
Dear Friends:
Our dual purpose today is to advocate a change in public policy, and to memorialize the lives lost in 2024. That is the context of Homeless Persons’ Memorial Day, December 21st, on which communities like ours gather annually. The importance of community and of the social identity each of us possesses impel us to remember the people who died homeless. And my advocacy for change is for passage of Assembly Bill 2200 for single payer health care, to be called Cal Care.
There is one human race. All people across the globe are genetically connected. We are like the cells of one organism. And because we recognize humans are not only individuals but also social creatures, the loss of other human lives in our struggling community holds a special significance for us. We seek to live good lives and believe we can do so properly in a responsive community. Then if we walk by an unsheltered person, whose basic human needs clearly are not being met—as Dr. Sam Tsemberis would say, a small part of us dies.
Today, we recognize the loss of distant relatives, our homeless neighbors, as basic morality directs us to do. Over the last decade, Fresno has made some progress toward that ideal, but this community still has far, far to go to reach it.
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Across all of California, more than 181,000 people were homeless on a given night in 2023.[i] That’s 47 out of every 10,000 people in the general population, about one of every 215 Californians. Also in our state, due to the on-and-off homelessness of many, there has been a shortage of nearly 190,000 shelter beds for homeless individuals who surely need them as they cycle in and out of homelessness. Last year, the number increased by 30,000. There are now nearly 220,000 “too few beds for individuals experiencing homelessness.” [ii] Unsheltered people generally don’t get adequate healthcare. Their lack of access to healthcare ultimately means they’ll die sooner than sheltered homeless people do.
As understood by National Alliance to End Homelessness,[iii] diabetes, heart disease, and HIV/AIDS are found at high rates among the homeless population, sometimes three to six times higher than that of the general population. These chronic diseases explain homeless people’s premature death. Stress is also a factors in this undesirable outcome.
For African American men, for example, stress and inaccessibility of care appear to be factors in the onset and worsening of type 2, adult, diabetes, according to a 2016 study in the American Journal of Men’s Health.[iv] The typical sugary and starchy fare served in most homeless shelters could also be a factor triggering diabetes.
A 2020 study published in JAMA, the Journal of the American Medical Association, concluded:
“[H]aving health insurance is necessary but not sufficient in improving access to care and improving health. Access to care comprises more than just health insurance; available services, timeliness of care, and prescription medication coverage are also important components that may vary across communities . . .” [v]
Assembly Bill 2200 “would enact a comprehensive framework of governance, benefits, program standards, and health care cost controls for a single-payer health care coverage system in California. Passing this policy framework, to be known as CalCare, will allow California to begin consolidating existing health care programs, obtaining necessary federal waivers, and determining public financing.”
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Still, barriers will remain between homeless people and the healthcare services they need. The barriers include “difficulties in keeping appointments, a bad experience of care and the fear of discrimination, or competing priorities, such as food and shelter needs. A 2018 study addresses the overall needs that homeless people have for healthcare:
Homeless people need complex health care, including medical (somatic and mental health care), and psychological, and social support. [Indeed,] They have worse physical and mental health status than housed people, and suffer from higher mortality. This poor health status is marked by chronic conditions, mental health problems, and substance use problems. Prevalence rates for mental disorders go from 30% to more than 60%, and more than 50% of homeless people have concurrent substance addiction and mental disorders. Ye
t they face multiple difficulties in accessing primary health care and receive less preventive health care than the general population. The barriers encountered can be lack of proof of health insurance, difficulties in keeping appointments, a bad experience of care, fear of discrimination, or competing priorities, such as the need for food and shelter . . .” [vi]
Meanwhile, emergency department visits are a poor substitute for primary healthcare, which is properly delivered for prevention and management of a patient’s health by a primary care physician.
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In addition to the trend of increased homelessness the country has been experiencing there is an alarming trend of increasing so-called ‘deaths of despair’: According to Deaton A. Case:
Deaths of despair, morbidity and emotional distress continue to rise in the US, largely borne by those without a college degree, the majority of American adults, for many of whom the economy and society are no longer delivering. Concurrently, all-cause mortality in the US is diverging by education in a way not seen in other rich countries. . . . Pain and despair created a baseline demand for opioids, but the escalation of addiction came from pharma and its political enablers . . . [vii]
To be sure, these are enormous challenges. In the face of those challenges, I propose that AB 2200 will be a step in the right direction—if the Legislature passes it, and the Governor allows or signs it.
Until then, however, homelessness is bringing increased risks of violence and exposure to unsanitary living conditions that tend to increase traumatic incidents, exposure to infectious pathogens, and death.
Even so, at the personal level each individual has a unique set of life experiences. Ron Hall coauthored a book, Same Kind of Different As Me, published in 2006, and then in 2007 produced a Christian drama film. Hall said: “Most people never really sat down and got to know a homeless person but every homeless person is just a real person that was created by God and it is the same kind of different as us; they just have a different story.”
As said by the Canadian-American psychotherapist, author, and educator Asa Don Brown: “Homelessness is not a choice, but rather a journey that many find themselves in.” We here memorialize our homeless neighbors whose journeys tragically ended in 2024.
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[ii] “In 2022 there was a shortage of 187,988 beds. In 2023, this shortage increased by 30,130 beds. There are now 218,118 too few beds for individuals experiencing homelessness.” https://endhomelessness.org/homelessness-in-america/ homelessness-statistics/state-of-homelessness
[vii] Case A, Deaton A. The Great Divide: Education, Despair, and Death. Annual Review of Economics 2022 Aug;14:1-21. doi: 10.1146/annurev-economics-051520-015607. Epub 2022 Apr 1; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9389919/.
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