In a country where healthcare is not guaranteed as a right, health crises represent a significant pathway into homelessness. Unexpected illnesses, injuries, or chronic health conditions can quickly deplete financial resources, reduce earning capacity, and create insurmountable debt—all factors that increase vulnerability to housing loss.
The Scale of the Problem
The connection between health issues and housing instability affects millions of Americans:
- Approximately 66% of all bankruptcies in the United States are tied to medical issues—either high costs of care or time away from work
- Over 100 million Americans (41% of adults) have healthcare debt, with nearly 1 in 5 owing more than $10,000
- A survey of people experiencing homelessness found that 66% identified a health issue as a contributing factor to their housing loss
A Uniquely American Problem
The pathway from health crisis to homelessness is far less common in countries with universal healthcare systems, where medical care doesn't create financial catastrophe. This highlights how this pathway is largely a product of policy choices rather than an inevitable outcome of illness or injury.
How Health Crises Lead to Homelessness
Health issues can trigger homelessness through several interconnected mechanisms:
Direct Financial Impact
- Medical bills: Even with insurance, out-of-pocket costs can be substantial
- Ongoing treatment costs: Chronic conditions require continuous expenditure
- Medication expenses: Prescription drugs, especially for chronic conditions, can cost hundreds or thousands of dollars monthly
- Specialized equipment or home modifications: Often not fully covered by insurance
Income Disruption
- Inability to work: Health conditions may temporarily or permanently reduce earning capacity
- Inadequate sick leave: Many workers, especially in low-wage jobs, have limited or no paid sick time
- Job loss: Extended absences or inability to perform job functions can lead to termination
- Reduced hours: Some may need to scale back work due to health limitations or treatment schedules
Insurance Complications
- Loss of employer-based insurance: When health issues lead to job loss, insurance often ends too
- High deductibles and co-pays: Even insured individuals face significant out-of-pocket costs
- Coverage gaps: Many treatments, medications, or services may not be covered
- Claim denials: Insurance companies may refuse to cover certain treatments
The Cascade Effect: From Health Crisis to Homelessness
The path from health crisis to homelessness typically involves a cascade of events:
- Initial health crisis: Illness, injury, or diagnosis of a chronic condition
- Financial strain: Medical bills accumulate while income may decrease
- Difficult choices: Paying for healthcare versus other necessities like housing
- Depleted savings: Using emergency funds to cover medical or living expenses
- Accumulating debt: Credit cards, medical debt, borrowed money from family/friends
- Housing instability: Falling behind on rent or mortgage payments
- Housing loss: Eviction, foreclosure, or forced move to seek cheaper accommodations
At each stage, the lack of adequate safety nets allows the crisis to escalate toward housing loss.
Vulnerable Populations
Some groups face heightened vulnerability to this pathway:
Uninsured and Underinsured
- Approximately 27.5 million Americans lack health insurance
- Millions more are "underinsured" with high deductibles and limited coverage
- Those without insurance face the highest medical costs and greatest financial risk
Low-Wage Workers
- Often lack benefits like paid sick leave or short-term disability
- Have fewer financial reserves to weather a health crisis
- May work in physically demanding jobs with higher injury risks
People with Disabilities
- Face ongoing healthcare costs and potential employment limitations
- Often experience long waiting periods for disability benefits
- May require specialized housing that is more expensive or limited in availability
Older Adults
- More likely to develop health conditions requiring expensive care
- May have limited income after retirement
- Often face age discrimination when seeking new employment
The Disability Trap
For many with serious health conditions, the path to receiving disability benefits creates a dangerous gap period. Social Security Disability Insurance (SSDI) has a five-month waiting period before benefits begin, and the application process often takes years. During this time, people may have neither income nor healthcare coverage, creating extreme vulnerability to homelessness.
Common Health Conditions Associated with Housing Loss
While any health crisis can potentially lead to homelessness, certain conditions create particularly high risk:
Catastrophic Injuries or Illnesses
- Traumatic injuries: Car accidents, workplace injuries, falls
- Cancer: Treatment costs can exceed $100,000 annually
- Stroke or heart attack: Can create both immediate costs and long-term disability
Chronic Conditions
- Diabetes: Ongoing costs for insulin, supplies, and management of complications
- Autoimmune disorders: Often require expensive medications and frequent medical care
- Heart disease: Medications, procedures, and lifestyle modifications
Mental Health Conditions
- Major depression: Can impair ability to work and maintain housing
- Bipolar disorder: May create periods of inability to maintain employment
- Schizophrenia: Often requires intensive treatment and support
Substance Use Disorders
- Can develop as a response to chronic pain or mental health issues
- Treatment is often expensive and not fully covered by insurance
- May lead to job loss and strained relationships that increase housing vulnerability
Medical Debt: A Growing Crisis
Medical debt has become a significant driver of housing instability:
The Scale of Medical Debt
- Americans collectively owe at least $195 billion in medical debt
- Medical debt is the most common form of debt in collections
- Unlike other forms of debt, medical debt often comes from necessary, unavoidable expenses
Impact on Housing
- Medical debt damages credit scores, making it harder to secure housing
- Debt collection actions can garnish wages, reducing income available for housing
- The stress of medical debt can exacerbate health conditions, creating a vicious cycle
The Bidirectional Relationship: Homelessness Worsens Health
Once homelessness occurs, health typically deteriorates further:
- Exposure to elements and unsafe conditions creates new health problems
- Limited access to nutritious food compromises immune function
- Difficulty maintaining medication schedules and storing medications properly
- Challenges accessing preventive care and managing chronic conditions
- Increased stress, which negatively impacts both physical and mental health
This creates a dangerous cycle where homelessness caused by health issues leads to worsening health, making it even harder to exit homelessness.
Prevention and Intervention Strategies
Several approaches can help prevent the pathway from health crisis to homelessness:
Policy-Level Solutions
- Universal healthcare: Eliminating or significantly reducing out-of-pocket medical costs
- Expanded Medicaid: Closing coverage gaps for low-income individuals
- Paid sick leave: Ensuring workers don't lose income during illness
- Disability benefit reform: Reducing waiting periods and streamlining application processes
Community-Level Interventions
- Medical-legal partnerships: Helping patients navigate insurance denials, medical debt, and housing issues
- Hospital-based housing programs: Identifying patients at risk of homelessness and connecting them with resources
- Medical debt forgiveness programs: Reducing or eliminating debt that threatens housing stability
Individual-Level Support
- Emergency financial assistance: Helping cover rent during health crises
- Case management: Coordinating healthcare, benefits, and housing services
- Benefits navigation: Assisting with applications for disability, Medicaid, and other programs
Promising Model: Medical Respite Care
Medical respite programs provide temporary accommodations for homeless individuals who are too ill or frail to recover from illness or injury on the streets but not sick enough to remain hospitalized. These programs not only improve health outcomes but also create opportunities to connect patients with permanent housing solutions.
Conclusion
Health crises represent a significant pathway into homelessness in the United States, reflecting the consequences of a healthcare system that leaves many vulnerable to financial catastrophe when illness or injury strikes. The connection between health and housing stability highlights the need for both healthcare reform and stronger safety nets to prevent medical issues from escalating to housing loss.
By addressing the gaps in healthcare coverage, improving income protections during illness, and creating better coordination between healthcare and housing systems, we can reduce the number of people who lose their homes due to health crises.
Key Takeaway
In a system where healthcare is treated as a commodity rather than a right, health crises will continue to be a major driver of homelessness. Effective solutions must address both immediate needs of those facing medical-related housing instability and the structural reforms needed to prevent healthcare from becoming a financial catastrophe that leads to homelessness.
References & Further Reading
- Himmelstein, D.U., et al. "Medical Bankruptcy: Still Common Despite the Affordable Care Act." American Journal of Public Health, vol. 109, no. 3, 2019, pp. 431-436. https://doi.org/10.2105/AJPH.2018.304901
- KFF (Kaiser Family Foundation). "Americans' Challenges with Health Care Costs." KFF, 2023. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/
- Consumer Financial Protection Bureau. "Medical Debt Burden in the United States." CFPB, 2022. https://www.consumerfinance.gov/data-research/research-reports/medical-debt-burden-in-the-united-states/
- U.S. Census Bureau. "Health Insurance Coverage in the United States." U.S. Census Bureau, 2023. https://www.census.gov/library/publications/2023/demo/p60-278.html
- National Health Care for the Homeless Council. "Medical Respite Care." NHCHC, 2023. https://nhchc.org/clinical-practice/medical-respite-care/
- Social Security Administration. "Disability Benefits." SSA, 2024. https://www.ssa.gov/benefits/disability/
- Doran, K.M., et al. "Housing as Health Care—New York's Boundary-Crossing Experiment." New England Journal of Medicine, vol. 369, no. 25, 2013, pp. 2374-2377. https://doi.org/10.1056/NEJMp1310121
- Woolhandler, S. and Himmelstein, D.U. "The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?" Annals of Internal Medicine, vol. 167, no. 6, 2017, pp. 424-431. https://doi.org/10.7326/M17-1403
- National Alliance to End Homelessness. "Health and Homelessness." National Alliance to End Homelessness, 2023. https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/health/