Salus Health Care Forum July 2, 2025

Jeremy

I can speak briefly for California. We have a CalAIM program that our Medicaid system has launched. It’s a 10-year strategy, which means it’s very hard to notice change very quickly. I would just say, from a practical purpose, one example would be the evidence that being housed actually improves your health outcomes is fairly substantial. But again, I think the evidence is epidemiological and retrospective in nature. So, I don’t know the prospective studies.

However, most of the health systems are trying to utilize that to get better services because we have the most expensive hospitals on earth. There are hospitals, and for those of us who’ve been doing this for decades, our hospitals have a subpopulation who are homeless. They live in the hospital for months sometimes, spending enough resources to have housed them independently for years.

Craig

One of the great observations of that MacArthur Social Network is essentially that all policy is health policy. Most of what happens in daily life, social circumstances, powerfully affects health in much stronger ways than does healthcare.

Jeremy

And as an example, Bill G, the barriers to manifesting the housing are policies of the 1970s, which are being unraveled as we speak, I think, in this state. We’ll have to see. I’m told that major environmental laws have been reversed in the most recent budget laws that were passed in California, so it’s very hard to tell. But the barriers to housing are so complex that it’s not clear that that policy is going to manifest itself very quickly. But if that’s what’s inducing California to change its building development laws, that would be an example where 10 years from we’ll be able to tell whether any of this stuff is working. This is my guess.

Bill G

Well, it’s going to be very difficult because if the big, beautiful Bill proves successful, a lot of the waivers that allowed funding of those programs under Medicaid, particularly, are going to go away. So, like withdrawal of a lot of research funding, the study will be half completed and we’ll continue to have a debate: It is theoretically very useful, but we don’t have solid evidence that’s going to continue indefinitely under this administration.

Bill B

Jack, I was thinking of your study of rural health. You have families that by some criteria would be considered dysfunctional, that is they come from a lower socioeconomic level, a number of problems, but they have a rural base. They’re in small communities where people do seem to take care of each other. Is there any work, Jack, about the ACE as it operates in rural communities? Do the ACE conditions has a different impact than in suburban and urban communities?