The Week in Brief: Treatment Tops Housing in Trump Homeless Policy

Plus: A $7,000 colonoscopy bill; when physical therapy coverage runs out; federal health workers are struggling with their mental health; Medicaid cuts; tooth decay; psychedelic mushrooms; our best of social; the KFF Health News Minute; and more

View in browser Not a subscriber? Sign Up Friday, March 28, 2025 Visit KFF Health News for the latest headlines The Week in Brief Drug Use, Mental Illness Shape Trump Policy on Homelessness (ERIC THAYER / BLOOMBERG VIA GETTY IMAGES) Hi. I'm Angela Hart, KFF Health News senior correspondent based in Sacramento, California. I'm tracking the state and national shift in homelessness policy. Send me tips at ahart@kff.org.   By Angela Hart   Is homelessness a mental health and addiction crisis, or is it driven by an affordable housing crisis? That question underpins the debate among policymakers and politicians struggling to move people off the streets faster than they become homeless.   Researchers say housing is the most important intervention to end homelessness, and now a report from the University of California-San Francisco sheds deeper insight: While California's high housing costs and low incomes drive people into homelessness, those with behavioral health conditions face added risk of becoming homeless. And once people lose housing, homelessness makes them more likely to use drugs or experience a mental health problem.   The report found that nearly half of homeless adults in California have a serious mental health condition or use drugs or alcohol, and 42% of people who regularly use drugs began doing so after becoming homeless.   "Complex behavioral health needs, including substance and mental health problems, increase the risk of becoming homeless, and homelessness exacerbates these problems," said Margot Kushel, director of the Benioff Homelessness and Housing Initiative at UCSF.   Kushel and others argue that housing and supportive services are critical. Instead, President Donald Trump is pushing a treatment-first approach.   During his campaign, Trump called for relocating homeless people to large camps and forcing treatment, a punitive approach that he says will come with jail time if people refuse.   Now in office, Trump has launched a broad assault on "Housing First."   The nationwide anti-homelessness policy, aimed at getting people into permanent housing, was created under President George W. Bush and for decades has steered federal funding into housing and social service programs.   Already, city and county officials are being told that the federal Department of Housing and Urban Development "will not enforce" homelessness contracts if they follow the Housing First model. And as Trump officials seek major funding cuts, the president this month issued an order shrinking the U.S. Interagency Council on Homelessness, which was established under President Ronald Reagan to coordinate homelessness initiatives around the nation.   The focus has been on offering housing and voluntary treatment, even if those promises elude too many people. Now, those programs will be eroded.   Democratic U.S. Rep. Maxine Waters of Los Angeles warns: "Make no mistake that Trump's reckless attacks across the federal government will supercharge the housing and homelessness crisis in communities across the country." Bill of the Month He Had Short-Term Health Insurance. His Colonoscopy Bill: $7,000. By Julie Appleby After leaving his job to launch his own business, an Illinois man opted for a six-month health insurance plan. When he needed a colonoscopy, he thought it would cover most of the bill. Then he learned his plan's limited benefits would cost him plenty. Read more from our 'Bill of the Month' series: https://kffhealthnews.org/news/tag/bill-of-the-month/ Do you have a medical bill that is exorbitant, baffling, infuriating, or all of the above? Send it to us and tell us about your experience: https://kffhealthnews.org/send-us-your-medical-bills/ Broken Rehab Their Physical Therapy Coverage Ran Out Before They Could Walk Again By Jordan Rau Health plans limit physical or occupational therapy sessions to as few as 20 a year, no matter the patient's infirmities. The limits persist despite federal rules banning insurers from setting annual dollar limits on the care they will provide. Best of Social The Trump administration is cracking down on diversity, equity, and inclusion programs. These Instagram slides break down the effects on already plummeting diversity at medical schools. After the Supreme Court's 2023 decision banning the consideration of race in college and university admissions, enrollment of Black, Hispanic, and Indigenous medical school students dropped by double digits this academic year. Experts worry the worst is to come. Follow KFF Health News online as we break down health care headlines: Mental Health 'I Am Going Through Hell': Job Loss, Mental Health, and the Fate of Federal Workers By Rachana Pradhan and Aneri Pattani; Illustration by Oona Zenda Since the Trump administration began firing federal workers, they say they feel overwhelmed, have obtained or considered seeking psychiatric care and medication, and are anxious about paying their bills. And soon, their health insurance will run out. Talk to us: We'd like to speak with personnel from the Department of Health and Human Services or its component agencies about what's happening within the federal health bureaucracy. Please message us on Signal at (415) 519-8778 or get in touch here. Public Health With Few Dentists and Fluoride Under Siege, Rural America Risks New Surge of Tooth Decay By Brett Kelman The anti-fluoride movement has more momentum than ever. In rural counties with few dentists, tooth decay could surge to levels that have not been seen in decades, experts warn.   Current, Former CDC Staff Warn Against Slashing Support to Local Public Health Departments By Jess Mador, WABE Public health and science researchers are concerned about the Trump administration's cuts to the Centers for Disease Control and Prevention. Reductions in staff and budgets could undermine the nation's ability to respond to threats, they say. The Trump Administration KFF Health News' 'What the Health?': The Ax Falls at HHS Health and Human Services Secretary Robert F. Kennedy Jr. has announced a proposed reorganization for the department — which, counting those who already have left the agency, amounts to about a 25% cut in its workforce. And its planned "Administration for a Healthy America" will collapse several existing HHS agencies into one. Meanwhile, the department continues to cut billions in health spending while the nation faces measles outbreaks in several states and the continuing possibility of another pandemic, such as bird flu. Alice Miranda Ollstein of Politico, Maya Goldman of Axios, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico join KFF Health News' Julie Rovner to discuss the news. This Week's KFF Health News Minute Recent firings at the CDC could make it harder to control infectious disease outbreaks, and hoarding disorder can be especially dangerous for older people. Listen to Jackie Fortiér ▶️ Medicaid Bill That Congressman Says Protects Medicaid Doesn't — And Would Likely Require Cutting It By Julie Appleby U.S. Rep. Nick LaLota, a Long Island Republican, told his constituents that he voted for the House-passed GOP budget resolution because it protects Medicaid, Medicare, and Social Security. However, the bill charges a committee with making cuts that likely can't be attained without slashing Medicaid.   Many People With Disabilities Risk Losing Their Medicaid if They Work Too Much By Tony Leys As politicians demand that more Medicaid recipients work, many people with disabilities say their state programs' income and asset caps force them to limit their work hours or turn down promotions. More from KFF Health News Montana Examines Ways To Ease Health Care Workforce Shortages By Sue O'Connell Bills before the legislature would license community health workers and make it easier for some other health professionals licensed in other states to do business in Montana.   The Colorado Psychedelic Mushroom Experiment Has Arrived By Kate Ruder With the first licenses for providing psychedelic mushrooms issued, excitement and questions build about the fungi's potential, affordability, and safety in the Centennial State. KFF Health News On Air Journalists Demystify Bird Flu, Medicaid Work Requirements, and Reproductive Health Research KFF Health News journalists made the rounds on national and local media recently to discuss topical stories. Here's a collection of their appearances. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.    (c) 2025 KFF. All rights reserved. KFF & KFF Health News  185 Berry Street, Suite 2000, San Francisco, CA, 94107, (650) 854-9400 Opt out of all KFF emails | Manage subscriptions