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Health care insurer urges Oregon lawmakers to address homelessness crisis in rural areas

AllCare, a Medicaid insurer in southern Oregon, urged state lawmakers to make changes to zoning laws to address homelessness and increase affordable housing. A makeshift campsite for people experiencing homelessness in Salem on Monday, Jan. 29, 2024.
Ben Botkin
Oregon Capital Chronicle
AllCare, a Medicaid insurer in southern Oregon, urged state lawmakers to make changes to zoning laws to address homelessness and increase affordable housing. A makeshift campsite for people experiencing homelessness in Salem on Monday, Jan. 29, 2024.

AllCare, which serves about 70,000 people in southern Oregon, highlighted the lack of affordable housing in its region.

A Medicaid insurer released a report this week on homelessness in southern Oregon that exposes the roots of the problem in rural communities.

Based on its findings, AllCare is urging Oregon lawmakers to ease zoning restrictions so that it’s easier for rural communities with fewer than 10,000 people to build affordable housing. AllCare provides health care coverage for more than 72,000 Oregonians in Jackson, Josephine, Curry and southern Douglas counties through Medicare and Medicaid, which covers low-income people.

Homelessness increased in Oregon by 8.5% between 2022 and 2023, with about 20,000 Oregonians recorded in a point-in-time count last year, according to a Portland State University report. As housing costs have increased, homelessness has also risen.

Homelessness has been a top priority for political leaders. In 2023, the Legislature approved $200 million to address the crisis, and followed that up this session by allocating $376 million for building new homes, adding shelter beds and rental assistance.

But it will take years to ease the crisis, experts say, and in the meantime people without stable housing face multiple issues.

The AllCare report, written by Julie Akins, AllCare’s senior housing director and a former TV journalist, documents the health care and other struggles those who are homeless face. Akins interviewed more than 300 homeless Oregonians who sleep in camps, rest stops, wildlands and crawl spaces of abandoned buildings throughout Josephine, Curry and Jackson counties.

“We have a community responsibility,” Akins said in an interview. “We see our members unnecessarily suffering and dying from conditions that they could get well from as a result of remaining unhoused. “

Her report, buttressed with stories from individuals, demonstrates how life on the streets exacerbates and worsens simple health problems. In one account, Susan, a 70–year-old woman who sleeps in her vehicle, said untreated blisters on her calves turned into an infection.

A former nurse, Susan could not keep the wounds dry, and the infection worsened, attracting maggots. After multiple trips to the emergency room, hospital staff put her in a hospital bed for a week or so.

“We’re spending a ton of money patching people up who are living on the street. We’re spending more money doing that than we would spend if we housed them,” said Akins, also a former Ashland mayor.

Grants Pass in the spotlight

The report, released this week, comes as Grants Pass, a city in AllCare’s service area, prepares for a U.S. Supreme Court case that has ramifications for homeless people across the nation. The case hinges on the question of whether cities should be allowed to arrest or fine homeless people when they are sleeping outside and no beds are available in shelters.

The case stems from a 2018 case filed by advocates against Grants Pass and the arrest of homeless people. It alleged the city was punishing people because they were homeless. The suit came amid the city’s crackdown on homelessness and a ban on sleeping bags and cooking stoves in public places. Violators have faced citations.

The 9th Circuit Court of Appeals sided with homeless advocates, finding that the city’s ordinances were unconstitutional and couldn’t forbid people from sleeping outside when they have no other options. But the city appealed to the U.S. Supreme Court, which has agreed to hear oral arguments for the case on April 22.

Its outcome will determine how much leeway cities have to enact ordinances that target homeless people and try to control where they sleep and live.

A vast problem

The report’s findings challenge common assumptions about homelessness as a problem confined to urban areas like Portland and Salem.

It has spread throughout rural pockets of the state – and among people who are not addicted to drugs, the report said.

Senior citizens living on Social Security checks of less than $1,000 a month are vulnerable and so are many low-income people who are renting. In Jackson County, Akins said 53% of the population is “rent-burdened,” which means a household pays more than one third of its gross income towards housing. They demonstrate a need for 100,000 more affordable homes in Jackson County alone, Akins said.

In comparison, the housing package passed by the Legislature this year includes a goal of building 36,000 homes per year statewide.

That shows that the problem is far from being solved, Akins said. Solutions will be needed across the state, including in the private and public sectors, Akins said, with officials potentially facing resistance from their communities.

“They have the pressure of local communities saying, ‘We don’t want this. This will be a drain on our resources. This will create more traffic. We like our rural, bucolic way of life,’” Akins said. “It takes local authorities expressing a willingness to look at this in light of the vastness of the issue.”

The Oregon Capital Chronicle is a professional, nonprofit news organization. We are an affiliate of States Newsroom, a national 501(c)(3) nonprofit supported by grants and a coalition of donors and readers. The Capital Chronicle retains full editorial independence, meaning decisions about news and coverage are made by Oregonians for Oregonians.

Ben Botkin covers justice, health and social services issues for the Oregon Capital Chronicle. Ben Botkin has been a reporter since 2003, when he drove from his Midwest locale to Idaho for his first journalism job. He has written extensively about politics and state agencies in Idaho, Nevada and Oregon.