In March, President Trump released his FY 2019 budget request, which proposed a steep cut in funding for the Department of Housing and Urban Development (HUD), the federal agency responsible for administering a range of programs that provide subsidized housing to roughly 9.8 million low-income Americans. In the request, HUD’s budget would be reduced by $8.8 billion—an 18.3 percent cut from what it was in 2017. The request also eliminates several grant programs and other initiatives that help fund the construction of affordable housing. Then in April, HUD outlined a proposal that would increase the portion of income that tenants in HUD-assisted housing are required to pay towards rent from 30% to 35%. HUD’s housing assistance programs currently serve only 1 in 4 eligible households.
If enacted, these changes would likely result in the loss of federal housing assistance for hundreds of thousands of individuals and families and rent increases for millions of others. There is also good reason to believe that reducing the number of households who receive HUD housing assistance will negatively impact population health.
A growing body of research shows housing to be an important social-determinant of health, and housing assistance is likely to promote better health by providing low-income households with housing that is more stable, of higher quality, more affordable, and located in better neighborhoods than they would otherwise be able to access. Indeed, a recent study demonstrated that access to certain HUD-funded housing assistance programs is associated with better overall health and psychological well-being among adults. A second study conducted by the same team of researchers linked receipt of HUD housing assistance with higher rates of health insurance coverage and lower rates of unmet medical need due to cost. Apart from their role in promoting the basic human and economic security of a substantial number of American households, these findings point to the potential of using HUD’s low-income housing assistance programs as a powerful lever to promote health and reduce health disparities. At the same time, they underscore the potential harm that might result from cuts to these already scarce benefits.
Existing evidence is less clear about the health effects of increasing required rent payments from people receiving housing assistance. Theory suggests that such a change, which effectively reduces the monetary value of housing assistance, would harm health by decreasing the amount of resources that families might otherwise spend on medical care or health-promoting goods and services such as food and medicine or by hurting their ability to save and weather unpredicted events such as periods of unemployment or a natural disaster.
Unfortunately, there have been limited attempts to test this theory with rigorous research, despite the obvious importance of such evidence. We are currently working on a study supported by the Robert Wood Johnson Foundation’s Policies for Action Program that would help address this gap. Our study will test whether differences in the monetary value of housing assistance received by households translates into meaningful differences in health outcomes.
It remains to be seen whether the proposed changes in funding-levels and structure of HUD’s low-income housing assistance programs will be enacted, but recently completed research and our current study can provide valuable evidence to policymakers as they weigh the relative costs and benefits of such changes. The decision of whether to support these policy changes is not one that leaders should take lightly in the context of recent trends in housing costs. Indeed, housing affordability problems are on the rise among low-income renters, and any changes to federal housing assistance programs will likely have implications for the health of a growing number of households.
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