He takes some risk with fat as well. We have more forest fires now in california than anybody has ever seen and now messing of the traffic which is sacrilegious by yet it goes up one day then goes down the next. The people say it is a big issue, paying attention. But it will be interesting to see. He understands this issue and he wants to the of the bright side. In an interesting moment for my point of view. But with the popes visit i am learning about how much it cost to travel to a country so with that financial burden to talk so much the impact of this message so food takes charge of that . The cost is the United States will be different than the cost of cameron because washington d. C. In particular and new york are two cities that are very used to do handily enormous events so in terms of cost there is always a security cost and you can go to Capitol Police and the secret service to see how much has been spent then they bring in the occupancy taxes with the department of revenue to read the compare similar events to get us sense of what money is coming in and and what is going out of there was the economy of scale it would be different if you look from that perspective to see a big difference there. What could be an interesting topic is the lobbying q the right before he comes here come the day do not have the infrastructure, were talking about super bowl cities her capable to absorber incredible demand to with the infrastructure to guarantee safety. Q but is different with a direct contrast between water redoing and then the next couple of days inn in new york or philadelphia or washington as a fascinating story. We focused on the popes visit to congress but it he is a listing other places added is the entry points for stories. In philadelphia he will go to a prison and he is rather outspoken on forgiveness and care of prisoners and social and criminal justice is a great opening on the day from the back of our system and reminded me we have one of the highest incarceration rates in this country of developed nations. This is a good entry point some even if you cannot get access, there are so many other Access Points to allow a journalist to find a really great story strike if we see a picture of him carrying his own bags i would like to see it. Any questions . The question i have is for my own purposes and but the policy issues, the cultural issue of a huge gathering of people. Them like the day after the super bowl with an empty stadium. So where do we go as a journalist . What do we tell in the wake of the visit . And all the is issues the next thing is whether or not he has the impact. Did he break in the consciousness . So that is a great thing to follow up to keep track of the issues that he addresses of there is movement in the congress. They appear to have lost the religious survey but if there is a surge in membership or even something so simple as having a Catholic Church but then one week after they see if the pews are filled to see if that had any of course, it is anecdotal not based on scientific evidence, but you get a feel if there is impact with those color stories sam policy followups. You can come after words about planet change. I cannot remember one but that is the good question. But a lot of people for the singular event but that is to look bad before and after who will introduce legislation . Check out that member of congress find out their issues to address the policy expertise. If they will capitalize on that. The panel was day ready made the list with before and after the visit that will dominate some peoples thinking of what they want to hear and have not been able to. Dont pay a lot of attention to the internal politics there is colonel sam bishops that do not think the pope is headed in the right direction and a great source of that is there is a catholic newspaper called the catholic reporter and they have some great story ideas to get as well lots of questions. Were they going to do about the language and if he gives speeches in spanish. So how are your organizations preparing for that . There is a lot of french and german speakers so we are in pretty a good shape that way. We do think there will be a great deal available spare mcfadyen is the idea to cover different ethnic groups. And hit it is growing among the hispanics are immigrant groups and look at where the church is a growing angelou the pope will try to send the message to. But maybe he will speak spanish to connect that makes for a great story. I will address this to the experienced the reporters on the panel. But to be there in the crowd . What equipment do you bring . How do you file your story . Etc. A crowd like this faith is not a problem. So the volume as restated earlier in the day the recorder but those are more likely and it has been easy and it is a shared a moment. Filing could be a bit of a problem if youre out on the mall obviously. You might want to preplan a coffeehouse of where you expect for that place to file. If you Cover Congress i would not bank on running outside and look for a place you can file even if it is against the wall early to avoid the tunnel of death. Just get to the mall early with as little as toughish possibly can. With the most recent inauguration was the cellphone tower overloaded you could not even been tweet something so you should be prepared for that. I had both my pad and phone with me when i was working in one that was not. But i never thought that i would say of the national mall. But it is something to think about. Even if you catch a disposable phone for that event. And whats a fair ratings . That is horrible. M a have a crowd like this with the march on washington i have never seen such a collection of umbrellas standing alongside his should prepare for that when the paper gets wet remember japan wont work some of the proponent to have a pencil with a little sharpener like did your schoolbag. Keep your eyes peeled for any mannerisms. Lake the parent and child but it is to take your eyes off and then what . What we want to accomplish is to let him as a multi dimensional human being an addition underneath all these trappings. What is he like . Along the lines of what to bring it is as much as you can and still be professional with comfortable shoes and clothing because if you spend time in washington is a temper it can be absolutely gorgeous or horrible you never know what you will get. You have to prepare for raid or sunshine or the cold blast. You dont want to be miserable. Hot were lucky he is coming in september instead of a january when one reporter got frostbite on her feet in 2009 inauguration. So be prepared with your own personal comfort. You may be required to be held for several hours or all day long. And it is a sport i i did not plan but a cat on a bicycle and i got to my office about 530 in the morning and i got to the hill, by 6 00 and i just waited then i went outside and started to interview people and i was out and tell the time that the president stopped speaking. That is how i planned for a larger defense as the all day in denver. There is no lastminute go here or go here. But to let them know what cannot be done logistically. Then they will say we heard there was of family can you go find them . [laughter] it isnt always that easy. Just to make that clear. I hate to say this but as a disaster reporter think through of a contingency plan if something bad happens and theres all kinds of bad from the stampede to a weather even and like last night in chicago where and a tent blew down and. How much a kid yourself, how are you thinking it through . And will be different depending upon your organization is to mix the have people coming in to town and to give them guidance. Has anybody seen the traffic map . It is road closures or anything around the mall. Probably not until it gets closer that is probably still being worked out. As you know, because with the d. C. Government sometimes they dont share the same idea of what is worthy to be closed so im sure there is negotiations going on about that. You expect inauguration type of closures . Yes. We knew those one week before. Find seats and we will try to get started here. My name is ed howard. I am with the alliance for Health Reform. I want to welcome you on behalf of the board of directors. I want to welcome you to the program on health and housing with an emphasis on the relationship between medicaid policy at the Community Level at the state level and the federal level as well. This is actually a first in a threepart series and we will explore the intersection of social policy over the next couple months. In october, i believe its october 9, you will be looking at how well Health Services correlate with nonmedical home and unity based services. Then in december we will examine some of the emerging issues in connection between health and incarceration, which is is a growing area of concern and activity. There is a connection between health and various determinants and we will look at the strength of that connection during this briefing and the subsequent ones in the theory. You may have seen yesterday the new york city mayor bellagio announced a milliondollar program to connect more Homeless People with Mental Health care. I think just another sign of growing activity at every level to connect the dots that link Better Health and better housing. I hope that will bring a lot of light on that topic. Our discussion will center on how housing stability affects Health Outcomes and healthcare costs. They will look at the role in addressing this program and how much flexibility there is in federal policy to allow states and communities to meld those together. We want to look at what the obstacles might be. What are the biggest obstacles. We are pleased very much to acknowledge the centime corporation. One of americas largest private insurers. They operate in two dozen states. Before we get to the program let me do a little bit of housekeeping. In your packets there is Important Information including speaker biography one page materials and the Powerpoint Presentation in hard copy so you can follow along. There will be a recording of this briefing available on the website on monday followed by a transcript a few days later along with all of the materials in your kit and links to more materials we think would be helpful to you. At the appropriate time you can ask our Panel Questions by filling out one of the green cards in your packet or you can come to the microphones there is one on either side of the room. You can use the health and housing to tweet us questions and if youre watching on cspan to want to ask a question, you can also tweet a question. We will be keeping an eye on that and having them brought to the panel to respond. And at the end of the briefing there is a blue evaluation form in your packet that i would very much appreciate your filling out so we can improve these briefings and target them to the needs of the folks who come and need the guidance. So, enough of that. That. Lets hear from our very wellinformed panelists. We gave them in adequate introductions and ill do it so i wont disrupt the flow of the discussion as we go along. He is the director of policy at the National Healthcare for the Homeless Council. He is also on the healthcare counsel for marilyn. He has a perspective on how to connect and address these problems. Why its important and the opportunities from the state federal and local levels to address it. Then we will hear from the Senior Advisor for housing and services and she will explain the current activities and describe how her agency and others are collaborating health and housing issues. Gretchen will be next. She is director of colorados department of Public Policy and financing and that is colorados medicaid and chip programs. She is going to tell us about the bridge and what gets in the way of those efforts. Our final panelists is a family physician and she is founder of a phoenix nonprofit that brings private and public sectors together to help those experiencing homelessness. They will describe the Innovative Housing model and what gets in the way of this approach. So weve arrived to the part of the program that also has some substance to it. Heres barbara. I really appreciate so many people being here today. I think it really is important about the growing awareness of how healthcare is changing the country and in particular the impact that housing has on health status. The National Healthcare for the Homeless Council represent many Healthcare Facilities and the Homeless Individuals they serve. Over 1 million patients are being seen in these facilities each year. The lack of housing is really an issue not only for the Health Centers but the larger Healthcare System that we are looking to change. One one of the things that might not be intuitive is how housing affects health care. Back in the 80s the institute of medicine did a study looking at that very impact and they found three major relationships. Poor health causes homelessness. Typically what we would see as a spiral of people who had an illness, were unable unable to work and when youre unable to work and you get fired or laid off and you can no longer bring in money. You cant make rent or mortgage so you move in with family and friends and that doesnt work out so you go to a shelter or live on the street. You also hear that homelessness causes poor health. Living on the street or in a shelter is stressful and you are exposed to other illnesses. Without getting hospitalization or Emergency Care that tends to be very high. High blood blood pressure, Mental Health issues alcoholism depression all tend to develop. If you didnt have them before you tend to develop them afterward or they get exasperated. You also think about how lack of housing complicates treatment. We are putting billions of dollars into our Healthcare Industry every year. 2 trillion. None of that funding works well. Nothing that we do as Healthcare Providers works well when someone is living on the seat. Street. Every time we turn someone to a 90 Day Treatment Program it is only to discharge them to the street we have complicated and probably compromise the treatment we just invested. When we discharge from hospital to the street the wound care that we just paid for is now compromise. These are the things that are really bundled up together in health and housing. We need to appreciate how we can rectify that through housing. One of of the things we are seeing, as again we represent the doctors in nurses and addiction counselors and the workforce that goes beyond caring for these patients, and what we see, not surprisingly, is very high rates of acute and communicable diseases. Respiratory illnesses, infections from cuts that you cant keep clean diabetics on the street, the rate in which we replace medication is astronomical because of the rate they are stolen. When you cant keep your medication safe or refrigerated its hard to maintain compliance with your healthcare. How many times as anybody here gone to the doctor and had a prescription given to them that may cause them to visit the bathroom more often . Thats just not possible. No need for show hands. [laughter] thats just not possible when Public Places dont allow homeless to use the public restroom. We have local ordinances increasingly that criminalize that activity so really what we see as Healthcare Providers, our client come in and say i didnt take that medication because otherwise id get arrested or i was afraid of getting arrested or i didnt have any place to go or made meds were stolen or my needles were stolen or its not safe for me to have needles. This is what we hear. We see when we look at the literature it shows people who are homeless get diseases at three to six times the rate everyone else does. Theres still asthma and diabetes and hypertension and high cholesterol and Heart Disease that everybody else has but it still in higher rates. We see a lot of intensive needs and we see both extremes of use of the Healthcare System. We are getting a lot of attention in the frequent user of very high end user were putting a lot of money into a small number of people that we need to stabilize, but we also see people who are living on the outskirts of our society who avoid our Healthcare System that have intensive needs, usually in the Mental Health and Substance Abuse treatment area. How is it that were reaching those people were very fragile and in need of care . Will look at our hospital systems, they are really stressed. They really get it when you are a hospital and you have no safe discharge option for a client that is ready for discharge. It is illegal to discharge to the street but as with anything else we get discharged for rest and recuperation. What do you do for someone who doesnt have any place to go . These are these are the real issue that local Healthcare Systems are facing. What can we do to provide safe and ethical treatment for people question what we see a lot of people wear when they are ill, its difficult to get back out of homelessness. Working on housing and getting a job, if youre fighting an addiction or Mental Health and not in treatment, its very hard to get out of the shelter or off the street. Just one example of in a healthcares situation, people who are homeless have disproportionate high rates of every disease you can imagine. That brings us to support of housing. When we think about what is Supportive Housing, its typic