HUD Housing Assistance Associated With Lower Uninsurance Rates And Unmet Medical Need

Abstract

To investigate whether receiving US Department of Housing and Urban Development (HUD) housing assistance is associated with improved access to health care, we analyzed data on nondisabled adults ages 18–64 who responded to the 2004–12 National Health Interview Survey that were linked with administrative data from HUD for the period 2002–14. To account for potential selection bias, we compared access to care between respondents who were receiving HUD housing assistance at the time of the survey interview (current recipients) and those who received HUD assistance within twenty-four months of completing the survey interview (future recipients). Receiving assistance was associated with lower uninsurance rates: 31.8 percent of current recipients were uninsured, compared to 37.2 percent of future recipients. Rates of unmet need for health care due to cost were similarly lower for current recipients than for future recipients. No effect of receiving assistance was observed on having a usual source of care. These findings provide evidence that supports the effectiveness of housing assistance in improving health care access.

HUD Housing Assistance and Levels of Physical Activity Among Low-Income Adults

“…We acknowledge, though, that the pseudo–wait-list approach may also be vulnerable to confounding and selection bias ( 3 , 4 ). Despite this, the comparison groups in the pseudo–wait-list approach — used in previous analyses of HUD housing assistance with this same data set ( 3 , 4 ) — were generally similar on observed characteristics included in our analysis, which increases our confidence in the pseudo–wait-list results. Another reason for caution is the lack of significant association between housing assistance and physical activity coded as a continuous variable among nonseniors.…”

“…Wait-listed respondents likely resemble the current assistance group on numerous observed and unobserved characteristics. This pseudo–wait-list approach was used in previous studies to examine the association of housing assistance with health status and health care utilization ( 3 , 4 ). As a check on the suitability of this control group, we compared current recipients of assistance and future recipients of assistance on observed health and sociodemographic characteristics reported in NHIS.…”

“…The US Department of Housing and Urban Development (HUD) manages and oversees federal housing assistance programs, which can include the provision of housing vouchers (eg, Housing Choice Vouchers), which help people rent private homes, or the provision of public housing ( 2 ). The receipt of housing assistance is linked with better overall self-rated health, less psychological distress ( 3 ), and lower rates of uninsurance and unmet medical needs ( 4 ) among adults, as well as lower blood-lead levels in young children ( 5 ). The extent to which housing assistance may also lead to healthier behaviors, such as physical activity, is uncertain.…”

“…Families that receive housing assistance pay no more than one-third of their household income on rent and utilities and move less often than those not receiving assistance ( 1 , 10 ). In contrast, low-income families without assistance frequently devote a substantial proportion of their incomes to housing expenses, and as a result, may need to move frequently, and are at a higher risk of becoming homeless ( 4 ). Costly and unstable housing environments could consume resources and time that could otherwise be used to support health promotion.…”

Misclassification of Rental Assistance in the National Health Interview Survey

“…Federal surveys could play an important role in estimating the effect of HUD assistance on health and in identifying the health needs of the assisted population. 5,6 Unlike administrative records, surveys provide a rich set of health outcomes and other important covariates, sample nonassisted populations that can be used as comparison groups, and can be easily obtained by the average researcher.…”