Health care providers in Colorado have been drawn into America's homelessness crisis, and are adding institutional weight into a push for solutions - according to a new report by independent health journalist Michele Cohen Marill.

Marill pointed to one "aha" moment experienced by physician Sarah Stella, who saw many people experiencing homelessness seeking emergency care at Denver Health.

"She had patients coming in with severe frostbite and other types of injuries," said Marill. "They would get patched up, they would be discharged, and ended up back on the streets. And then within a brief period of time, she would see them back in the ER."

One patient living outdoors had severe frostbite, which required several toes to be amputated. He was discharged to a shelter, but because it was relatively warm he chose to sleep outside.

He awoke covered in snow and went back to the emergency room with frostbite on his remaining toes.

Stella then went to work, connecting area health providers to nonprofits and foundations to find ways to break this cycle.

In October of 2022, the Colorado Coalition for the Homeless opened the Stout Street Recuperative Care Center, which provides a recovery space for people who are well enough to be released from the hospital - but still need time to heal.

Marill said on average clients stay two weeks - although some need prolonged care, such as chemotherapy, that may last as long as two or three months.

"Patients can be discharged safely. It's really a life saver," said Marill. "Many of these individuals would be very medically fragile if they were just living on the streets."

Last December, Denver Health opened a converted floor of an administrative building to provide transitional housing for recovering patients.

Clients are connected to case managers who help them find permanent housing and other services.

Marill said these sorts of interventions show that health care institutions can play a critical role in communities.

"Poor health is both a cause and an effect of homelessness," said Marill. "Health care, and specifically health systems, are an important part of the solution."




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This spring marks the 50th anniversary of the Vietnam War ending. In North Dakota, veterans from the war, along with others who have served, are in line for extra state support if they have issues with housing stability.

During this legislative session, the state approved $1 million over the next two years, with half of it going to the Post War Trust Fund, which helps veterans cover expenses like dental care. The other half will help fund existing efforts that focus on finding stable housing for military veterans struggling to keep a roof over their head.

Rick Olek, a Vietnam combat veteran from Fargo, was a big voice in getting the funds across the finish line.

"It's very rewarding that we accomplish something here but part of the reward is just making our community and our Legislature aware that it's an ongoing problem," Olek explained.

Nationally, the number of veterans experiencing homelessness declined last year but there was a 7% increase the previous year, marking the first such spike in a while. Support organizations said like many other populations, veterans are feeling the squeeze of rising rents.

Olek said the action is meaningful to those who served in Vietnam, with historians often noting the general lack of public support they received when first returning home.

"Vietnam vets have had to fight and basically really get activated to get these benefits or whatever else that they've been able to get," Olek pointed out.

Another component of the initiative allows veteran charitable groups, such as local VFWs, to donate gaming proceeds for these services. A key partner organization, Community Action Partnership of North Dakota, said the resources will help make veteran homelessness in North Dakota rare, brief and nonrecurring.

By Angela Hart for KFF Health News.
Broadcast version by Suzanne Potter for California News Service reporting for the KFF Health News-Public News Service Collaboration

President Donald Trump is vowing a new approach to getting homeless people off the streets by forcibly moving those living outside into large camps while mandating mental health and addiction treatment — an aggressive departure from the nation’s leading homelessness policy, which for decades has prioritized housing as the most effective way to combat the crisis.

“Our once-great cities have become unlivable, unsanitary nightmares,” Trump said in a presidential campaign video. “For those who are severely mentally ill and deeply disturbed, we will bring them to mental institutions, where they belong, with the goal of reintegrating them back into society once they are well enough to manage.”

Now that he’s in office, the assault on “Housing First” has begun.

White House officials haven’t announced a formal policy but are opening the door to a treatment-first agenda, while engineering a major overhaul of the housing and social service programs that form the backbone of the homelessness response system that cities and counties across the nation depend on. Nearly $4 billion was earmarked last year alone. But now, Scott Turner, who heads Trump’s Department of Housing and Urban Development — the agency responsible for administering housing and homelessness funding — has outlined massive funding cuts and called for a review of taxpayer spending.

“Thanks to President Trump’s leadership, we are no longer in a business-as-usual posture and the DOGE task force will play a critical role in helping to identify and eliminate waste, fraud and abuse and ultimately better serve the American people,” Turner said in a statement.

Staffing cuts already proposed would hit the part of the agency overseeing homelessness spending and Housing First initiatives particularly hard. Trump outlined his vision during his campaign, calling for new treatment facilities to be opened on large parcels of government land — “tent cities where the homeless can be relocated and their problems identified.” They could receive treatment and rehabilitation or face arrest. Now in office, he has begun to turn his attention to street homelessness, in March ordering Washington, D.C., to sweep encampments, potentially separating homeless people from their case managers and social service providers, derailing their path to housing.

The administration is discouraging local governments from following the federal policy, telling them it will not enforce homelessness contracts “to the extent that they require the project to use a housing first program model.” And, in a recent order “reducing the scope of the federal bureaucracy,” Trump slashed the U.S. Interagency Council on Homelessness, shrinking the agency responsible for coordinating funding and initiatives between the federal government, states, and local agencies, known as Continuums of Care.

“Make no mistake that Trump’s reckless attacks across the federal government will supercharge the housing and homelessness crisis in communities across the country,” Democratic U.S. Rep. Maxine Waters of Los Angeles said in response to the order.

Support Without Forced Treatment

Housing First was implemented nationally in 2004 under the George W. Bush administration to combat chronic homelessness, defined as having lived on the streets with a disabling condition for a long period of time. It was expanded under President Barack Obama as America’s plan of attack on homelessness and broadened by President Joe Biden, who argued that housing was a basic need, critical to health.

The policy aims to stabilize homeless people in permanent housing and provide them with case management support and social services without forcing treatment, imposing job requirements, or demanding sobriety. Once housed, the theory goes, homeless people escape the chaos of the streets and can then work on finding a job, taking care of chronic health conditions, or getting sober.

“When you’re on the streets, all you’re doing every day is figuring out how to survive,” said Ann Oliva, CEO of the National Alliance to End Homelessness. “Housing is the most important intervention that brings a sense of safety and stability, where you’re not just constantly trying to find food or a safe place to sleep.”

But Trump wants to gut taxpayer-subsidized housing initiatives. He is pushing for a punitive approach that would impose fines and potentially jail time on homeless people. And he wants to mandate sobriety and mental health treatment as the primary homelessness intervention — a stark reversal from Housing First.

The shift has ignited fear and panic among homelessness experts and front-line service providers, who argue that forcing treatment and criminalizing homeless people through fines and jail time simply doesn’t work.

“It’s only going to make things much worse,” said Donald Whitehead Jr., executive director of the National Coalition for the Homeless. “Throwing everybody into treatment programs just isn’t an effective strategy. The real problem is we just don’t have enough affordable housing.”

Trump got close to ending Housing First during his first term when he tapped Robert Marbut to lead the U.S. Interagency Council on Homelessness in 2019. Marbut pushed for mandating treatment and reducing reliance on social services, while curtailing taxpayer-subsidized housing. He argued that forcing homeless people to get sober and enter treatment would help them achieve self-sufficiency and end their homelessness. But covid-19 stalled those plans.

Now, Marbut said, he believes the president will finish the job.

“Trump knows that what we need to do is get funding back to treatment and recovery,” Marbut said. “The Trump administration is laser-focused on ending Housing First. They realized it was wrong the first time and that’s why I was selected to change it. They still realize it’s wrong.”

Trump and administration officials did not respond to questions from KFF Health News. A request to interview Turner was not granted. Project 2025’s “Mandate for Leadership,” a conservative policy blueprint from some of Trump’s closest advisers, explicitly calls for an end to Housing First.

Under Attack

Housing First is under attack not only from Republicans who have long criticized taxpayer-subsidized housing for homeless people, but also from Democrats responding to public frustration over homeless encampments multiplying around the nation. Last year, the federal government estimated that more than 770,000 people in the U.S. were homeless, a record high. That was up 18% from 2023. And while housing grows increasingly unaffordable, homeless camps have exploded, spilling into city parks, crowding sidewalks, and polluting sensitive waterways, despite unprecedented public spending.

Already, cities and states, liberal and conservative, are cracking down on street homelessness and targeting the mental health and addiction crisis. This is true even in deep-blue states like California, where Gov. Gavin Newsom has created a “CARE Court” initiative that can mandate treatment even though housing isn’t always available and threatened to withhold funding from cities and counties that don’t aggressively clear encampments.

San Francisco Mayor Daniel Lurie has proposed ending harm reduction for drug users. Los Angeles Mayor Karen Bass is prioritizing encampment sweeps even though the promise of housing or shelter is elusive. And San Jose Mayor Matt Mahan won initial City Council support for plans to arrest people who refuse shelter three times in 18 months and to divert permanent housing funding to pay for an expansion of homeless shelters.

Mahan believes liberals and advocates have been too “purist” because housing isn’t being built fast enough, while investments in shelter and treatment have been inadequate. “It can’t only be about Housing First,” he said.

Homelessness crackdowns have exploded since the U.S. Supreme Court made it easier for elected officials and law enforcement agencies to fine and arrest people for living outside. Since June, roughly 150 laws imposing fines or jail time have been passed, with about 45 in California alone, said Jesse Rabinowitz, campaign and communications director for the National Homelessness Law Center.

Rabinowitz and other experts say both Republicans and Democrats are undermining Housing First by criminalizing homelessness and conducting encampment sweeps that hinder the ability of front-line workers to get people into housing and services.

However, there’s disagreement on whether to entirely dismantle the policy. Liberal leaders want to maintain existing streams of housing and homelessness funding while expanding shelters and moving people off the streets. Conservatives blame Housing First for the rise in homelessness and are instead pushing for mandatory treatment and cutting housing subsidies.

“I used to think it was just a waste of taxpayer money because it wasn’t treatment-based, but now I think it actually enables people to remain homeless and addicted,” Marbut said of the Housing First approach. He favors requiring behavioral health treatment as a prerequisite to housing.

Evidence shows Housing First has been successful in moving vulnerable, chronically homeless people into permanent housing. For instance, a systematic review of 26 studies indicated that, compared with treatment-first, “Housing First programs decreased homelessness by 88%.”And the approach has shown remarkable improvements in health, reducing costly hospital and emergency room care.

Experts say Housing First has been severely underfunded and implemented unevenly, with some homelessness agencies taking federal money but not providing appropriate services or housing placements.

“Making it the broad policy to all homelessness leaves it vulnerable to being attacked the way it’s currently being attacked,” said Philip Mangano, a Republican who spearheaded the development of Housing First as the lead homelessness adviser to George W. Bush. “The truth is it’s a mixed bag. For some people like those who are using substances, the evidence just isn’t there yet.”

Others say it has been ineffective in some places because of rampant misspending, abuse, and a lack of accountability.

“This works when it’s done right,” said Marc Dones, a policy director for homelessness initiatives at the University of California-San Francisco, arguing that housing can save lives and lower spending on costly health care. “But I think we have been too polite and too nice for too long about some real incompetence.”

Jeff Olivet, who succeeded Marbut at the U.S. Interagency Council on Homelessness under Biden, said Marbut and Trump’s positions are misguided. He argues that Housing First has worked for those who have gotten indoors, yet the number of people falling into homelessness outpaces those getting housing. And he says there was never enough money to provide housing and supportive services for everyone in need.

“Housing First is not just about sticking somebody in an apartment and hoping for the best,” Olivet said. “It’s really about providing stable housing and access to health care, mental health and substance use treatment, and to support people, but not forcing it on people.”


Angela Hart wrote this story for KFF Health News.


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Nebraska is among the states with the sharpest increases in housing prices between 2021 and 2024, according to a new report.

The hike has been accompanied by dramatically higher homeowners' insurance premiums.

Only four states saw home prices spike more dramatically than in Nebraska in the three-year period - three of them in the West. More expensive homes bring higher insurance costs.

The Consumer Federation of America's Director of Housing Sharon Cornelissen said it's often not the cost of the house, but the cost of insuring it that keeps some potential home buyers out of the market.

"Our insurance crisis is increasingly also a housing crisis, right?" said Cornelissen. "These are not separate. We know for example that first-time homebuyers already struggle to afford a mortgage today, and with spiking insurance costs, many may feel that they can never own a home."

The housing price hike and increase in insurance costs come despite Nebraska having among the lowest costs of living in the nation.

The CFA report shows Nebraskans have seen a 35% increase in homeowners' insurance prices in the three-year period.

While many people are trying to qualify for a mortgage, the Federation's Director of Insurance Doug Heller said insurance companies are making it increasingly difficult for buyers by hiking premiums - and denying coverage based on "perceived risk."

"The crisis is also a reflection of some brazen bullying we have seen from insurance companies around the country," said Heller, "as they put customers that have paid premiums for decades on the chopping block, and turn their back on communities that have relied on them for generations."

The report says insurance companies claim they're still trying to recover from $11 billion in losses caused by damaging derecho winds that leveled parts of Nebraska and other Midwest states in 2020.




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