HKS Student Explores Access to Healthcare for Seattle’s Tent City Residents

By Sara Steinmetz, Women and Public Policy Program

Recent changes to healthcare coverage will require all health insurance providers to completely cover the cost of contraceptives for patients (including removing co-pays or other fees) by January 2013. This measure is part of an effort to remove cost as a barrier to women’s access to birth control, preventative care services including prenatal care, screening for STDs, and counseling and equipment to encourage breast feeding.

Residents of Tent City 3 are required to relocate 
every 90 days, meaning further barriers to 
accessing health care since many host sites are
far from the downtown clinics. These are the 
piles of people's belongings, ready to be 
loaded onto moving trucks.

Although the new legislation will facilitate access to health care for many women, one group with particularly high need is unlikely to benefit: low-income and homeless women. This past summer the Women and Public Policy Program, with support from the Roy Family Fellowship, enabled a Harvard Kennedy School student to analyze the specific issues resulting from this gap in coverage and access. Emily Polak, a second-year MPP student, conducted a survey for the Seattle Women’s Commission evaluating access to healthcare for women living in Seattle’s Tent City 3 and for those in longer-term shelters.

Polak found that access to many services is very difficult. “Because women largely learn about the services from other women, there are many holes and break downs in this form of information dissemination,” she explains. “Seattle is a city with tremendous primary health care services for low income and people who are homeless. But the take up rates among Tent City Women seemed low because many women largely don't know about them. This is true for primary care, mental health care, and reproductive health care.”

Additionally, for those who do have the information, co-pay and other fees are often too high for residents; even sliding-scale fees are too high for someone without a regular income. Many clinics will not accept patients who cannot afford to pay or impose long wait periods on new patients without insurance. “As a result of being turned away for lack of insurance, funds, or a permanent residence, many women give up trying to find a provider for vision, dental, specialty care, and prescription coverage,” adds Polak. Furthermore, access to bus routes that service clinics and social services offices is also limited, further impacting the accessibility of preventative care. Many patients instead elect to visit the ER for healthcare needs, effectively using the ER as a primary care physician since the ER is required to provide treatment.

As part of her project, Polak spent time tracking down and later compiling a set of resources to share with residents to help support their health care needs. This guide included information on free vision exams and glasses, free dental care including dentures, and free prenatal care. This resource manual will be especially helpful to Tent City 3 residents who have limited access to telephones, the internet, or other sources of information on clinics and health services, and should hopefully provide an alternative to ER visits for obtaining health care. She also produced a report with key findings, demographical data, and other information from her interviews, and plans to build upon this work for analyses of healthcare accessibility for homeless in other cities.

• For more information on Emily Polak’s work: http://emilyssummerinseattle.blogspot.com/
• For more information on WAPPP summer funding opportunities: http://www.hks.harvard.edu/centers/wappp/for-students/summer-internship-program