Housing Committee
JOINT FAVORABLE REPORT
Bill No.: SB-188
AN ACT ESTABLISHING THE HEALTHY HOUSING ASSISTANCE PILOT
Title: PROGRAM.
Vote Date: 3/10/2020
Vote Action: JFS To Floor
PH Date: 2/27/2020
File No.:
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
Open Choice Community Alliance
Co-Sponsor: Sen. Saud Anwar, 3rd Dist.
REASONS FOR BILL:
A growing body of research shows that when interested families with housing vouchers move
to lower poverty areas they experience life improvements, including positive health outcomes.
As documented in a recent paper published in the Journal of the American Medical
Association (December 2019), one persistent health challenge that can be ameliorated with a
move to opportunity is childhood asthma. Along with health improvements come cost
savings for hospitals and insurance programs. Despite these benefits, housing voucher
holders face a host of barriers to moving to healthy neighborhoods. Other recent research
demonstrates that many of these barriers to accessing healthier neighborhoods can be
overcome by 40% of voucher families when they are given access to specialized counseling
called Mobility Counseling, an approach which has been adopted by Connecticuts
Department of Housing.
RESPONSE FROM ADMINISTRATION/AGENCY:
None Stated.
NATURE AND SOURCES OF SUPPORT:
Erin Boggs Executive Director Open Communities Alliance - 75 Charter Oak Avenue
Suite 1-210 Hartford, CT 06106 - promotes equitable access to housing - supports the
investment is well worthwhile both the health cost savings and the tax revenue likely gained
through moves out of poverty. It is time to break down the silos between health and housing
and make investments that break the cycle of poverty, overcome historical segregating
policies, address homelessness and improve health outcomes.
Hartford Foundation for Public Giving 10 Columbus Blvd 8th floor - Hartford, CT 06106 -
supports We are hopeful that this pilot will create a model for an effective and replicable
program design and will put forth a roadmap for implementing a cost effective health-focused
housing intervention that produces positive health outcomes for children while at the same
time enhancing residents' access to quality, affordable housing in high opportunity
neighborhoods.
Kiley Gosselin Executive Director Partnership For Strong Communities 227 Lawrence
Street Hartford, CT 06106 - support - We support Senate Bill No. 188 and its aim to assist
families with children who have persistent asthma to move to healthier environments. Small
multifamily housing, or residential buildings between 2 and 19 units, accounts for 57% of all
rental stock in the state, and remains the most affordable option for many low-income
families. However, 51% of Connecticuts small multifamily housing stock is at least 60 years
old. Without proper rehabilitation, many of these homes have fallen into disrepair, leading to
unhealthy environments for families. This PILOT would increase access to safe, stable
housing by allowing them to relocate to healthier homes. We are supportive of programs
designed to subsequently rehabilitate those units to provide healthy homes to additional
families.
John Levin Norwalk , CT 06851- support This seems like a great pilot to address systemic
problems such as endemic health challenges for poor communities. As a Connecticut
resident and tax payer I am proud to see my state government seeking creative solutions to
important problems. This is EXACTLY how I would like to see my tax dollars spent and the
experimental approach is really smart.
Craig Pollack, MD, MHS - Associate Professor in the Department of Health Policy
Management at the Johns Hopkins Bloomberg School of Public Health and the Johns
Hopkins School of Medicine support - I am a practicing primary care physician and health
researcher who, for over 10 years, has studied the connection between housing and health.
Through my clinical experience and research, I have observed the importance of affordable
housing in health-promoting environments on health and well-being.
Through my clinical practice, I have seen the trade-offs that my patients and their families
make between paying for rent and paying for medicines. I have witnessed the extreme stress
of living in unstable housing, frequently described as symptoms of anxiety or depression. In
short, many of my patients have needed a prescription for affordable housing in healthy
neighborhoods to get at the root of their health problems.
Research in the area of housing and health supports my clinical experience on the critical
connection between housing affordability, its neighborhood context, and health. My research
team recently published a study in JAMA (attached) that examined the long-term impact of
receiving a voucher on health care use. The study made use of the Moving To Opportunity
experiment and followed families for up to 21 years.
Page 2 of 4 SB-188
Our key finding is that children who were exposed to lower levels of neighborhood poverty
had lower levels of hospitalizations and hospital spending over the long-term follow-up. For
every 10 percentage point reduction in neighborhood poverty that children were exposed to,
they had on average, $152 less per year in the hospital spending. It is important to note that
current programs designed to help children move to low poverty neighborhoods may lead to
much larger reductions in neighborhood poverty exposure. And the fact that these reductions
in hospital spending accrue over the long-term may lead to sizable financial and health
benefits.
With funding from the National Institutes of Health, I am currently working on another study in
Baltimore. We have been recruiting children with asthma who are participating in a housing
mobility program in Baltimore that helps families move from neighborhoods of concentrated
poverty into lower poverty neighborhoods. Initial results, though still preliminary, suggest a
reduction in allergens known to trigger asthma and an improvement in asthma symptoms.
In summary, both my clinical experience working as a primary care physician and my
research support the importance of investing in housing mobility programs as one way to
improve health.
Craig Schramm, Division Head of Pulmonology;
Jessica Hollenbach, Director of the Asthma Center,
Marcus Smith, Director of the Healthy Homes Program
at Connecticut Childrens Medical Center support - We applaud the intent of this bill and
appreciate being named a partner in this proposal. We are also grateful for the considerable
timeline given for establishing the new program, as there are undoubtedly some logistical
challenges to consider, such as HIPAA compliance.
Asthma is the most common chronic childhood disease. Asthma incidence, morbidity, and
mortality co-localize with poor housing conditions and disproportionately afflict low-income,
African-American, and Latino children. Hartford, one of the poorest medium-sized cities in the
US, is particularly hard hit by these childhood asthma disparities. Over 40% of Hartford
families live in poverty, compared with 14% statewide and 18% nationally. Mean per capita
income in Hartford in 2013-2017 was $28,930, less than mean per capita income in the US.
Hartfords population is 44% Latino (of whom 78% are Puerto Rican, the racial/ethnic group
with the highest asthma prevalence) and 35% African-American. Hartford is riddled with old,
poorly repaired housing stock (53% built before 1950). Medicaid data tell us that 18% of
Hartford children have asthma, of whom 44% requiring daily, preventive asthma therapy.
There are concentrated geographical pockets, or hot spots, of asthma morbidity and
incidence that overlap with areas of substandard housing in Hartford. Multiple asthma hot
spots are located in the North End and South End of Hartford. The state of housing in
Hartford is among the worst in the country. Recently, the Connecticut Data Collaborative
published a geographical report, Health in Hartfords Neighborhoods, demonstrating how
housing code violations cluster in the North and South Ends and are significantly associated
with poor health outcomes.
Childhood asthma accounts for the largest proportion of Medicaid spending on any health
condition in Hartford, and often is directly associated with poor housing conditions. In
Hartford, Puerto Rican children have high asthma prevalence (32%) and ED-visit rates
(174/10,000), whereas African-American children have high hospitalization rates (37/10,000)
Page 3 of 4 SB-188
and longer hospital stays. Asthma ED visits and hospitalization rates in Hartford children are
3.5-4 times higher than the rest of CT, and 20 times higher than national rates.
We know that environmental exposures are critical in the initiation and exacerbation of
asthma. The indoor environment, in particular the home, contains numerous exposures with
the potential to influence asthma development and morbidity. Many trials aiming to improve
asthma outcomes by altering the indoor environment have been conducted over the past four
decades. Unfortunately, evidence to date has not established the effectiveness of any widely
used products and strategies for improving patient outcomes by reducing home
environmental allergen exposures. Therefore, we believe a housing mobility voucher
program, in tandem with continued investment in safe, stable housing options in Hartford,
may give families of children with persistent asthma the opportunity to live in a healthier home
with a lower burden of not just physical/environmental exposures, but also access to safer
neighborhoods with less segregation and crime, and improved social capital. These social
factors may be of added benefit, related to the well-known contribution of psychosocial stress
to asthma.
Victor Villagra MD Associate Director - Health Disparities Institute UCONN School of
Medicine 241 Main Street 5th floor Hartford, CT 06106 support The Institute
strongly supports this bill because it addresses a root cause of healthcare disparities.
Connecticut is one of the only states that has made reducing healthcare disparities a top
priority. SB-188 is precisely the kind of investment needed to honor that commitment.
NATURE AND SOURCES OF OPPOSITION:
None Stated.
Reported by: Karen Godbout Date: 3/25/2020
Page 4 of 4 SB-188