Pediatrician Michael Hole knows that helping his low-income patients stay healthy requires more than correctly diagnosing and treating their illnesses. That’s why he routinely asks families if they receive anti-poverty resources such as the federal earned income tax credit and other government benefits.
What puzzled him was why so many of his patient’s parents, many of them single mothers, weren’t signing up for programs that could help their families escape poverty and thrive. A gentle complaint from a single mother visiting Dr. Hole’s office with her toddler provided an answer. After asking about her taxes and the earned income tax credit, she replied, “I just waited 45 minutes to see you, why can’t I do my taxes here?”
That gave Hole an idea. “I didn’t understand the reasons behind the program’s underutilization until I heard that mother’s explanation of barriers like confusing forms, unreliable public transportation, and high fees” charged by for-profit tax preparers, he told me.
Thus was born StreetCred, the brainchild of Hole and Dr. Lucy Marcil, fellow pediatricians at Boston Children’s Hospital and Boston Medical Center. This nonprofit program lets people prepare their taxes — and claim the earned income tax credit — when they visit the doctor.
The link between wealth and health is what statisticians call a “line of perfect fit.” As your wealth declines, so, too, does your health. Consider that 33 percent of children in poverty are reported to have “less than very good health” compared to just 7 percent of children who grow up in families at or above 400 percent of the poverty line.
Financial stress also makes it more difficult to manage one’s health — from making and keeping doctor’s appointments to following prescription regimens. New data, which my organization, Prosperity Now (formerly the Corporation for Enterprise Development) released today show that 13.3 percent of Americans did not see a doctor due to cost in 2015.
Programs like the earned income tax credit can help. Numerous studies show, for example, that this tax credit for America’s working poor is associated with everything from improved infant and maternal health to better school performance. Yet more than 20 percent of eligible families never collect the credit, which translates into a tax refund of up to $5,572 for a single parent who has two children and earns $20,000 a year.
I’m not a medical professional. I spend my days in the wonky world of economic policy, advocating for reforms that will help American families become more financially secure and close the country’s racial wealth divide. I’ve been increasingly hearing from doctors that they want to learn more about how to help their low-income patients build financial security as a way to help them get or stay healthy.
Earlier this year, I spoke about the wealth-health connection at Zuckerberg San Francisco General Hospital’s Grand Rounds. I challenged the doctors and administrators in the room to work with organizations like mine to connect health providers with financial service providers to give patients who are often juggling multiple jobs and complicated child care arrangements a practical way to apply for and receive the benefits they need. The response was immediate and enthusiastic.
I believe that organizations like StreetCred have the potential to make an enormous difference in people’s lives. During the 2016 tax season, the initial StreetCred pilot program at Boston Medical Center returned more than $400,000 in tax refunds to nearly 200 families. During the 2017 tax season, StreetCred expanded to three additional sites in Boston and returned more than $1.1 million to 562 families.
StreetCred’s formula is simple. It takes advantage of the trusting relationships that families have with their pediatricians and makes productive use of the time typically wasted in doctors’ waiting rooms. In partnership with the IRS-sponsored Volunteer Income Tax Assistance program and other government agencies, StreetCred uses trained volunteers and staff to help families file taxes, attain tax refunds, and apply for anti-poverty government programs.
Other models show similar potential. Community health centers such as DotWell, also based in Boston, ask patients about their physical and financial health as part of their standard intake process. Based on the answer, case managers develop a care plan that includes ongoing financial coaching and connecting patients to services such as credit counseling and federal and state benefits. DotWell also offers on-site Volunteer Income Tax Assistance program services and a matched college savings program.
Another model, the Presa Community Center in San Antonio, Texas, dispatches community health workers to the homes of patients recently discharged from local hospitals to ensure they are following their treatment plan and to link them to free tax preparation and financial coaching services offered at the center.
If efforts like these are expanded, the health and financial security of millions of Americans will improve. And as health improves with wealth, this should generate significant savings in health care costs. For that to happen, though, hospitals, doctors, community health organizations, financial service providers, and government agencies need to work together to do what’s best for low-income patients.
At a time of great uncertainly over the future of traditional safety-net programs, we all need to be a little more creative. Helping improve families’ wealth during a visit to the doctor is one way to do that.
Andrea Levere is the president of Prosperity Now (formerly the Corporation for Enterprise Development), a Washington, D.C.-based nonprofit that helps low- and moderate-income families achieve financial stability, wealth, and prosperity.