This is an archived article that was published on in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Many are familiar with Fourth Street Clinic and our work in providing health care services to homeless Utahns. But few know that the vast majority of homeless Utahns who live in poverty do not qualify for Utah's Medicaid insurance program.

In fact, in 2012, 80 percent of Fourth Street Clinic's patients reported being entirely uninsured. The reason for this large gap in Medicaid coverage is because to qualify under Utah's program, one must be both poor and either have dependents or be disabled.

Every day at Fourth Street Clinic we see the devastating effects that the double blow of no home and no health insurance has on our patients' health, self-worth and hope. It shakes families for generations. And we also witness the positive life-changing impact that access to health care can have. It enables men, women, children and entire families to get back on their feet and to return to the mainstream of life. 

 Volunteer health care services can play a role in alleviating this crisis, but volunteers will never fill the multiple and complex health care needs of all those who are poor and presently not eligible for Medicaid. Fourth Street Clinic knows this first hand because it is a large-scale coordinator and utilizer of volunteer medical services.

The Affordable Health Care Act's subsidies to assist purchasers of insurance policies also will not fill this gap in the absence of Utah's accepting the proposed Medicaid expansion. This is because the majority of those earning less than 100 percent of the federal poverty guidelines will not be eligible for insurance subsidies and will remain subject to the current narrow Medicaid eligibility criteria.

Fourth Street Clinic has also carefully reviewed the alternatives to Medicaid expansion that were presented at the Governor's Health Care Summit and finds them lacking.

We have concluded that expanding Medicaid is the most economical and widely accessible means to helping those in poverty move toward better health and out of homelessness.

 For these reasons, the board of directors of The Fourth Street Clinic, the primary health care provider for homeless Utahns, after careful review of all the alternatives, endorses Utah adopting a full expansion of the Medicaid program, eliminating all categorical restrictions and making health insurance accessible to all its poor residents.

Michael Zimmerman is Policy & Advocacy Committee chair for Fourth Street Clinic and a former chief justice of the Utah Supreme Court.