The U.S. Supreme Court’s ruling on homelessness on Friday will make it easier for elected officials and law enforcement agencies nationwide to fine and arrest people living on streets and sidewalks, in broken-down vehicles or inside city parks — something that could have a long reach. health implications for homeless Americans and their communities.
In a 6 to 3 decision City of Grants Pass v. Johnsonthe justices in their majority said that allowing the targeting of homeless people who occupy public spaces by imposing bans on public sleeping or camping with criminal or civil penalties is not cruel and unusual punishment, even if there are no alternative shelter or housing options for them.
“It’s hard to imagine the chaos that’s going to ensue. It’s going to have horrible mental and physical health consequences,” said Ed Johnson, director of litigation at the Oregon Law Center and lead attorney representing the homeless defendants in the case.
“If people are not allowed to survive while living outside with things like a blanket and a pillow or a tarp and a sleeping bag, and they have nowhere else to go, they can die,” he said. .
The case, the most significant on homelessness in decades, comes amid widespread public dismay at the proliferation of homeless encampments — especially in Western cities such as Los Angeles, San Francisco, Phoenix and Portland, Oregon — and the dangerous and unsanitary conditions that often surround them.
An estimated 653,100 people were homeless in the United States in 2023, according to the most recent federal estimates, with the vast majority residing in shacks, wrecked RVs, and sprawling tent camps scattered throughout urban and rural communities.
The city of Grants Pass, Oregon, at the center of the legal battle, successfully argued that it was not cruel and unusual punishment to fine and arrest homeless people who lived outdoors or camped illegally on public property.
Mike Zacchino, a spokesman for Grants Pass, issued a statement Friday that the city was “grateful” to make the decision and is committed to helping residents struggling to find stable housing. Theane Evangeli, the city’s chief prosecutor, told the Supreme Court in April that if she can’t enforce anti-encampment laws, “the city’s hands will be tied. It will be forced to surrender its public spaces.”
In the majority opinion, Justice Neil Gorsuch argued that the homelessness crisis is complex and has many causes, writing, “With encampments on neighborhood sidewalks, adults and children in these communities are sometimes forced to navigate around used needles, human waste and other risks. to get to school, the grocery store, or work.”
But, Gorsuch wrote, the Eighth Amendment does not give Supreme Court justices the primary responsibility “for evaluating those causes and devising those answers.” A handful of federal judges cannot “begin to ‘match’ the collective wisdom of the American people in deciding ‘how best to handle’ a pressing social issue like homelessness,” he wrote.
In a dissenting opinion, Justice Sonia Sotomayor wrote that the decision focuses on the needs of local government and “leaves the most vulnerable in our society with an impossible choice: Either stay awake or get arrested.”
Elected officials, both Republican and Democratic, have increasingly argued that life on the streets makes people sick — and they should be allowed to transport people for health and safety reasons.
“If the government offers people help and they can’t or won’t take it, there should be consequences. We have laws that have to be used,” said Sacramento Mayor Darrell Steinberg, who is an adviser to California Gov. Gavin Newsom. on homelessness, citing laws that allow the state to require mental health and addiction treatment, for example.
The Supreme Court ruling could further encourage cities to sweep encampments and could force homeless people to be more transient — constantly moving around to avoid law enforcement. Sometimes they are offered shelter, but often there is nowhere to go. Steinberg believes many cities will more aggressively sweep encampments and keep the homeless on the move, but he doesn’t think they should be fined or arrested.
“I feel comfortable telling people you can’t camp in public, but I wouldn’t criminalize it,” he said. “Some cities will issue fines and arrest people.”
Homeless advocates say continued relocations will further jeopardize the health of this population and magnify public health threats such as the spread of communicable diseases. They fear that conservative communities will criminalize street camping, pushing the homeless into liberal municipalities that provide help and housing services.
“Some cities have decided they want to fine, arrest and punish people for being homeless, and the majority opinion tells communities they can go ahead and do that,” said Steve Berg, head of policy for the National Alliance. on Ending Homelessness. . “If communities really want less homelessness, they need to do what works, which is to make sure people have access to housing and supportive services.”
As they disperse and move — and are likely to be arrested or slapped with fines — they will lose relationships with the doctors and nurses who provide primary and specialty care on the streets, some health experts say.
“It’s just going to contribute to more deaths and higher mortality rates,” said Jim O’Connell, president of the Boston Homeless Health Program and an assistant professor of medicine at Harvard Medical School. “It’s tough, because there’s a public safety versus public health” debate that cities are grappling with.
As homeless people get sicker and sicker, their treatment will become more expensive, O’Connell said.
“Stop thinking about the emergency room, which is cheap compared to what we’re actually seeing, which is homeless people being admitted to the ICU,” he said. “I have 20-something patients at Mass General today who are getting a huge amount of money to take care of them.”
In Los Angeles, which has one of the largest homeless populations in America, street medicine provider Brett Feldman predicts more patients will need emergency intensive care as chronic conditions like diabetes and heart disease go untreated.
Patients taking anti-addiction drugs or those undergoing treatment to improve their mental health will also struggle, he said.
“People are already moving and the camps are being swept all the time, so we already know what’s going on,” Feldman said. “People lose their medication, they lose track of us.”
Homeless people die at rates two to six times higher than residents living in stable housing, according to May report from the Los Angeles County Department of Public Health. Drug overdose and coronary heart disease were the top two causes of death as of 2017.
Feldman said it may become more difficult to house people or place them in treatment programs.
“We rely on knowing where they are to find them,” Feldman said. “And they rely on us knowing where they are to get their health care. And if we can’t find them, often they can’t complete their housing paperwork and they don’t get in.”
The Biden administration has pushed states to expand the definition of health care to include housing. At least 19 direct money from Medicaid — the state-federal health insurance program for low-income people — to housing assistance.
California is doing the most, pumping $12 billion into an ambitious Medicaid initiative, mostly to help homeless patients find housing, pay for it and avoid eviction. It is also dramatically expanding street medicine services.
The Supreme Court ruling could halt those programs, said Margot Kuschel, a primary care physician and homelessness researcher at the University of California-San Francisco.
“Now you’re going to see disconnects from these case managers and housing navigators and people just losing touch in the chaos and the shuffle,” he said. “But what’s worse is that we’re going to lose the trust that’s so important to getting people to take their medicine or to stop using drugs and, ultimately, to get people into housing.”
Kushel said the decision will make homelessness worse. “Having only fines and jail time makes it easier for a landlord to turn you down for housing,” he said.
At the same time, Americans are increasingly frustrated by encampments spreading through neighborhoods, public parks circling and popping up near schools. The spread is characterized by more garbage, dirty needles, rats and human feces on the sidewalks.
Local leaders across California welcomed the conservative majority’s decision, which will allow them to fine and arrest homeless people even if they have nowhere to go. “The Supreme Court today took decisive action that will ultimately make our communities safer,” said Graham Knauss, CEO of the California State Association of Counties.
Newsom, a Democrat who leads a state with nearly 30 percent of the nation’s homeless population, said the ruling gives state and local officials “the definitive authority to implement and enforce policies to clear unsafe encampments from our streets,” ending legal ambiguity that has “tied the hands of local officials for years and limited their ability to implement common-sense measures to protect the safety and well-being of communities.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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