 The Crisis Before the Crisis
What the VA Is Teaching Us About Prevention One of the most underreported success stories in veteran services is happening right now. While homelessness across the United States increased in 2024, veteran homelessness declined by approximately 7.5%, according to the U.S. Department of Housing and Urban Development (HUD) and the Department of Veterans Affairs (VA). That did not happen by accident. It happened because organizations across the veteran support ecosystem are increasingly focused on identifying risk before a crisis becomes visible. For years, homelessness programs were largely designed to respond after housing had already been lost. Today, the conversation is evolving. The question is no longer simply how to help a veteran once they become homeless. The question is whether we can recognize the warning signs early enough to prevent homelessness from occurring in the first place. Looking for Risk Before Housing Is Lost The VA has invested heavily in shifting from crisis response to early detection. According to a 2025 VA Office of Inspector General audit, the Veterans Health Administration screened more than 2.4 million veterans between January and June of 2024 using its Homelessness Screening Clinical Reminder. During that six-month period, 31,149 veterans were identified as homeless or at risk of homelessness. Think about what that means. The VA was not waiting for veterans to lose housing. The VA was actively looking for signs that a veteran's stability may be at risk. The goal was simple: identify potential problems early enough to connect veterans with support before housing is lost. That distinction may be one of the most important lessons in modern veteran services. What Researchers Are Discovering This shift toward prevention is now being reinforced by emerging research. A 2026 study analyzing healthcare and social data from approximately 4.27 million veterans found that incorporating social and behavioral information significantly improved the ability to identify veterans at elevated risk for future homelessness. Researchers were not claiming that homelessness can be predicted with certainty. Instead, they reached a different conclusion. Social and behavioral indicators can help identify elevated risk long before a housing crisis occurs. Other veteran-focused research has reached similar findings. Studies examining homelessness risk among veterans have identified factors such as depression, PTSD, and trauma exposure as important risk indicators that may appear well before housing is lost. The emerging lesson is straightforward: Homelessness may not be the first sign of a crisis. It may be the last. The Warning Signs Before the Warning Sign The most important takeaway from both VA prevention efforts and recent research may not be about housing at all. It may be about learning to recognize vulnerability before it becomes visible. Financial strain. Transportation challenges. Behavioral health concerns. Housing insecurity. Reduced engagement with support systems. These factors do not guarantee a future crisis. But they may signal increasing risk. This reality helps explain why the VA continues to invest in homelessness screening, peer specialist programs, staff education, and Motivational Interviewing techniques designed to strengthen engagement before a crisis escalates. Recognizing risk is only the first step. Acting on it is what matters. A Lesson Beyond Housing At the Medic Now Foundation, this research resonates because it reinforces a broader lesson that extends beyond homelessness. Major challenges are often preceded by smaller signs of instability. In healthcare, those signs may appear differently. A delayed prescription. A missed appointment. A transportation barrier. An out-of-pocket expense that interrupts care. A patient who begins disengaging from treatment. Each event may seem minor in isolation. Yet each may represent an opportunity for intervention before a larger problem develops. The most important lesson emerging from the VA's work is that successful prevention begins long before a veteran loses housing. The earlier instability is recognized, the greater the opportunity to respond before consequences become more severe. The Crisis Before the Crisis The most important lesson emerging from the VA's homelessness prevention efforts may not be about housing. It may be about prevention itself. By the time a veteran loses housing, the warning signs may have already been present for weeks or months. The opportunity for intervention may have already existed. The question facing healthcare providers, veteran service organizations, policymakers, and communities is becoming increasingly clear: Can we learn to recognize vulnerability before the crisis becomes visible? Because if we can, we may not simply become better at responding to homelessness. We may become better at preventing it. Sources
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 How small healthcare costs can create much larger healthcare consequences.
Most healthcare conversations begin with access. Do people have coverage? Can they see a provider? Can they get into the system? Those questions matter. But an equally important question receives far less attention: What happens after care begins? Because for millions of Americans, the challenge is no longer gaining access to healthcare. The challenge is successfully carrying care through to completion. And the numbers suggest this challenge is larger than many realize. America's medical debt burden is estimated at approximately $220 billion, making medical debt one of the largest sources of financial strain facing households today. At the same time, healthcare affordability remains a significant concern even among insured individuals. National surveys continue to find that roughly one in four adults report difficulty affording healthcare or prescription medications. Research published in JAMA Network Open has also shown that prescription abandonment rises significantly as out-of-pocket costs increase. In some cases, patients never begin treatment despite having access to a prescribed therapy. These statistics point toward an important reality: Healthcare access and healthcare completion are not always the same thing. A patient can have insurance. A treatment plan. A referral. A prescription. An appointment. And still encounter barriers that interrupt care. When that happens, the consequences often extend beyond the individual healthcare encounter. Conditions remain unmanaged. Treatment plans are delayed. Additional healthcare services may become necessary. What began as a manageable issue can become a more complex and costly healthcare event. As conditions progress, patients may require additional healthcare services, including urgent care visits, emergency department visits, hospitalization, or more intensive treatment interventions. When patients eventually return to the healthcare system, they often require more complex care than was originally needed. The consequences extend beyond the patient. What This Means for Families Healthcare challenges rarely affect only one person. Within military and veteran families especially, healthcare decisions often affect entire households. When affordability interrupts care:
Why This Matters in Military Healthcare This challenge exists within military healthcare as well. The Defense Health Agency identifies retail network pharmacies as one of the primary access points for TRICARE beneficiaries. For many patients, the final step in a treatment plan occurs not in a hospital or clinic. It occurs at the pharmacy counter. Coverage helps reduce the financial burden. It does not eliminate it entirely. Care is prescribed. Cost is introduced. Completion becomes uncertain. The gap between access and completion is where affordability barriers often emerge. What We Are Seeing in Practice At the Medic Now Foundation, this pattern is not merely theoretical. Through the Healthcare Cost Assistance Program (HCAP), support is most frequently used in small, targeted amounts at routine healthcare touchpoints, particularly pharmacies and other healthcare-related expenses. The observation is straightforward: Many healthcare disruptions are not caused by the absence of care. They occur after care has already been authorized, prescribed, or made available. In many cases, relatively small out-of-pocket expenses become the barrier that prevents the next step from happening. When those barriers are removed, care can continue. The Final Mile of Care The Medic Now Foundation's Healthcare Cost Assistance Program focuses on what might best be described as the final mile of care. The program does not replace healthcare systems, insurance coverage, or clinical providers. Instead, it provides targeted support designed to help military-connected individuals complete prescribed care when affordability barriers create disruption risk. Because healthcare success is not measured solely by whether care is available. It is measured by whether care is completed. America's $220 billion medical debt problem is ultimately more than a financial issue. It is a reminder that access alone does not guarantee completion. And for many patients, the final mile of care remains one of the most important challenges in healthcare today. Sources
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