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Late Tuesday afternoon, Congress reached agreement to replenish funds in the CARES Act to the tune of a $484 billion package. The major pieces of the deal include $310 billion for the Paycheck Protection Program (PPP) that provides forgivable loans to small businesses, $25 billion for COVID-19 testing and $75 billion to support hospitals. While this is good news for businesses struggling amidst the pandemic and a step in the right direction, it is insufficient. Congress must return to address the ongoing challenges that states, communities and individuals are confronting as a result of an unpredictable virus that is disproportionately affecting populations such as people with substance use disorders, people with complex needs, people who identify as LGBTQ+, and people of color.
Conversations are already underway and now that CARES is financially replenished, congressional staff will work in the coming days and weeks to craft a “CARES 2” package. We stand with our allies in demanding an effective response to the twin health and economic crises that we are facing – one that addresses the pervasive racial, ethnic and class inequities in our society that COVID-19 is exacerbating.
Below are the broad issue areas and legislative reforms needed to respond to the crisis and begin to reorient and restructure our health and social systems toward equity. We also encourage you to dig into our longer set of recommendations here.
Coverage and Affordability
As people lose their jobs, they are losing their health insurance too, further widening the longstanding coverage gap for people of color in this country. Even before COVID-19 hit, 29 million people in the U.S. lacked health insurance coverage, including a disproportionate share of people of color who face unjust and discriminatory barriers to health and economic security. For example, 11.5 percent of Black people are uninsured versus 7.5 percent of white people. With the COVID-19 pandemic already having caused the unemployment rate to skyrocket to 10 percent, it is estimated that 12 million people have lost their employer-sponsored insurance, further exacerbating the underlying coverage gap for people of color. These disparities in coverage can be reduced by expanding Medicaid in non-expansion states, increasing funding of Medicaid and maintaining that enhanced funding as long as unemployment remains high. In addition, Congress must improve ACA Marketplace plan affordability and eliminate cost-sharing for COVID-19 treatment.
Access and Quality
While coverage and affordability are key components of responding to the public health crisis, it is vital to ensure access to high quality care – and advance policies that specifically address inequity in access to resources while supporting populations that are left behind. We know that some populations are disproportionately affected by COVID-19. People who work in jobs that are deemed “essential” are having greater exposure to the virus, yet many of these jobs lack any guaranteed health insurance and are low-wage occupations leaving people without savings, paid leave and social supports. Congress must invest more funding in under-resourced communities to support the health and financial security of essential workers. This includes ensuring that providers who serve a disproportionate share of low-income and uninsured patients have access to enhanced funding, and this must include community-based service providers receiving state-only funding (e.g., certain SUD treatment providers, doulas, Community Health Workers (CHWs), and others).
Finally, while CMS has signaled that the reporting of racial and ethnic data related to COVID-19 is forthcoming, there is more to be done. Congress must pass legislation that requires policy makers and researchers to identify and address ongoing disparities and health inequities that risk accelerating the impact of the novel coronavirus and the respiratory disease it causes. This data must be transparent and requires deep investment in public health infrastructure.
Social Determinants of Health
The social determinants of health – poverty, unequal access to care, housing, employment, education, environmental hazards, and structural racism – must be confronted, as they are significant contributing factors to worsening health inequities, as well as obstacles to the coverage and quality objectives in addressing the COVID-19 pandemic. As such, individuals and families need their most basic needs fulfilled during this crisis in order to mitigate spread, allow people to recover and ensure long-term health and economic security. In short, Congress must address shortcomings in paid leave, unemployment insurance, housing security and food access, including a moratorium on evictions, foreclosures and collections on medical debt.
In most of the country, state and local officials have been working hard to address the COVID-19 pandemic and the resulting economic fallout. But only federal policymakers have both the power and access to resources to respond adequately and deliver what is needed to help our communities recover. Although it may seem like Congress has already done a lot, their work is far from done. The current crisis has laid bare the weaknesses and inequities of our health care and economic support systems. In their next bill, Congress must tackle the current crisis in a comprehensive way that lays the groundwork for systems that promote justice, equity and security.