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As President Biden turns his attention to the proposed infrastructure package, the passage last month of the American Rescue Plan Act (ARPA) may feel like it is in the rear-view mirror. In reality, the implementation work is just beginning and our shared agenda for health and economic security for all is dependent on its success. The ARPA funding is an exciting opportunity to advance health equity and racial justice, specifically by investing in communities. As we rebuild and recover from the ground up, we must continue to demand that resources and investments be directed to those most excluded from our systems and create space for communities to build power and voice. The American Rescue Plan Act offers the opportunity to roll up our sleeves and get to work making change. As we move forward, we want to partner with our network of state and local advocates on several key areas to maximize ARPA’s beneficial impact.
1) Help People Understand the Provisions of the American Rescue Plan Act (ARPA)
According to Pew Research Center and Gallup, most Americans (close to 70 percent) approve of the American Rescue Plan. However, below the surface is a deep partisan divide – over 95 percent of Democrats support ARPA compared to 18 percent of Republicans. Just over a year ago, the CARES Act enjoyed 77 percent approval overall and carried equal support across party affiliation. The shift in unity in support of the government’s response seems to embody our collective exhaustion and differing views about the best road to recovery. The polling data also lifts up the importance of public education. As health advocates, we know from our experience with the Affordable Care Act how important it is to educate our communities about the individual provisions of a new law. President Biden and his team know this too – following passage, they launched a tour to promote ARPA’s stimulus plan. And unlike the past administration, the White House is using its web presence to provide tools to educate consumers about what is in it for them (also see this infographic from the Pandemic Response Accountability Committee). There is ample material to draw from to ensure your community feels fully informed and can access the benefits of ARPA. In sum: get the word out.
2) Demand a Seat at the Table
Beyond helping communities and stakeholders understand the provisions of ARPA, advocates must demand a seat at the decision-making table. The funds are already flowing and will continue to flow and many decisions need to be made about where and how they are invested (more on that next). Communities must be a part of these decisions. It is evident from local media to statewide reporting that plans are being hatched – whether that is calling a special legislative session or contemplating how to direct funds within a small community, work is underway. Some ways advocates can ensure that those hardest hit by the pandemic are at the center of resource decisions would be to:
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Reach out to key decision makers to understand how the state and localities will engage communities in determining use of ARPA funds – this could be a local public health board, a state representative and/or members of Congress.
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Leverage existing bodies focused on COVID-19 and equity. A number of states developed task forces and launched community-level efforts to address racism as a public health issue over the past year. These groups are focused on the intersection of equity and COVID-19 and should inform decisions about ARPA.
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Demand creation of a local coordinating committee that has consumer representation to ensure community-based organizations central to the health and wellness of communities are part of rebuilding the public health infrastructure.
3) Follow the Money
As we know from our first public education task, the provisions of ARPA are broad and the “buckets” of funds are substantial. At first glance, we home in on the robust financial incentives to close the coverage gap, boost affordable coverage, expand access to home and community-based services, and increase services for substance use and mental illness – but there is more. There are several funding streams that offer states and localities significant flexibility and discretion in how they are used. Following the money can be complicated. Release of funds is just beginning at the federal level while funding from the December relief package also continues to flow. Disentangling the funding and its potential opportunity to help communities requires persistence; we must demand transparency and accountability. Some key ”buckets” to pay attention to include state and local aid and public health provisions. Below is some helpful information as we do this work together:
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The state and local funds ($350 billion) are substantial and available to use until 2024. They can be leveraged for a broad set of priorities (see this chart from Brookings Institute). There are also clear guardrails: funds may not be used for tax relief (guidance anticipated from Treasury next month). The funds are dispersed based on a needs-formula so may vary county to county (tip: check out this guide from National Association of Counties).
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The COVID-19 vaccine development and distribution funds provide $7.5 billion for the Centers for Disease Control and Prevention to support vaccine-related activities “to prepare, promote, distribute, administer, monitor and track COVID-19 vaccines.” Go under the hood of this line item and you will find funds to support public health departments and community-based organizations to provide vaccine-related services (outreach, mobile clinics, data reporting, etc.)
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The COVID-19 testing and tracing funds are another important category of resources. Within this ”bucket,” there is $46 billion in funding to the Department of Health and Human Services to monitor and mitigate COVID-19 infections. This includes grants to states, localities and territories for these activities and specifically, a $7.66 billion investment in state, local and territorial public health departments to strengthen the public health workforce.
As we already know from the White House, there is commitment to directing these resources to those communities hardest hit by COVID-19, specifically Black and Brown communities. The recent announcement from the administration invests in vaccine equity and community health workers.
4) Dictate the Terms
While there is a lot of good work underway to advance an agenda that helps those that face longstanding barriers to health and economic security, there are also efforts to set up road blocks in states. This comes in multiple forms and it is important to build a counter narrative to the narrow view of how to use ARPA funds, including simply blocking any use of resources. For example, fiscal conservatives are already advancing a set of principles for how state and local governments should use the federal funding. These include limiting the use of funds to short-term projects and squirreling away funds to shield states from future tax hikes; these responses are short-sighted. The infusion of resources is an opportunity to advance a progressive agenda that leverages ARPA funds for transformation that directly addresses inequity. The Florida Policy Institutes provides a great example (and ARPA guide) of how to set the terms of the debate (also see this good piece from the Brookings Institute). They highlight the importance of the moment as one to dismantle old systems that perpetuate inequity and rebuild systems with equity at the center. As summarized from their toolkit, principles include:
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Help those most in need due to the COVID-19 and the consequent economic crisis – specifically, protecting those with health challenges.
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Advance antiracist, equitable policies to dismantle persistent inequalities.
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Promote strategic investments that set up and sustain long-term change.
5) Spearhead the Feedback Loop
We know from experience that no rollout of legislation this big is without glitches and learning opportunities. Advocates are best positioned to communicate feedback upwards on what is working and what is not. Most of the ARPA provisions are temporary, requiring further federal action to make them permanent. Communicating needed improvements AND the importance of permanency will be critical. Importantly, the work to rebuild communities in a post-COVID era is a long road; ARPA provides a natural experiment to more closely connect and align community voice to federal priorities. First, make sure that members of Congress know that you are their feedback loop and second, hold them accountable to maximize ARPA’s success.
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After you’ve thanked your member of Congress for the passage of ARPA, keep up the line of communication and report out regularly where you see opportunity and where you are seeing challenges that must be addressed.
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Extend your public education work to include story collection as the law is implemented to show how ARPA improves lives and strengthens community.
We are here to provide tools and supports along the way. Stay tuned for more.