Since the earliest days of the COVID-19 pandemic, Congress has treated people’s physical health and economic health as separate and distinct. While legislators would never think of cutting off free access to COVID treatment and vaccinations in the midst of this health crisis, they are quite willing to eliminate or underfund the economic supports that are vital to the survival of individuals, families, and communities.
The COVID-19 relief bill Congress passed in December is a perfect illustration. Its provisions expire throughout the year like the seasons. Enhanced federal unemployment insurance ends on March 14. Tax credits to encourage paid family leave expire on March 31. Expanded Supplemental Nutrition Assistance Program benefits run out on June 30. Remaining CARES Act funds must be spent by December 31.
Every COVID relief bill has been crafted with temporary supports and arbitrary end dates, chasing an unpredictable virus and an unclear timeline.
Our policy response to this pandemic has been inadequate because it fails to recognize that one’s economic health and one’s physical and mental health are intertwined. For instance, a person exposed to COVID, but without paid sick leave or family leave, must make impossible choices. Rather than follow the public health protocols to stay home and isolate, they often must go to work in order to pay the rent and put food on the table.
To become a society in which health prospers, we need to move from a mindset of health being simply about the choices we make as individuals, to a recognition that health is about the communities in which we live and the policies that shape the living conditions in those places.
For so many in America, in particular people of color and people in low-income jobs, the barriers to healthy choices are profound. One by one, Congress must begin to remove these barriers. Today, the U.S. must provide crucial short-term economic support through the duration of this pandemic, but we must also use this moment to lay the groundwork for a long-term and broad policy agenda that aims to improve Americans’ health and well-being. This will require persistence, a sense of urgency and the dismantling of the systemic barriers that have allowed inequities to fester.
The short and long-term needs are many, but Congress can put a down payment on a more equitable future by focusing on these five policy needs:
Housing: A person’s ability to secure quality, affordable and stable housing is directly tied to health. Discriminatory housing policy is a root cause of the health differences people of color experience today. In fact, high levels of segregation in a community can literally take years off of people’s lives and during this COVID-19 pandemic, evictions have led to additional cases and deaths. Millions of Americans are at risk of losing their homes because of COVID-19 economic hardships. The problem is particularly acute for people of color who tend to pay a greater share of their income on housing. Moratoriums on eviction and mortgage foreclosure have helped, but they have been limited in scope and reach and rental assistance has been inadequate. Ensuring people do not lose their homes during the pandemic must be considered precursors to longer-term approaches that will ultimately enshrine safe and secure housing as a fundamental right for all people. These could include more inclusive zoning regulations, expansion of tax credits and housing choice vouchers to reach all who need them and sorely needed upgrades to public housing.
Nutrition assistance: In 2020, as many as 50 million Americans — including 17 million children — spent time not knowing when their next meal would arrive. As a short-term response, Congress has provided additional funding and temporarily increased benefits for SNAP, which provides critical food aid to individuals and families — particularly people of color who are disproportionately in lower paying jobs and those living in poverty — who are having trouble affording food. Given SNAP’s proven ability to improve children’s health, reduce poverty and lower food insecurity, Congress should make SNAP increases permanent while removing access barriers for college students, unemployed adults without children and lawfully residing immigrants. An increase in the federal minimum wage to a living wage would have an added benefit of fewer people needing food and housing assistance.
Paid leave. Far too many Americans lack paid family and sick leave. Women of color are most likely to be denied this benefit and many frontline workers such as grocery store clerks and childcare providers — with a high risk of COVID-19 exposure — are least likely to have paid sick days. Paid family leave is linked to reduced infant mortality, healthy child development and improved mental health for mothers. Congress has approved temporary tax credits to encourage businesses to provide paid leave to workers. This is not nearly enough. All workers should be guaranteed paid leave to care for themselves and their families during the pandemic and beyond.
Unemployment insurance. About 10 million fewer people are working today compared with the start of the pandemic. The $600 weekly federal unemployment insurance payments included in the CARES Act, along with stimulus checks, helped keep about 18 million people out of poverty. However, those payments were permitted to expire and the latest round of assistance — half that amount — will expire in a few weeks. Congress must increase the amount and duration of those payments so people have the time and ability to find stable employment. In addition, the nation’s unemployment insurance system needs long-term structural reforms, from expanding access to increasing the benefits to shoring up state trust funds.
Health care access. The pandemic has exposed the U.S. healthcare system as outdated, insufficient, expensive and discriminatory. Even before the pandemic, nearly 30 million people lacked health insurance and millions more had inadequate coverage. While health is about more than just health care, it’s hard to lead one’s healthiest life without access to high quality, affordable health care that addresses physical and mental health needs. Needed reforms include: increasing the federal financial incentive for the 12 remaining states to expand Medicaid and bolstering subsidies for people to afford Affordable Care Act marketplace coverage while seeking opportunities to control the increase in health care costs. Achieving universal healthcare in the United States must be viewed as a matter of when, not if.
The pandemic has shown once again that wealth, skin color, and privilege continue to play an outsized role in how long and how well people in the United States live. Congress must move now to provide support for people’s immediate needs while at the same time not missing the political opportunity afforded by this crisis to begin to address the long-term objective of building a society in which all people can thrive.
Richard Besser is president and CEO of the Robert Wood Johnson Foundation in Princeton, N.J. He worked at the CDC for more than a decade, including as acting director at the dawn of the H1N1 pandemic in 2009. Twitter: @DrRichBesser