{"id":168900,"date":"2020-06-29T16:48:13","date_gmt":"2020-06-29T20:48:13","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?p=168900"},"modified":"2024-02-23T15:21:17","modified_gmt":"2024-02-23T20:21:17","slug":"four-ways-covid-19-has-exposed-gaps-in-the-us-social-safety-net","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2020\/four-ways-covid-19-has-exposed-gaps-in-the-us-social-safety-net\/","title":{"rendered":"Four Ways COVID-19 Has Exposed Gaps in the US Social Safety Net"},"content":{"rendered":"\n
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Soldiers from the Georgia National Guard COVID-19 response force support warehouse and distribution operations at the Atlanta Community Food Bank in April.<\/figcaption><\/figure>\n

This viewpoint originally appeared in\u00a0The Conversation.\u00a0<\/a><\/em><\/p>\n

Viewpoint articles are written by members of the SPH community from a wide diversity of perspectives. The views expressed are solely those of the author and are not intended to represent the views of Boston University or the School of Public Health. We aspire to a culture where\u00a0all can express views in a context of civility and respect. Our guidance on the values that guide our commitment can be found at\u00a0Revisiting the Principles of Free and Inclusive Academic Speech<\/a>.<\/em><\/p>\n

The United States is experiencing its\u00a0steepest economic slide<\/a>\u00a0in modern history. Tens of millions of Americans\u00a0have filed new unemployment claims<\/a>\u00a0as the coronavirus shutters businesses and forces companies to lay off staff.<\/p>\n

People need support to help them through the crisis in a few key ways \u2014cash to meet immediate financial needs<\/a>, health care to cover them should they become ill and housing even if they\u00a0can\u2019t make rent<\/a>. Despite federal stimulus efforts north of $2 trillion\u2014so far<\/a>\u2014it is likely that some of those currently being affected will\u00a0fall through the cracks<\/a>.<\/p>\n

As scholars who study how\u00a0people enroll in public programs<\/a>\u00a0and research\u00a0social programs related to women\u2019s health<\/a>, we have seen how well-intentioned policies can sometimes fail those they are supposed to help.<\/p>\n

We took a deeper look at how difficult it might be for people to navigate their way through the US’s patchwork of social safety net measures as they try to stay afloat during the pandemic and economic downturn. Here are four gaps that we found:<\/p>\n

1. Delays, exemptions to financial aid<\/h4>\n

Congress passed stimulus measures that are providing some Americans with a\u00a0one-time check<\/a>\u00a0of up to $1,200 per adult and $500 per dependent child along with a\u00a0temporary boost<\/a>\u00a0in unemployment benefits. Many received their stimulus through direct deposit, but millions of low-income Americans\u00a0experienced problems and delays<\/a>\u00a0receiving payment. As many as 20 million may have had stimulus deposits go to tax preparers who take a fee out of refunds because clients are\u00a0too poor to pay for tax prep up front<\/a>. There are a\u00a0variety of other reasons<\/a>\u00a0for delays: if individuals haven\u2019t filed their 2019 tax returns yet, if their address has changed recently or if they\u00a0don\u2019t have a bank account<\/a>.<\/p>\n

Not everyone benefits from stimulus measures.\u00a0Young adults over the age of 17 who can be claimed as a dependent<\/a>\u00a0will not receive checks, nor will people who jointly filed their taxes with\u00a0immigrant spouses who are not citizens<\/a>, even if they are here legally.<\/p>\n

Workers in\u00a0more than half of states<\/a>\u00a0will receive, on average, more in unemployment benefits than their normal salaries. But there are challenges to receiving unemployment benefits too, as the\u00a0rules vary from state to state<\/a>\u00a0and labor agencies are\u00a0struggling to keep up with unemployment filings<\/a>. There are also thresholds for minimum earnings to qualify and limits on how long a person can collect unemployment.<\/p>\n

2. Free testing but costly treatment?<\/h4>\n

Congress mandated that private insurance cover\u00a0testing at no cost<\/a>, but not treatment. Infected? Get your deductible ready. Many will count on Medicaid, which typically covers medical bills retroactively for three months prior to application if you were eligible, but people in states that have broad\u00a0restrictions on retroactive coverage<\/a>\u00a0could be left holding the bag. And anyone in the process of getting their\u00a0Medicaid coverage renewed<\/a>\u00a0might be concerned, to say nothing of the\u00a0nearly 30 million Americans uninsured\u00a0before the crisis.<\/p>\n

A\u00a0$100 billion fund<\/a>\u00a0will help hospitals cover the cost of treating uninsured people affected by COVID-19. But the\u00a0CARES Act<\/a>\u00a0was unspecific about\u00a0how fast and to what areas<\/a>\u00a0the funds will be distributed, and\u00a0what they can be used for<\/a>. That needs to be figured out quickly, as\u00a0treatment costs<\/a>\u00a0may be as high as $40,000 per patient.<\/p>\n

And none of this funding even addresses those who develop long-term complications that require ongoing care.<\/p>\n

3. Unemployed and uninsured<\/h4>\n

Losing employment and health insurance coverage counts as a qualifying event to sign up for health insurance through HealthCare.gov or a state-based marketplace, but that assumes people know that they can. The Trump administration has\u00a0avoided<\/a>\u00a0any broad reopening of enrollment, but\u00a0several states<\/a>\u00a0have done so. Laid-off employees may have the option of extending their former employer\u2019s health insurance through\u00a0COBRA<\/a>, but this tends to be more expensive and unsustainable.<\/p>\n

Two recent studies project that\u00a0nearly 20 million Americans<\/a>\u00a0may face disruptions in employer-based health insurance, with as many as\u00a011 million becoming uninsured<\/a>. For those newly uninsured, living in a\u00a0Medicaid expansion state<\/a>\u00a0like New York or California might mean you are OK. But even before the pandemic, there were already an estimated 2.3 million people living in nonexpansion states like Texas or Florida who fell into the\u00a0coverage gap<\/a>\u2014making too much money to qualify for Medicaid and yet not enough to afford coverage.<\/p>\n

4. Safe from eviction, but for how long?<\/h4>\n

Stay-at-home orders have been seen as key in slowing the spread, but rely on the false assumption that everyone has access to safe and stable housing. Some people looking for affordable housing placements in March and April found themselves in limbo, with\u00a0progress on paperwork<\/a>\u00a0suddenly stalled. For those with housing, unpaid rent was\u00a0up 50 percent<\/a> in April over March. Many large cities and states have temporarily\u00a0halted evictions<\/a>\u00a0and a federal eviction ban covers about a\u00a0quarter of rental housing<\/a>. But this is only for nonpayment, leaving a loophole for landlords to continue pursuing eviction for other reasons. And that one-time stimulus check won\u2019t even cover the\u00a0median monthly rent<\/a>\u00a0in a number of states, especially in parts of California and the New York City metro area. So what happens when the check has been spent and the eviction ban is lifted?<\/p>\n

A solution<\/h4>\n

What if these safety net programs were better integrated? Imagine if filing for unemployment triggered a next step\u2014either presenting a series of subsidized health plan options through HealthCare.gov or auto-enrolling those eligible in Medicaid. It would potentially alleviate administrative burden and address gaps in information. States could use a mechanism like\u00a0Express Lane Eligibility<\/a>, which allows officials to use information provided from one state agency to make eligibility determinations for Medicaid, though there are\u00a0good reasons<\/a>\u2014mostly solvable\u2014why many states haven\u2019t yet.<\/p>\n

The US\u2019s social safety net is more a loose patchwork unprepared to handle a crisis like the pandemic, relying on disconnected public programs and\u00a0old technology<\/a>. The federal government is relying on short-term measures directed to those affected by the crisis, but we believe it does little to address the plight of those who were already economically vulnerable and those who will be long after this pandemic.<\/p>\n

Disaster preparedness isn\u2019t just the National Guard, personal protective equipment and bottled water anymore. This pandemic has shown that it is now also the ability to keep people economically afloat through a potentially prolonged and sudden financial crisis.<\/p>\n

Paul Shafer<\/a> is an assistant professor of health law, policy & management. Cecille Joan Avila<\/a> is a policy analyst in health law, policy & management.<\/em><\/p>","protected":false},"excerpt":{"rendered":"

Disaster preparedness isn\u2019t just the National Guard, personal protective equipment, and bottled water anymore. <\/p>\n","protected":false},"author":10989,"featured_media":169066,"comment_status":"closed","ping_status":"open","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"","_bu_prepress_primary_term_manual":"Viewpoint"},"tags":[3430,3434,2284,2233,2330,2125,1751],"bu-publication":[3516],"sphnews-article-category":[3519,3526,3531,3535,3543,3545],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[3286],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/168900"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/10989"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=168900"}],"version-history":[{"count":5,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/168900\/revisions"}],"predecessor-version":[{"id":237374,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/168900\/revisions\/237374"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/169066"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=168900"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=168900"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=168900"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=168900"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=168900"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=168900"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=168900"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=168900"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}