A Public Health Framework for Implementing Economic and Social Supports

Now that President Trump has signed a $2 trillion-plus Coronavirus response law (along with two other pandemic-related funding bills earlier this month), attention will rightly shift to federal, state, and county agencies charged with implementing a vast array of new federally-funded programs and policies. These policies are aimed at helping individuals and families battered by a global pandemic and harmed by the economic downturn precipitated by our broad-based public health response.

While these massive bills improve access to testing and care (and much more needs to be done in future legislation, including mandatory coverage for COVID-19 treatment), these new laws provide the financial and in-kind supports necessary for Americans who have lost jobs and income, and who need to comply with strict public health measures, such as social distancing, sheltering-in-place, and staying home from work. This is not a counter-cyclical stimulus designed to get people and businesses back to work right away; instead we need people to double-down on physical distancing. This also is not a situation in which governments at any level can treat this as business-as-usual with each agency working in its own lane and at its own pace. Time and speed are of the essence to protect Americans living paycheck to paycheck, in poverty, or on the margins.

In considering this mammoth task, I recommend adopting an overarching public health framework to guide the shared work of federal agencies, including Agriculture, Housing and Urban Development, Health and Human Services, Labor, Education, and Treasury, and their counterparts in state and local governments charged with implementing these new policies and programs. Public health is about protecting and improving the health of people and their communities, ensuring that nobody is left behind. This is especially critical in a pandemic when we need every person to take individual actions in order to protect our entire communities from the spread of infectious diseases.  Leaving some people out presents a risk to us all.

In fact, the collective measure of success for federal, state, and local agencies working to implement the workforce, health, nutrition, tax, and housing provisions of the coronavirus bills should be whether we are supporting as many Americans as possible in taking the public health steps we need to “flatten the curve” of COVID-19. This means using these new provisions to build on and strengthen elements of our fragile, torn, and uneven social safety net as quickly as possible – and to identify gaps that still need to be filled by future coronavirus legislative packages.

Specifically, this requires states and counties (especially in states such as California which have devolved many social programs to county governments) to quickly implement newly-created Coronavirus stimulus programs (e.g., special unemployment programs, child care, etc.) and coordinate effectively with complementary federally-administered policies (e.g., individual payments, tax preparation support, industry-specific recovery loans). At the same time, agencies need to utilize the flexibilities that exist in current programs (e.g., Medicaid, CHIP, SNAP, housing, WIC, etc.) to coordinate benefits and services as seamlessly as possible for families and households. Finally, states and localities will want to consider imposing special time-limited protections for essential services and family supports (moratoriums on evictions, utility shutoffs, internet cutoffs, etc.).

This also means prioritizing the best mix of policies and programs for at least four key populations whose relative security will be indispensable for sustaining the public health response: (1) economic stability for low-wage workers in industries profoundly impacted by public health measures (e.g., restaurant, hospitality, travel, retail, food service, etc.); (2) work supports like child care for people who need to continue working in essential industries (e.g., health care, first responders, caregiving, food, public utilities, etc.); (3) outreach to vulnerable populations people outside the workforce (e.g., people with disabilities, homeless, fragile families); and (4) engagement of immigrants, tribes, and other communities that warrant special attention (e.g., undocumented persons, refugees, mixed-status families, tribal institutions).

Because millions of Americans live paycheck to paycheck with little or no savings cushion, it will be important to coordinate key elements of multiple programs (e.g., application, eligibility, recertification, benefit delivery) to the greatest extent possible so people are able to comply with mitigation strategies. In other words, we need to err on the side of serving the most people at risk and leaving nobody behind ‑- core public health concepts — so we can sustain community mitigation as effectively as possible in flattening the curve.

This public health approach to implementing social welfare programs will not happen naturally. It runs contrary to the typical fault lines in American politics that establish complex eligibility criteria, enrollment requirements, documentation standards, recertification procedures, benefit methodologies, and programmatic mandates (e.g., work requirements) that seek to target resources to so-called “deserving” persons. This enduring focus was seen in Congressional debates over whether persons must file tax returns in order to receive individual benefits even if they had not been required to do so (yes, they do); whether to increase SNAP benefit levels (Congress declined); and whether unemployment benefits should be lowered to promote work (this amendment failed despite last-minute efforts by four Republican senators). We cannot afford to let these kinds of restrictions constrain the effectiveness, speed, and reach of the economic and social supports that people will need to comply with public health mandates in this unprecedented emergency. While program integrity is important to protect taxpayer dollars, in this case, the cure would truly be worse than the disease.

While the new and existing federal statutes will ultimately constrain some federal, state, and county agency discretion, there will remain enormous flexibility available to implementing agencies in making it easier (or harder) for individuals to receive benefits faster (or slower). Federal agencies will need to develop and transmit timely guidance encouraging states and counties to implement new programs swiftly (e.g., individual payments, paid leave, family leave), clarifying flexibilities available to states and localities during this crisis (e.g., Medicare, Medicaid, SNAP, WIC), approving waivers, interpreting laws and regulations generously, and providing relief from penalties for error rates and audit findings. States and counties will need to consider how individuals and families who are out of work can access the supports they need through Unemployment Insurance, Paid Leave, SNAP, Medicaid/CHIP, Housing subsidies, Child Care, TANF, and other programs without applying in person, waiting long times for eligibility determination, filling out complex forms, or supplying voluminous documentation. New and existing information technologies might help eligible people find and apply for the benefits they need.

There is a vital role here for nonprofit organizations. Philanthropists can commit to supporting federal, state, and local agencies with technical assistance necessary to implement this historic package of social policy changes along with organizations representing communities impacted by COVID-19. Employers, unions, advocates, faith communities and others can make their voices heard in calling on state governments to move quickly and efficiently to make available economic and social supports available so people can do what public health authorities are asking them to do.

This is a remarkable moment in which federal, state, and local leaders have a special opportunity to come together in viewing our social safety net as a critical asset for our country as we pursue an aggressive public health strategy in combating the COVID-19 pandemic. If we do so, once this health emergency passes, we will have a chance to evaluate the safety net’s readiness for future crises and its effectiveness in promoting the public health and economic security of Americans in the more normal times we hope lie ahead soon.