Equity must be a guidepost for Congress on reconciliation

The devastating health toll of COVID-19 caused the United States to shed a net total of nearly 10 million jobs in 2020: The worst annual employment figure in more than 80 years, hitting hardest those populations for whom every day can be a health and economic crisis. 

A sharp increase in the nation’s poverty rate appeared all but inevitable. Yet thanks to historic infusions of federal dollars directly into people’s pockets, poverty rates actually declined in 2020 and are projected to fall even further this year. 

Whether these declines represent the start of a more equitable policy era will soon be revealed as Congress enters the homestretch of negotiations over a budget reconciliation measure that represents a historic opportunity to transform people’s lives both in the short-term and long after the pandemic recedes. Congress simply cannot let this opportunity pass. 

More than 700,000 — or, 1 in 500 people in the United States — have now died from COVID-19, with death rates among Black, Latino and Indigenous people at least twice as high as those among white people. We continue to see nearly 100,000 new cases and 2,000 deaths every day. 

A new poll from NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health shows the resulting economic fallout. Even with increased economic assistance, 38 percent of U.S. households report facing serious financial problems over the past few months amid the Delta variant surge. The impact is most pronounced among households with incomes below $50,000 and Black and Latino households with children, with approximately 60 percent of those households reporting serious financial problems. 

These findings must shake Congress from a state of complacency. While our current national economic situation has improved since the early days of the pandemic, the recovery has been uneven and inequitable. The budget reconciliation measure is the best chance in decades to help create an America in which skin color, income level, neighborhood, disability, occupation and immigration status no longer determine how long and how well people live. Congress must:

• Make the expanded Child Tax Credit permanent. Within one month of expanded Child Tax Credit payments being distributed, the number of people reporting food insecurity dropped by an astounding 24 percent. It is estimated that an expanded Child Tax Credit in a typical year would cut childhood poverty by more than 40 percent. But the expanded and now fully refundable payments — which allow those with no or low incomes to receive the full amount — are currently in place for 2021 only. With the cost of childhood poverty and hunger in the U.S. pegged at more than $1 trillion annually, the price of inaction is far higher than any upfront investment.     
• Expand Medicaid to those caught in the “coverage gap”. More than 2.2 million people — disproportionately people of color and those in low-paying jobs that do not provide health insurance — are being denied health care in 12 states that have refused to expand their Medicaid programs under the Affordable Care Act. The health and economic benefits of Medicaid expansion are well-documented. The holdout states’ ongoing refusal to expand their Medicaid programs even during a pandemic is simply indefensible; the federal government must act now.
• Ensure people have safe and affordable housing. The connections between housing and health are clear, but even before the pandemic, the U.S. did not have nearly enough affordable housing to meet demand. A federal eviction moratorium put in place during the pandemic is no more and the vast majority of additional rental aid previously approved by Congress has not been distributed. As a result, millions of people remain at risk of losing their homes. A significant expansion of housing choice vouchers is essential to help people secure and keep their homes. Provisions to build new and upgrade existing public housing units while shoring up the National Housing Trust Fund are also essential to undoing the damage caused by the intentional segregating of America through redlining and other discriminatory housing policies both past and present.
• Help working families to care for their children when they are well and when they are sick. The United States remains the only wealthy nation that does not guarantee paid leave for all workers, nor does it adequately support quality, affordable and accessible childcare for working families — twin failings that fall hardest on those who earn the least, disproportionately people of color who are overrepresented in minimum wage jobs. This nation has long forced working parents to choose between earning a paycheck and providing proper care for children. Congress must finally end these inequities with a national paid leave program while providing meaningful support to child care employees and domestic workers who devote their lives to caring for others.  
• Maintain universal school meals. Enhanced nutrition support during the pandemic has led to permanent increases in Supplemental Nutrition Assistance Programs benefits and universal school meals through the 2021-2022 school year. Universal school meals should be permanent, but if Congress balks at that, it still must significantly expand the Community Eligibility Provision, which allows schools in high-poverty areas to serve free meals to all children regardless of family income. Given the impact of healthy school meals on children’s health and academic success, families deserve the peace of mind that comes when children are well-nourished during the school day. This is an investment in our future.    

The final negotiations over the budget reconciliation measure could be among the most consequential in generations. The notion of America being a land of opportunity is a fantasy for millions of people, reserved only for those of privilege. The short-term policy response to the pandemic has revealed the type of nation we could be if we continue to move forward — one where all people truly have a fair and just opportunity to live the healthiest life possible. The next few weeks will reveal whether our congressional representatives are up to the task.   

Richard E. Besser, a physician, is president and chief executive of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention.  Twitter: @DrRichBesser