Understanding there is no silver bullet, we are outlining immediate, intermediate and long-term ideas that could reduce the devastating impact that will inevitably hit those already facing inequities and hardship. The coronavirus exploits vulnerabilities associated with inequality and health disparities and highlights key shortfalls in our health systems. This is our time to finally effectively address those issues. Also note that most of the below relate primarily to the U.S. We\u2019ll continue to update with ideas for those in other parts of North America. We’ve broken these up into three areas:<\/p>\n
Immediate<\/a> Statistically, vulnerable populations are least likely to have access to a general practitioner and this is especially true for people living in the South or in states with minimal access to health programs like Medicaid. We should:<\/p>\n In partnership with local and state public health and social services, we need to focus efforts on those who need it most. This includes testing in health care facilities as well as low-income communities with high rates of hourly essential workers (such as industrial areas and near distribution centers) and areas with high concentrations of older adults (such as known retirement communities), linking these people to the necessary social services they may need. This could include services such as Meals on Wheels or SNAP, or utility assistance through LIHEAP<\/a>. We should:<\/p>\n There is the inevitable mental toll of the pandemic, and particularly so for those that still must interact with others through work and those who had an existing issue, including those addressing addiction. A pandemic not only compounds already existing issues; it can create new anxieties for those who have not previously accessed mental health care. This is especially true for those on the front lines who may be uninsured or underinsured and do not have a mental health provider, and who are now dealing with a pandemic, food insecurity and fear. We can:<\/p>\n This includes support to seniors and others managing prescriptions they now may not be able to afford.\u00a0 Pharmacists are often on the front lines in prescribing to people and may even act as a bridge to care. This could be especially disrupted during this pandemic. We should:<\/p>\n Food banks and other critical community resources are already pushed to the limit, and we\u2019re just at the beginning. Lost jobs mean more demand for social services.\u00a0Kids out of school mean that families have to provide more meals to more children.\u00a0We need to ensure that critical social services \u2014 such as food stamps and utility assistance \u2014 aren\u2019t interrupted. This is particularly important in the South, where the pandemic is expected to hit just as the summer heat waves begin to roll in. We should:<\/p>\n The USPS should receive Congressional relief through emergency funds, and a task force should be formed to identify and address the USPS’s longterm sustainability. Without a doubt, low-income and rural communities will suffer the most without postal service. Storefronts for suppliers such as FedEx and UPS are generally in suburban and urban communities only, and their costs far eclipse that of the postal service. Added social distancing measures make accessing these suppliers even harder. Additionally, poorer and\u00a0rural populations are also less likely to have internet to access correspondence and online systems of care<\/a>.\u00a0Also, keep in mind that many services, including Medicaid in many states, require mailed correspondence to complete registration.<\/a><\/p>\n The ramifications go beyond health issues. Many residents throughout the country rely on mail to cast their vote, and particularly for absentee voting or those in small communities.<\/a> We need this option now more than ever, as we aren\u2019t sure when it will truly be safe to be in groups in public, the most common set-up for voting now. Finally, keep in mind that the USPS employs many veterans \u2013 about three times their share of the national workforce. It\u2019s critical we protect these employees that already face many unique difficulties in the labor market<\/a>.<\/p>\n As advocated by the Urban Institute, the U.S. Treasury should use its\u00a0federal prepaid debit card program<\/a> to get payments safely to these groups, just as it does for Social Security beneficiaries. The IRS has put in place two primary mechanisms to disperse funds: direct deposit and paper checks, and both can be problematic. And keep in mind \u2013 should the postal service close, the paper checks are not worth the pulp on which they\u2019re written.<\/p>\n <\/p>\n Many hospital financial assistance policies require patients to provide an extensive list of documentation to prove their poverty and job status, including paperwork from state and local departments that are currently closed during the pandemic. Additionally, many hospitals require in-person consultations to qualify for financial assistance. Finally, many hospitals look at a prior year\u2019s income tax to determine eligibility. That information is likely irrelevant for many, considering nearly 22 million U.S. residents have already filed for unemployment in the last month alone, a figure that\u2019s continuing to sharply rise. \u00a0Keeping federal rules around nonprofit hospital-financial assistance in mind, hospitals should:<\/p>\n Since mid-March, the federal administration expanded Medicare telehealth coverage, which enabled access to many physician services for enrollees from their home. Among gains were limitations on site, including those that excluded many rural communities. Additionally, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), two types of organizations that traditionally serve low-income populations, are now eligible providers. We should:<\/p>\n This could be particularly important for those who lose their jobs in the middle of the pandemic and cannot afford the usually very high costs to partake in COBRA. We should revive the COBRA subsidy implemented in 2009 under the American Recovery and Reinvestment Act.<\/p>\n The issues of health inequities are long-standing, and minorities, low-income populations and those living in rural communities have faced significant barriers to care for decades. What is happening with the pandemic is heartbreaking and, in many ways, amplifies issues that have plagued our communities for too long. Never before have these issues been at the forefront as they are now. Although we may now be experiencing a “perverse safety net,” we must ensure that people have access to care and services that they need even without a pandemic. This would not only lessen the burden on individuals, but collectively we would be much more equipped to deal with national hardships. We have enacted many emergency measures to help. We should build upon these, folding in other measures that specifically address the needs of vulnerable populations, knowing that these are the populations that need our help the most now and in the future.<\/p>\n COVID-19 is highlighting a core failing of our health systems in all states, but none as much as those who have so far declined Medicaid funding. Medicaid expansion, which has a 90 percent federal matching rate, offers states the ability to care for tens of thousands of residents. But many have declined, and particularly those in the South, where high rates of chronic conditions and poverty are creating a perfect storm for accelerated infection rates. In the long term, expect even higher rates of uninsured populations in these states, as the economy stumbles to recovery. These people will have limited access to care, relying on already-stressed safety net systems for even the most basic of care.<\/p>\n We are in the middle of a hard lesson on what it means to continuously defund public and community health for a number of years. Human capital helps drive pandemic response, and cuts to hard-working staff and committed health workers made us ill-equipped to ramp up boots-on-the-ground ways to prevent spread of this virus. States can provide funds earmarked specifically for these groups, utilizing mechanisms such as state associations to distribute funds. This is particularly important in states that have not expanded Medicaid. Please read additional recommendations in our recent editorial for Georgia Health News<\/a>.<\/p>\n","description_es":" Translation coming soon.<\/p>\n","description_fr":" Translation coming soon.<\/p>\n","teaser_en":"The issues COVID-19 bring will take years, if not decades, to solve. But there are things we can do to help reduce the impact on us all, and especially those already facing inequities and hardship.","teaser_es":"The issues COVID-19 bring will take years, if not decades, to solve. But there are things we can do to help reduce the impact on us all, and especially those already facing inequities and hardship.","teaser_fr":"The issues COVID-19 bring will take years, if not decades, to solve. But there are things we can do to help reduce the impact on us all, and especially those already facing inequities and hardship.","author":null,"tangle_title_en":null,"tangle_title_es":null,"tangle_title_fr":null,"tangle_link_title_en":null,"tangle_link_title_es":null,"tangle_link_title_fr":null,"tangle_url":null}
\nIntermediate<\/a>
\nLong-term<\/a><\/p>\n<\/h2>\n
Immediate<\/h2>\n
Support links to primary care for low-income and minority patients.<\/h3>\n
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Smartly target prevention, testing and treatment for high-risk populations.<\/h3>\n
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Widely advertise and support available mental health services.<\/h3>\n
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Ensure uninterrupted supply of medicine.<\/h3>\n
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Ensure social services aren\u2019t disrupted.<\/h3>\n
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Ensure that the United States Postal Service remains in business.<\/h3>\n
Utilize the federal prepaid debit card program to provide relief funds to those without bank accounts.<\/h3>\n
<\/h2>\n
Intermediate<\/h2>\n
Reduce paperwork and other burdens for hospital-based financial assistance.<\/h3>\n
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Support continued expansion of telehealth services.<\/h3>\n
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Provide federal subsidies for COBRA coverage.<\/h3>\n
<\/h2>\n
Long-term<\/h2>\n
Make the \u201cnew normal\u201d better than the \u201cold normal.\u201d<\/strong><\/h3>\n
Expand Medicaid.<\/h3>\n
Provide sustainable state funding for\u00a0public health departments, community health centers, and charitable clinics.<\/h3>\n