Since the beginning of COVID-19, the federal government has distributed more than $100 billion in financial relief to health-care providers — lifelines that preserve health-care access in communities around the country. Though they have not publicized the formulas for allocating funding, officials have prioritized funds to providers in rural settings, those who care for more COVID-19 cases and those who rely heavily on federal and state funding like Medicaid.
Officials should be commended for mobilizing these funds. But the reality is that they have not been allocated in a way that protects communities that are most vulnerable to COVID-19.
A dangerous myth about COVID-19 is that it “does not discriminate.” Instead, though all communities are susceptible to the virus, some of our most socially vulnerable ones have borne the brunt of it. Black and Latino individuals are infected at higher rates than white individuals, while COVID-19 hospitalizations and deaths have been higher in communities with more racial and ethnic minorities and individuals living in poverty. The evidence is clear: Race, ethnicity, poverty and other social determinants of health can dictate COVID-19 risk and outcomes.
The reasons go beyond biology. Discrimination, structural racism and distrust of the medical system lead to worse outcomes for racial minorities. Poor individuals are more likely to live in overcrowded accommodations, reducing their ability to socially distance. The nature of their work in areas such as public transportation may increase COVID-19 exposure and worsen health outcomes. And if they contract COVID-19, Americans in poor communities have less access to intensive care services than individuals in wealthier communities.
The government should immediately start prioritizing relief funds to health-care providers in high-need communities. While well-intentioned, the current approach of distributing funds based on hospitals’ COVID-19 cases may provide more relief to communities with more geographic segregation between white residents and Black residents, and more individuals facing housing-cost burdens. Relief policies may perpetuate inequality if they don’t explicitly account for social needs.
The stakes are too high to miss this mark. Instead, officials should take three steps to revise relief fund decisions to combat disparities. First, officials should update formulas using principles from welfare economics, a field focused on allocating economic resources to improve overall societal well-being. One solution would be to first commit funds to a group of communities with the most COVID-19 cases and then preferentially allocate funds between them based on social determinants that affect COVID-19 risk. This approach would not only direct relief to communities where COVID-19 is but to those where each dollar can have the greatest benefit.
Second, the government should expand on existing systems for uninsured individuals to create a path for health-care providers caring for vulnerable patients to request more relief funds. In doing so, officials could prioritize funds for providers actively working to address the needs of vulnerable groups, such as housing stability or food security. Though officials have directed some funds to “safety-net” hospitals, the goal should be to support providers actively using their funds to address community needs.
Third, officials should monitor the impact of provider-relief funds. For instance, providers receiving relief funds could be required to provide reports about how these funds are being used, overall and in service of vulnerable patients. This focus on parity would complement government investments in funding COVID-19-related biomedical and vaccine research.
To be fair, provider-relief funds by themselves will not solve long-standing disparities, and strong public-health surveillance is needed to direct funds over time. Officials should also consider provider-relief funds alongside other allocations (e.g., funds directed to taxpayers for unemployment and other purposes) to ensure that overall, financial relief matches community needs.
Nonetheless, as Congress considers additional relief packages, it would be a mistake to simply focus on COVID-19 cases or the needs of health-care providers. The pandemic has discriminated along social lines, and officials must combat it by considering communities’ needs too.