Federal Policy Recommendations to Advance Health Equity from the Robert Wood Johnson Foundation
A series of policy briefs include evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure a fair and just opportunity for health.
The pandemic has exposed a stubborn, harsh truth about life in America, and revealed glaring failures in our public policies.
The COVID-19 pandemic has uprooted the lives of everyone living in the United States and around the world, but the most severe health and economic impacts have been concentrated among people of color, those with low and middle incomes, and people who live in places that were already struggling financially before the economic downturn. The pandemic has exposed a stubborn, harsh truth about life in America: People’s ability to live a long and healthy life depends to a significant degree on the color of their skin, how much money they have, and where they live.
This pandemic has also revealed glaring, long-standing structural failures in our public policies. No one should have to choose between paying rent and putting food on the table and protecting the health of themselves, their families, and their communities. The Robert Wood Johnson Foundation (RWJF) is working to change policies and systems so no one has to make that choice.
This policy brief series, Federal Policy Recommendations to Advance Health Equity from the Robert Wood Johnson Foundation, includes evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure all people in the United States have a fair and just opportunity to be as healthy as possible.
The first brief in the series, Improving Housing Affordability and Stability to Advance Health Equity, focuses on how millions of families in America—particularly families of color—are denied shelter, security, and access to opportunity. The brief lays out a roadmap for how we 1) ensure people do not lose their homes during the COVID-19 pandemic and beyond, and 2) build toward transformational change that guarantees housing as a human right and a public good that advances racial and economic equity.
- Safe, stable, and affordable housing is associated with better physical and mental health, improved educational and developmental outcomes for children, and financial security and economic mobility.
- 17.6 million households spend 50 percent or more of their income on housing alone.
- When people are forced to devote a substantial portion of their income to housing, it strains their ability to pay for other essentials including health care, food, and transportation.
- Discriminatory housing policy—including redlining, exclusionary zoning, and many other actions—has resulted in widespread residential segregation and systematic public and private sector disinvestment in Black, Latino, and Indigenous communities.
- COVID-19 has exacerbated this crisis through job loss, reduction in household wages, and inability to work due to illness or caregiving responsibilities.
Considerations for Policymakers
Keep People Stably Housed During COVID-19 by:
- Strengthening and extending the eviction moratorium issued by the Centers for Disease Control and Prevention
- Issuing a moratorium on utility shut-offs
- Providing substantial additional funding for tenants and landlords to prevent evictions
- Providing additional funding for homeless services and housing providers
Advance Long-Term Change in Housing Equity by:
- Reversing harmful housing regulations, including reduced discrimination protections including the gutting of the Affirmatively Further Fair Housing Rule
- Establishing a Presidential Commission on reparations to redress discriminatory federal housing policy that unjustly restricted Black peoples’ access to housing and opportunity
- Making rental costs more affordable by ensuring all income-eligible people can receive Housing Choice Vouchers and creating new tax credits for renters
- Restructuring and expanding the Low Income Housing Tax Credit and other programs that produce affordable housing
- Rehabilitating, preserving and rebuilding public housing
- Improving housing safety and security for Indigenous people
- Incentivizing state and local governments to address exclusionary zoning
- Repealing the June 2020 revisions to the Community Reinvestment Act and revising it to promote equitable development and affordable housing
The second brief in the series, Increasing Access to Supplemental Nutrition Assistance Program (SNAP) to Advance Health Equity, focuses on SNAP, the nation’s largest food assistance program which serves as a critical lifeline for millions of families in America who have trouble affording food. It is proven to reduce poverty, improve the economy, lower food security, and improve children’s health and educational attainment. The brief recommends steps policymakers can take to strengthen SNAP during the COVID-19 pandemic and beyond.
SNAP participation has risen dramatically during the COVID-19 pandemic, increasing from roughly 37 million in February 2020 to 43 million in September 2020, an increase of 16.5 percent.
Increasing SNAP expenditures during an economic downturn is one of the most effective ways to drive economic activity and create and protect jobs.
Research shows access to nutritious food helps children’s brains develop, improves their academic performance, has long-term health benefits, and establishes healthy eating habits that can last a lifetime.
Considerations for Policymakers
For the remainder of the pandemic and economic recession:
- Continue higher SNAP benefits (at least 15 percent) and federal support for state administrative costs.
- Ensure that the lowest-income households are eligible for emergency SNAP allotments.
- To supplement SNAP, continue Pandemic Electronic Benefit Transfer (Pandemic-EBT) through the summer and into the new school year as needed, which provides money for families with low incomes and millions of children missing meals due to school and child care closures.
- Continue to suspend SNAP work requirements for adults under age 50 without children.
Beyond the pandemic and recession:
- Increase SNAP benefits by at least 20 percent from pre-pandemic levels to enhance anti-hunger and anti-poverty effects while updating the underlying system for calculating benefits to ensure that they cover food costs in specific communities for all participants. Read the research and analysis on why increased benefits are necessary and current levels are based on an outdated system.
- Expand availability of resources to support healthier food purchases, including SNAP-Ed (the Supplemental Nutrition Assistance Program-Education) and other financial incentive programs, to enable SNAP participants to purchase more fruits and vegetables.
- Streamline eligibility and enrollment processes and focus enrollment efforts on communities with low participation, including immigrants, people of color and rural residents.
- Roll back harmful regulations that would limit access to SNAP benefits including the public charge rule and proposed restrictions on the ability of states to waive work requirements for childless adults and narrowing of broad based categorical eligibility.
- Broaden SNAP eligibility to cover more college students, unemployed adults without children, and lawfully residing immigrants.
The third brief in the series, Increasing Access to Affordable and Comprehensive Health Insurance, focuses on the inability of many people to afford health insurance—particularly people of color or those in low-wage jobs—which has uncovered one of the nation’s clearest vulnerabilities during the COVID-19 pandemic. There is a large and growing body of research that demonstrates the positive impact of health insurance coverage on health and mortality. The brief recommends steps policymakers can take to strengthen access to high quality and affordable health care during the COVID-19 pandemic and beyond.
- Access to health insurance coverage has important economic benefits. Studies of recent Medicaid expansions show improved economic impacts at the individual and neighborhood level, demonstrating the financial importance of health insurance to low-income families and communities.
- The uninsured, including disproportionately racial and ethnic minorities and individuals with low incomes, are more likely to forgo preventive care, leading to later-stage disease diagnoses, lower life expectancy, and greater risk of hospitalization.
- Financial barriers to care are not only a problem of the uninsured. Excessive cost-sharing is a problem affecting millions of people whose health insurance is inadequate.
- Creating a truly equitable coverage system will require significant eligibility expansion, meaningful cost containment, and additional revenue.
Considerations for Policymakers
During COVID-19, maximize coverage through existing channels.
- Increase enrollment in the ACA Marketplace. Preliminary data from the special enrollment period are promising and should increase when additional premium subsidies become available later in the year.
- It is essential to reverse current policies that have the potential to limit coverage in the ACA Marketplace and Medicaid.
- Maintain the protections established under the Public Health Emergency. Policies such as continuous coverage requirements have allowed states to keep more people enrolled in Medicaid during the pandemic.
- Provide additional incentives for states to expand Medicaid. If the remaining twelve states expand Medicaid eligibility it could cover more than two million people.
- Increase affordability of Marketplace coverage. Temporarily increasing subsidies and placing a cap on premiums as a share of income makes Marketplace coverage far more affordable to millions.
- As a temporary emergency measure, the American Rescue Plan subsidizes the cost of COBRA payments to help some of those losing jobs keep their employment-based coverage.
- Expand post-partum access to Medicaid so all women have a source of insurance coverage before, during and after pregnancy.
- Increase funding for home and community-based services for the elderly and people with disabilities.
Beyond the pandemic, prioritize permanent policies that provide universal coverage and cost containment.
- Close the Medicaid coverage gap. Congress should consider using either the Marketplace or other federal approaches, including but not limited to a public option to close the coverage gap.
- Permanently increase the affordability of Marketplace plans. In addition to increasing subsidies, policymakers should consider increasing the actuarial value of the benchmark plan to reduce out of pocket costs.
- Reduce the cost of prescription drugs. Address anticompetitive behavior and delays to competition that skew the market prices of prescription drugs.
- Reform the Medicare Part D benefit design and establish a maximum out of pocket limit for beneficiaries, creating incentives for plans and pharmacy benefit managers to better manage the drug benefit and reduce costs.
- Implement the No Surprises Act in a manner which maximizes the cost containment potential.
- Promote competition and address market power and the negative impacts of health system consolidation through active anti-trust and other strategies, including the possibility of rate regulation in persistently uncompetitive markets.
- Open the firewall between the ACA Marketplace and employer insurance. Permit employees to choose between Marketplace plans and their employer’s offering, in a manner that protects against insurance companies dumping patients or adverse selection.
- Improve opportunities for working people with disabilities to access Medicaid.
Healthy School Meals for All
School meals are a lifeline for millions of children, helping to prevent hunger and ensuring families have enough to eat, especially among those living furthest from economic opportunity.
Achieving Health Equity
Supplemental Nutrition Assistance Program (SNAP)
WIC: Ensuring a Healthy Start for All Kids and Families
This brief provides background on the Special SNAP for Women, Infants, and Children (WIC) program: its purpose, who it serves, and how it works. It also offers recommendations for policymakers on how to strengthen the program.
Improving Access to Paid Family Leave to Achieve Health Equity
This brief provides background on federal and state paid family leave policies (PFL), highlights domestic and international research that shows PFL provides a range of benefits, and lays out principles for a universal PFL program.