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The public health breakthroughs of the American Rescue Plan

Speaker Nancy Pelosi (D-Calif.) and Majority Leader Charles Schumer (D-N.Y.) enroll the American Rescue Plan
Greg Nash

The newly signed landmark American Rescue Plan, which the Biden administration has been promoting cross-country, is certainly a long-overdue lifeline for millions of Americans struggling amid the COVID-19 pandemic. But there’s far more to the $1.9 trillion legislation than the direct stimulus payments that have grabbed most headlines. In fact, the American Rescue Plan represents the most significant investment in public health in a generation. 

This pandemic has triggered a series of wake-up calls: to the looming threat of infectious disease, the vast vulnerabilities in our health systems and the social determinants of health that are responsible for 80 to 90 percent of our overall health and well-being. 

Indeed, the American Rescue Plan could have a transformative impact by reducing health disparities, making health care more affordable and accessible and helping Americans lead longer, healthier lives for generations to come.  

It’s the most ambitious anti-poverty legislation in 50 years 

Poverty is widely recognized as a critical public health issue, with those affected facing greater risks of mental health challenges, chronic illnesses like diabetes and heart disease, and lower life expectancy, compared to wealthier populations. And child poverty in particular is endemic in the United States, with nearly half of young children living near or below the poverty line. That contributes to a range of health challenges, from poor nutrition to the long-term effects of chronic stress. 

That is precisely why the American Rescue Plan is such a big deal. The bill contains a significantly expanded child allowance — giving families between $1,000 and $1,600 more per child this year — and expands eligibility for the first time, so even the poorest families can qualify for the full credit. It also expands benefits for food stamps and rental assistance, extends more generous unemployment insurance through September, and makes it easier for families to afford child care. 

Altogether, the bill is estimated to cut poverty by one-third and to reduce child poverty by more than half. If those predictions pan out, we will see one of the fastest and most widespread drops in poverty on record in the United States.

It will make health care more affordable and accessible 

We also know that affordable health insurance saves lives. From 2013 to 2017 alone, more than 19,000 deaths were prevented among low-income adults in states that expanded Medicaid. Here, too, the American Rescue Plan is poised to make a major impact, investing in our health care infrastructure and increasing subsidies to help more people afford insurance. 

First, the bill will shore up our health care system in some of the places we need it most: sending $3 billion to cities and states to help pay for mental health and substance use disorder treatment and providing new grants for rural and tribal health care. And unlike past COVID relief bills, the American Rescue Plan will allow Planned Parenthood and other reproductive health providers to access federal funds to provide vital care to their patients. 

Second, the bill aims to increase the number of Americans who have health insurance. It incentivizes holdout states to expand Medicaid through more generous federal payments and significantly increases premium subsidies for low- and middle-income people who buy health insurance through state exchanges. And maybe most significantly, the bill will also ensure that no one who is buying insurance on the exchanges pays more than 8.5 percent of their income for coverage — creating all-new subsidies for middle-class families who were previously ineligible. 

It will invest in public education, public transit and public health infrastructure

Beyond responding to the immediate economic and health impacts of the COVID-19 pandemic, the American Rescue Plan lays the groundwork for a substantial reinvestment in our nation’s social infrastructure — the institutions and services that serve the needs of individuals and communities. 

Take schools. Not only does the bill contain significant funding to help schools reopen safely, including by upgrading ventilation systems and reducing class sizes, it also aims to address the educational inequities that the pandemic has only worsened. A recent study found that on average, elementary school students had fallen three months behind in math and one and a half months behind in reading, compared to their pre-pandemic peers; these “learning losses” were even more acute in schools where a majority of students are of color. The American Rescue Plan lays the groundwork for tackling these gaps by requiring schools use 20 percent of any funding toward reversing learning losses. 

Pandemic-related shutdowns also put public transit agencies deep in the red, as people began working from home to prevent the spread of COVID-19. Transit is critical for public health — cutting air pollution, reducing traffic fatalities and critically, helping people get where they need to go. The new bill contains enough funding for public transit to support operations for about two years, which will help stave off deep cuts to services that would have disproportionately hurt low-income workers. 

Finally, the bill extends significant aid to state, local and tribal governments, with $350 billion in total funding. Importantly, it bars states from using this money to fund tax cuts for the wealthy — meaning that we should see real investments in areas like clean water infrastructure, increased funding for public health departments and even more targeted aid for workers and small businesses who have been hit the hardest by the pandemic.  

What’s next? 

Despite the huge scale and transformative potential of the American Rescue Plan, one piece of legislation won’t be sufficient to address a global pandemic — or to rebuild our public health infrastructure to take on the deep-seated social, economic and racial inequities in our society. For starters, many of the bill’s most ambitious provisions, including the investments that will slash the child poverty rate in half, aren’t permanent. The United States dramatically underspends on public health in general, with experts estimating that we need at least $4.5 billion in additional ongoing investment to build a strong, national public health infrastructure. And leaders of states that would benefit most from Medicaid expansion are already signaling that they would rather leave their residents without affordable health care than work with the Biden administration. 

But at the very least, the American Rescue Plan shows the path forward dismantling the systemic inequities that have long determined who in America suffers and who thrives. And that is a public health victory worth celebrating. 

Michelle A. Williams is dean of the faculty, Harvard T.H. Chan School of Public Health, and Angelopoulos Professor in Public Health and International Development at the Harvard Chan School and Harvard Kennedy School.

Tags American Rescue Plan Act Child poverty Health Health economics Health equity Health insurance Healthcare reform debate in the United States Healthcare reform in the United States Medicaid

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