The $600 weekly Pandemic Unemployment Assistance (PUA) has expired and is gone until Congress acts. Opponents of continuing the PUA cite a fictional entitlement myth, just like Reagan’s welfare queen — namely that people will refuse to work, staying at home and living off government largesse if they make more on unemployment than they did working. The problem with this position, in addition to being false, is that PUA detractors view these payments through an exclusively economic lens. A public health lens shows how necessary these payments are.
Social determinants shape health — our neighborhoods, housing, and the food we eat, to name a few. Experts project that in this economic downturn, some 17 million people may be unable to purchase sufficient food for their household. Renters have few protections, and it is estimated that 20 million people are at risk of eviction and possible homelessness in the coming weeks.
Our safety net programs were inadequate to meet the needs of the deeply impoverished even before the pandemic. Without significant additional aid to those suffering economic hardship, the coming wave of need may utterly break them. Masks and social distancing will not protect people from the devastating health effects of unmet social needs.
Take hunger as an example. Many individuals receiving PUA are using it to feed themselves and their families. Food insecurity is linked to worse outcomes in virtually every chronic disease and is even associated with premature death. The evidence connecting hunger and poor health outcomes is so overwhelming that payors, care delivery organizations, and provider organizations are now themselves providing food for food-insecure patients.
Some might wonder if food stamps, or the Supplemental Nutrition Assistance Program (SNAP), could meet this need. But health care providers have found that those benefits are so meager that to keep patients healthy, they must provide additional food assistance. The typical SNAP benefit is only about $1.41 per person per meal.
Congress has authorized some easing of regulations on food stamps over the last few months, but as the recent lines at food banks across the nation tell us, SNAP itself remains insufficient to meet the current level of need. If lawmakers wish to have a strong, healthy workforce come through this pandemic that is capable of restoring the economy, they must renew the PUA.
Similarly, I know that the coming wave of evictions and homelessness will deeply damage the health of millions. The PUA was helping to keep our workforce housed and healthy. The stresses and dangers of homelessness can destroy health, and even seem to accelerate aging.
Homeless individuals suffer from higher rates of chronic disease, accidental injury and death, infection, mental illness and substance use disorders than domiciled counterparts. The millions at risk of eviction and homelessness will suffer not only economic devastation but also significant adverse effects on their health in the ensuing months and years.
Dr. Megan Sandel, a housing expert, likens housing to a vaccine: housing prevents illness. The evidence that housing improves health outcomes and reduces healthcare costs is so profound that health care organizations are getting into housing. The widespread shortage of affordable housing and lack of government action to address the problem has left them with no alternative.
Another critical health consequence of Congress’s failure to renew the PUA is the devastation that extreme poverty will visit upon the mental health of millions. Rates of anxiety and depression are already skyrocketing and will worsen if there are mass evictions and widespread hunger.
I saw a patient in my clinic this week who is counting on the PUA to feed and house himself and his family. He wept as he described to me how worried he is about their situation. He can’t eat or sleep and has lost 10 pounds over the last few weeks. Aside from preventing this profound suffering, lawmakers should understand that mental illness exacts an immense cost on our economy — perhaps as much as a half-trillion dollars.
These calculations were based on typical conditions, not at the height of a pandemic. Renewing the PUA will significantly ease the mental distress of millions. Aid that helps to preserve mental health will allow affected individuals to more easily rejoin the workforce as the economy improves.
Even if lawmakers refuse to look at the PUA benefit through a health lens, the economic lens still reveals a picture of pending economic disaster. As the virus continues to surge in areas of the U.S., there’s little possibility of economic recovery. And without economic recovery, there won’t be any jobs for people to return to. The spectacular failure of the response to the pandemic rests with negligent policymakers, not people who have found themselves unemployed.
Just like the coronavirus itself, hunger, homelessness, and the attendant mental suffering of financial ruin are grave threats to the health of our nation. Unless Congress restores the PUA, I fear that the most far-reaching health and economic effects of the pandemic are yet to come.
Audrey Provenzano, M.D., is an internist and Unit Chief of the Massachusetts General Hospital Chelsea Healthcare Center.