[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
HEALTH AND WEALTH INEQUALITY IN
AMERICA: HOW COVID 19 MAKES
CLEAR THE NEED FOR CHANGE
=======================================================================
HEARING
before the
COMMITTEE ON THE BUDGET
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
HEARING HELD IN WASHINGTON, D.C., JUNE 23, 2020
__________
Serial No. 116-27
__________
Printed for the use of the Committee on the Budget
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available on the Internet:
www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
42-158 WASHINGTON : 2020
COMMITTEE ON THE BUDGET
JOHN A. YARMUTH, Kentucky, Chairman
SETH MOULTON, Massachusetts, STEVE WOMACK, Arkansas,
Vice Chairman Ranking Member
HAKEEM S. JEFFRIES, New York ROB WOODALL, Georgia
BRIAN HIGGINS, New York BILL JOHNSON, Ohio,
BRENDAN F. BOYLE, Pennsylvania Vice Ranking Member
ROSA L. DELAURO, Connecticut JASON SMITH, Missouri
LLOYD DOGGETT, Texas BILL FLORES, Texas
DAVID E. PRICE, North Carolina GEORGE HOLDING, North Carolina
JANICE D. SCHAKOWSKY, Illinois CHRIS STEWART, Utah
DANIEL T. KILDEE, Michigan RALPH NORMAN, South Carolina
JIMMY PANETTA, California KEVIN HERN, Oklahoma
JOSEPH D. MORELLE, New York CHIP ROY, Texas
STEVEN HORSFORD, Nevada DANIEL MEUSER, Pennsylvania
ROBERT C. ``BOBBY'' SCOTT, Virginia DAN CRENSHAW, Texas
SHEILA JACKSON LEE, Texas TIM BURCHETT, Tennessee
BARBARA LEE, California
PRAMILA JAYAPAL, Washington
ILHAN OMAR, Minnesota
ALBIO SIRES, New Jersey
SCOTT H. PETERS, California
JIM COOPER, Tennessee
RO KHANNA, California
Professional Staff
Ellen Balis, Staff Director
Becky Relic, Minority Staff Director
CONTENTS
Page
Hearing held in Washington, D.C., June 23, 2020.................. 1
Hon. John A. Yarmuth, Chairman, Committee on the Budget...... 1
Prepared statement of.................................... 4
Hon. Steve Womack, Ranking Member, Committee on the Budget... 6
Prepared statement of.................................... 8
Sir Angus Deaton, Ph.D., Senior Scholar, Princeton University
Woodrow Wilson School, Presidential Professor of Economics,
University of Southern California.......................... 11
Prepared statement of.................................... 13
Patrice Harris, M.D., M.A., Immediate Past President of The
American Medical Association............................... 19
Prepared statement of.................................... 21
Damon Jones, Ph.D., Associate Professor, University of
Chicago Harris School...................................... 30
Prepared statement of.................................... 32
Avik Roy, President, Foundation for Research on Equal
Opportunity................................................ 41
Prepared statement of.................................... 43
Statements from America's Essential Hospitals and the
Campaign for Tobacco-Free Kids submitted for the record.... 90
Hon. Sheila Jackson Lee, Member, Committee on the Budget,
statement submitted for the record......................... 104
Hon. Barbara Lee, Member, Committee on the Budget, questions
submitted for the record................................... 108
Answers to questions submitted for the record................ 109
HEALTH AND WEALTH INEQUALITY IN
AMERICA: HOW COVID-19 MAKES
CLEAR THE NEED FOR CHANGE
----------
TUESDAY, JUNE 23, 2020
House of Representatives,
Committee on the Budget,
Washington, D.C.
The Committee met, pursuant to notice, at 2:34 p.m., via
Webex, Hon. John A. Yarmuth [Chairman of the Committee]
presiding.
Present: Representatives Yarmuth, Higgins, Boyle, DeLauro,
Schakowsky, Kildee, Panetta, Morelle, Horsford, Scott, Jackson
Lee, Peters; Womack, Woodall, Johnson, Flores, Holding, Norman,
Meuser, Crenshaw, and Burchett.
Chairman Yarmuth. This hearing will come to order.
Good afternoon, and welcome to the Budget Committee's
hearing on Health and Wealth Inequality in America: How COVID-
19 Makes Clear the Need for Change. I want to welcome our
witnesses here today.
At the outset, due to the new virtual hearing world that we
are in, I ask unanimous consent that the Chair be authorized to
declare a recess at any time to address technical difficulties
that may arise with such remote proceedings.
Without objection, so ordered.
As a reminder, we are holding this hearing virtually, in
compliance with the regulations for committee proceedings,
pursuant to House Resolution 965.
First, consistent with regulations, the Chair or staff
designated by the Chair may mute participants' microphones when
they are not under recognition for the purposes of eliminating
inadvertent background noise. Members are responsible for
unmuting themselves when they seek recognition, or when they
are recognized for their five minutes.
We are not permitted to unmute Members unless they
explicitly request assistance. If I notice that you have not
unmuted yourself, I will ask you if you would like staff to
unmute you. If you indicate approval by nodding, staff will
unmute your microphone. They will not unmute you under any
other conditions.
Second, Members must have their cameras on throughout this
proceeding, and must be visible on screen in order to be
recognized. As a reminder, Members may not participate in more
than one committee proceeding simultaneously.
Now I will introduce our witnesses. This afternoon we will
be hearing from Professor Sir Angus Deaton, Senior Scholar at
Princeton University Woodrow Wilson School, and Presidential
Professor of Economics at the University of Southern
California; Dr. Patrice Harris, Immediate Past President of the
American Medical Association; Dr. Damon Jones, Associate
Professor at the University of Chicago Harris School; and Mr.
Avik Roy, President of the Foundation for Research on Equal
Opportunity.
I will now yield myself five minutes for an opening
statement.
The word ``unprecedented'' is often overused, but right
now, what we are facing as a nation and a society is truly
unprecedented. We are simultaneously battling a global pandemic
as the coronavirus rages on, an economic freefall from business
closures and waves of mass unemployment, and a crisis of
conscience as we grapple with the deadly effects of entrenched
systemic racism in our country.
Nearly every American has experienced uncertainty and far
too many extreme hardships during the last several months. But
these crises have something else in common: they all
disproportionately impact Americans of color.
Today the Budget Committee will examine one aspect of this:
the underlying health and economic inequalities that have
exacerbated COVID-19's impact on our minority communities.
Historic and persistent racial disparities in income,
employment, education, wealth, health care, housing, and more
have made Americans of color more vulnerable to the virus, both
in terms of health and economic status.
Nowhere is the disproportionate impact of coronavirus
clearer than in the virus's death rates. If Black and Latino
Americans died of COVID-19 at the same rate as white Americans,
at least 14,400 Black Americans and 1,200 Latinos would still
be alive today. While the CDC may not list structural racism as
one of the chronic conditions putting people at a higher risk
for severe COVID-19 disease, long-term health inequities and
barriers to accessing quality, affordable health care have made
communities of color more vulnerable to serious illness and
death from coronavirus.
Where you live, where you work, and how you get to work all
influence health status and outcomes. And more often than not,
it is to the detriment of Black and Latino families. These
longstanding inequities are only hard to see if you refuse to
look. And when it comes to economic justice, the facts are
plentiful: in terms of median household earnings, the most
recent Census data shows that, for every dollar a white family
earns, a Latino family earns $.73, while a Black family earns
just $.59.
Decades of income inequality and the resulting wealth gap
have left Black and Latino Americans with less savings and far
less ability to weather a serious health emergency or an
economic crisis. Today families are battling both. The same
households that had less going into this economic crisis have
faced far more layoffs and job loss. While all groups have seen
a historic rise in unemployment compared to pre-pandemic
levels, the May 2020 unemployment rates for Black and Latino
Americans were substantially higher than for white Americans.
The pandemic has redefined essential work. And while Black
and Latino workers comprise--compose 29 percent of the national
work force, they account for 34 percent of frontline workers.
Every day they are forced to choose between their health and a
paycheck. Despite this, many of these workers still do not have
access to paid leave or hazard pay. And more than one in four
frontline workers have said the coronavirus has made it harder
to meet their basic needs.
But workers aren't the only ones whose daily life has been
upended. The coronavirus has led to widespread school closures
across communities, and children of color may be impacted the
most. One study estimated that, while the average white student
may lose about six months of learning, the average Latino
student may lose nine months, and the average Black student may
lose 10 months. Without action, this could exacerbate
graduation rates, disparities among students of color, further
perpetuating economic inequality for generations to come.
The COVID-19 pandemic has exposed the cracks in our systems
and laid bare the underlying inequities that have existed in
the United States for generations. And our health care system,
our economy, in education, and in our justice systems. It
threatens to widen the economic chasm between white Americans
and Americans of color. If not contained and reversed, we will
not only jeopardize the future of millions of American
families, we risk the well-being of our nation.
As we look forward to the next phase of recovery efforts,
we must strive for structural change that will not only help
our economy recover, but also help more people, specifically
people of color, prosper when it does. We cannot be foolish
enough to think that a rising tide will lift all boats. If we
are, we will sink the country. This has to be a turning point.
There is too much need, too much pain, and too much anger for
Congress to do little or nothing.
I know we cannot end institutional racism overnight, but we
can certainly start. We can build a stronger nation, a more
inclusive economy, and an America that better reflects our
values. And that is what I hope to focus on today.
[The prepared statement of Chairman Yarmuth follows:]
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Chairman Yarmuth. I now yield five minutes to the Ranking
Member, Mr. Womack, for his opening remarks.
Mr. Womack. I thank the Chairman, and thanks to all of the
Members of the Committee for participating today. It is great
to be in this hearing.
Prior to the coronavirus, the U.S. economy was increasing
wages and living standards. The median average income, adjusted
for inflation, increased by 3.4 percent in 2018. The poverty
rate fell from 12.3 to 11.8 percent, according to the latest
Census Bureau data. Unemployment was at a five-decade low of
3.5 percent. Black, Hispanic, and Asian unemployment rates fell
to 5.4, 3.9, and 2.1 percent, respectively, all of which were
record lows. Wages were growing faster for low-income workers
and for higher-income workers. But the pandemic, as we all
know, brought these upward trends to a screeching halt.
While I think the topic of today's hearing is extremely
important, and one that we need to carefully discuss and
address, I am concerned that this Committee ought to be focused
on a large and growing crisis that threatens income security
programs for all Americans. And that threat is our out-of-
control deficit and debt. Congress has--and, I might add,
appropriately, and on a bipartisan basis--enacted $2.5 trillion
worth of legislation to address our current public health and
economic crisis.
Even while we take such unprecedented action, we can no
longer ignore our country's long-term fiscal imbalance. The
nation's structural budget deficits, which exist not only in
economic emergency, but also during peace and prosperity, are a
severe challenge to the critical programs that millions of our
seniors and low-income Americans rely on every day, like Social
Security, Medicare, Medicaid--and that list goes on and on.
The federal government's future ability to fund these
programs is under a real threat by the growth of net interest
payments, which are growing far more rapidly than the rest of
the federal budget, even with historically low interest rates.
Ultimately, if we fail to live up to our duty to
responsibly budget, future generations may face a sovereign
debt crisis that would not only threaten our ability to fund
these programs that tens of millions of Americans rely on, but
would also cause economic hardship for all Americans. And let
me just add, too, that the pressure on the discretionary budget
of the U.S. Congress is--speaks for itself in--with deficits
and debt the way we are calculating them today.
Since we failed to do our job during normal times and put
the nation on a fiscally responsible path, we set ourselves up
for an even more challenging budget outlook when the pandemic
crisis hit. Now our deficit this year is projected to be under
just under $4 trillion, by far the highest in American history.
This Committee needs to get back to its job of writing a
budget resolution for Congress and making the tough choices we
have been tasked to do. It is not going to be easy. Indeed, it
is going to be much more difficult with a pandemic. But it
needs to be done. This is the only way these critical safety
net programs, programs so vital to our most vulnerable
communities, will continue to exist for current and future
generations.
The past few months have been extremely challenging for the
entire country and, in fact, the entire world. In the United
States, over 2 million cases of COVID-19 have ravaged the
health of our nation,and our economy has been infected, as
well. The economic downturn caused by the quarantine orders has
significantly increased the impact of COVID-19 on our most
vulnerable. Today, we will discuss how the pandemic has
exacerbated pre-existing health care and economic inequalities
in the nation.
So I look forward to today's discussion. And, Mr. Chairman,
again, I thank you for hosting the hearing today, and I look
forward to it. And I yield back the balance of my time.
[The prepared statement of Steve Womack follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. I thank the Ranking Member. I would also
again, once again, like to thank our witnesses for being here
this afternoon.
The Committee has received your written statements, and
they will be made part of the formal hearing record. Each of
you will have five minutes to give your oral remarks.
As a reminder, please unmute your microphone before
speaking.
Dr. Angus Deaton, please unmute on your microphone. You may
begin when you are ready. You are recognized for five minutes.
Thank you for being here.
STATEMENT OF SIR ANGUS DEATON, PH.D., SENIOR SCHOLAR, PRINCETON
UNIVERSITY WOODROW WILSON SCHOOL, PRESIDENTIAL PROFESSOR OF
ECONOMICS, UNIVERSITY OF SOUTHERN CALIFORNIA; PATRICE HARRIS,
M.D., M.A., IMMEDIATE PAST PRESIDENT OF THE AMERICAN MEDICAL
ASSOCIATION; DAMON JONES, PH.D., ASSOCIATE PROFESSOR,
UNIVERSITY OF CHICAGO HARRIS SCHOOL; AND AVIK ROY, PRESIDENT,
FOUNDATION FOR RESEARCH ON EQUAL OPPORTUNITY
STATEMENT OF SIR ANGUS DEATON, PH.D.
Dr. Deaton. Chairman Yarmuth, Ranking Member Womack, and
Committee Members, thank you for inviting me to talk on the
inequalities in the COVID-19 pandemic.
The pandemic is exposing and exaggerating longstanding
inequalities in health and wealth. It will worsen the
inequalities between Black and white, between the more and the
less educated, and between ordinary people and the well-off.
Enlightened policy can moderate these effects, as is already
being the case, but we are not done.
The pandemic may turn tolerable inequalities into
intolerable inequalities. There is a danger of social unrest,
but there are also opportunities to address all problems. The
need to repair our policing has already become urgent. Other
outstanding issues include health care, antitrust policy, and
our system of unemployment benefits.
In the past half century, the lives of Americans have
become increasingly divided according to whether or not people
have a four-year college degree. Those with a BA have prospered
and are living longer, while those without are foundering. Not
only are the gaps widening, but the lives of less educated
Americans are getting worse. The American economy is not
delivering for less educated Americans.
In our book, ``Deaths of Despair and the Future of
Capitalism,'' Anne Case and I document this disaster. Mortality
rates have risen, driven by rapid increases in deaths of
despair, suicides, overdoses, alcoholic liver disease, and an
uptick in deaths from heart disease. At the same time, wages
and employment have declined, as have marriages, socializing,
and churchgoing. In all of these areas, more educated Americans
continue to make progress.
The disintegration of white working class life parallels
the earlier disintegration among African-American communities
in the 1960's and 1970's, culminating in the crack epidemic.
African-American mortality rates have long been higher than
those of whites. The gap has diminished steadily, closing
particularly rapidly when white mortality rates began to rise
in the mid-1990's. This convergence came to a halt after 2013,
when fentanyl deaths among Blacks where Blacks with a BA were
largely exempt.
American health care played a role in the disaster.
Pharmaceutical companies were largely responsible for the first
wave of the opioid epidemic. The exorbitant cost of health
care, much of which is financed through employment, has lowered
wages and destroyed goods jobs for less educated Americans. At
the same time, it is expanding wealth inequality.
This was before the pandemic. COVID death rates are higher
for African-Americans and Native Americans than for whites.
Occupation, segregation, population density, transportation,
and the patterns of pre-existing health conditions for all
involved. High incarceration rates for African-Americans have
brought excess mortality from COVID.
Lives of the more educated are less at risk because many of
us can work and earn while social distancing. Poorer kids are
likely to do less well with Internet classes.
The pandemic has exposed the folly of tying health
insurance to work. African-Americans and Hispanics were less
likely to have insurance pre-COVID, and they and the millions
who became unemployed find themselves at risk. Temporary
arrangements are covering COVID-related health care, but they
are not sustainable. America needs what other rich countries
have: health care that is not tied to employment, that covers
everyone from birth, and that controls costs.
Our patchwork, state-based system of unemployment benefit
is also being exposed by the pandemic. Many have been concerned
about consolidation and growing market power of large firms,
prices rising faster in the U.S. than in Europe, and the
falling share of labor and national income. COVID has shuttered
many businesses, increased the power of big tech, and will
cause further consolidation. Reinvigorating antitrust
enforcement was a priority before, and will be urgent
afterwards.
The four largest states have a third of the population, but
only 8 percent of the votes in the Senate. COVID victims are
even less well represented: half of all deaths, and only 8
percent of Senate votes, an inequality that will narrow as the
epidemic moves into rural America. Unequal political
representation in the pandemic serves further to divide us.
Thank you.
[The prepared statement of Angus Deaton follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you, Dr. Deaton.
I now recognize Dr. Harris for five minutes.
Please unmute your mic, Dr. Harris.
STATEMENT OF PATRICE HARRIS, M.D., M.A.
Dr. Harris. Thank you. Good afternoon, Chairman Yarmuth,
Ranking Member Womack, and Committee Members. The American
Medical Association commends you for holding today's hearing.
My name is Dr. Patrice Harris, and I am Immediate Past
President of the AMA. I am a practicing child and adolescent
psychiatrist from Atlanta. And thank you for the opportunity to
testify today.
As our nation confronts a dual crises of a deadly pandemic
that has triggered economic instability and joblessness unseen
since the Great Depression, inequities have been starkly
revealed, most notably among Black Americans, the Latinx
community, and Native American communities, and I would like to
highlight just a few facts.
Black Americans have been among the hardest hit population
by this virus. Not only are we hospitalized and dying in
disproportionate numbers, we also are more likely than white
Americans to have lost income because of the pandemic. In 42
states plus Washington, DC, Hispanics and the Latinx community
make up a greater share of confirmed cases than the share of
their population. In eight states, it is more than four times
greater. The death rate in the Navajo Nation is higher than in
any single U.S. state.
So clearly, COVID-19 is having a disproportionate impact on
minoritized and marginalized communities. And why? Structural
inequities that result from long-term policies, practices, and
procedures that determine access to comprehensive health care,
as well as those determinants of health: inadequate housing,
education, food insecurity.
And these are all influenced by bias and racial
discrimination; higher prevalence of chronic health conditions
such as diabetes, hypertension, asthma, and obesity; an
increased likelihood of working essential jobs such as bus
drivers, train operators, those who are working in our
supermarkets and meat packing plants, hospitals and nursing
home--and, of course, that increases the risk of exposure; a
stronger likelihood of living in congregate, multi-generational
living arrangements; and major mistrusts of medical
institutions because of historical abuses of science and
research; and, of course, misinformation and disinformation.
So the AMA is very concerned that the pandemic and the
economic fallout will further exacerbate these longstanding and
long-term health, economic, and social inequities experienced
by minoritized and marginalized communities.
Now, these dual crises are also having an impact on our
collective mental health. The toll is not yet known, but I will
tell you that people are angry, exhausted, and frustrated. And
in nearly every community, people are demanding change.
New data from the Household Pulse survey suggests that
COVID-19 is worsening mental health for communities of color,
which, as a group, have less access to mental health services.
As a child and adolescent psychiatrist, I worry about the
short-term and the long-term mental health impact this pandemic
will have on our children, particularly our children of color.
The AMA is deeply committed to achieving greater health
equity by raising awareness about its importance to patients
and communities, and by working to identify and eliminate
inequities. The good news is we are talking about it. The
public is more aware; we are having this conversation today. So
we must use this opportunity to move our country forward on
health equity through change at the individual level in our
policies and procedures and in our culture.
And how do we move forward? Briefly, some suggestions. We
have to address implicit and unconscious bias at all levels and
in all systems. We need targeted outreach on COVID-19 testing.
We need to make sure that vaccine trials include a diverse
population. We need federal and state agencies to collect and
report COVID-19 data on infections. We need support for
increasing diversity of the medical work force. We need a
national strategy with state partnerships for increased
resources for a mental health infrastructure that has, for
decades, gone under-resourced and underfunded. And we need to
expand access to health insurance and high-quality health care.
We cannot go back to business as usual. We must work
together to build a society that supports equitable
opportunities for optimal health for all.
Thank you.
[The prepared statement of Patrice Harris follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you, Dr. Harris.
And I now recognize Dr. Jones for five minutes.
Dr. Jones, thank you for joining us. Unmute your mic,
please.
STATEMENT OF DAMON JONES, PH.D.
Dr. Jones. Thank you, Chairman Yarmuth and Ranking Member
Womack, for having me. I am Damon Jones, an Economist and an
Associate Professor at the University of Chicago Harris School
of Public Policy. My research and teaching focus on inequality,
tax policy, and household financial well-being. My comments
today will focus on four aspects of inequality in the U.S. and
how they interact with the current COVID-19 pandemic.
I will begin with the well-documented decline in the
individual and collective leverage of workers relative to their
employers. Unionization rates have reached record lows, and
recent research has highlighted market power by employers,
which allows them to suppress worker pay. These developments
have coincided with stagnant wages for the typical worker.
It is in this context that we now find frontline workers in
between a rock and a hard place. On the one hand, they have an
opportunity to continue working when many others are forced
into unemployment. On the other hand, they are being asked to
risk exposure to COVID-19 infection. And the erosion in worker
power I just mentioned leaves them unable to demand adequate
protection equipment, paid sick leave, or hazard pay. To
paraphrase Economist Rhonda Sharp, though these jobs are deemed
essential, the workers who perform them are being treated as
anything but.
My second point will be quite brief. By linking one's
insurance coverage to one's employment status, the U.S. is in
the minority amongst peer OECD countries. The flaws of this
system are made painfully clear as we undergo historically
rapid spikes in unemployment, thrusting millions into the ranks
of the uninsured. During both a public health crisis and a
recession, many are dreading the potential of enduring long-
term unemployment and chronic health complications related to
COVID-19 infection, all the while with limited access to health
care.
Next, let me turn to wealth inequality. Many households
lack adequate liquid assets, which I define as cash on hand or
assets that can be easily converted into cash. The typical
household has less than one month of income saved up for a
rainy day, meaning--leaving many in a state of financial
precarity. In recent research, my colleagues and I have shown
that, when faced with an unexpected cut in pay or a job loss,
households with the least amount of assets have to cut spending
on necessities by two to four times as much as their wealthier
counterparts.
During the current pandemic millions of families found
themselves in this very position. While payments via the CARES
Act and extensions to unemployment insurance have filled the
gaps for many, there remain households who have experienced
delays in receiving relief. And there are others, people
experiencing homelessness and undocumented people, who are
unlikely to receive payments or who are outright excluded from
these benefits.
I will end with the issue of racial inequality. In the
above three instances, the patterns of inequality are strongly
predicted by one's racial and ethnic identity. Black workers
make up a disproportionate share of frontline workers and
Latinx workers are over-represented in key frontline
industries.
Insurance coverage is lower for people of color, especially
native families, relative to white ones. And the
disproportionate increases in unemployment among these groups
is likely to exacerbate this gap.
The typical white household has between nine to 10 times as
much wealth as their Black and Latinx counterparts. Our
research shows that this racial wealth gap leads Black and
Latinx households to have to cut spending significantly more
than white ones when faced with a reduction in pay or job loss.
Given the above discussion, I recommend the Committee
consider the following policies.
First, protect workers' right to engage in collective
bargaining, strengthen and enforce existing U.S. labor
standards. And during a pandemic, convene bodies with
representation from both workers and employers to address
ongoing concerns of workplace health and safety.
Second, in the short run, expand Medicaid eligibility for
those who have experienced job loss. In the longer run,
transition to a system of universal health care provision and
health insurance coverage.
Third, continue extensions of the unemployment insurance
program beyond their expiration at the end of July. Tie this
continued renewal to macroeconomic indicators, and disperse
additional periodic direct payments to households through the
IRS. Provide resources to state and local governments to better
reach individuals not covered by either of these previous two
channels, and extend relief to undocumented families.
Finally, the racial disparities I have summarized are
driven by longstanding factors such as historical and
structural racism. They, therefore, require more fundamental
interventions. As an example, we should move forward with H.R.
40 and establishing a committee to explore reparations for
African-Americans. Such policies directly address racial
inequality by moving toward what William Darity, Jr. and A.
Kirsten Mullen described as acknowledgment, redress, and
possible closure with respect to historic racial injustice.
Thank you, and I look forward to your questions.
[The prepared statement of Damon Jones follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you very much, Dr. Jones.
And now I yield five minutes to Mr. Roy.
Welcome to the Committee, Mr. Roy. Thanks for being with
us.
STATEMENT OF AVIK ROY
Mr. Roy. Thank you, Mr. Chairman, and also to Ranking
Member Womack and Members of the Committee. Thanks for inviting
me here today.
The Foundation for Research on Equal Opportunity, or
FREOPP, for short, is a nonpartisan think tank that focuses
exclusively on ideas that can improve the lives of Americans on
the bottom half of the economic ladder. I welcome the
opportunity to discuss our work on how COVID-19 economic
lockdowns have widened racial inequities in education, health,
and the work force.
My written statement contains a more detailed discussion of
our findings. In my oral remarks I will focus on three topics.
First, I will discuss how economic lockdowns imposed by states
and localities have disproportionately harmed minority
employment and minority owned businesses; second, I will touch
on how economic lockdowns have further destabilized the fiscal
sustainability of the United States; third, I will discuss how
COVID-19 mortality by race and ethnicity, and how states'
failure to protect nursing homes in particular has harmed
vulnerable seniors of all races.
As Mr. Womack noted, in late 2019 Black unemployment
reached its lowest rate in history, 5.4 percent. Today the
Black unemployment rate is 16.8 percent. The Hispanic
unemployment rate was 3.9 percent in late 2019. Now it is at
17.6 percent. In my written testimony I detail how disparities
between white and non-white unemployment rates also reached
their lowest levels in history prior to the pandemic. But the
economic lockdowns have brought those disparities back to
levels last seen a decade ago.
Compared to whites and Asians, Blacks and Latinos are less
likely to work in white collar occupations, where working from
home is feasible. Instead, they are seeing their jobs and hours
slashed. Hourly wage work is down 50 percent, on average, and
even more in places with the most stringent lockdowns.
But Black-owned businesses have also been hit far harder
than white-owned businesses. It is estimated that Black-owned
businesses have experienced losses of 41 percent between
February and April, versus 32 percent for Hispanic-owned
businesses, and 17 percent for white-owned businesses. Put
simply, racial and ethnic disparities are worse when the
economy is worse, and especially during the government-mandated
shutdowns of the economy we are experiencing today.
As you know, the CARES Act and related legislation has
increased the federal deficit by trillions of dollars. Material
increases in the federal debt further destabilize what is
already a dangerous situation. If demand for U.S. Treasury
bonds declines on account of decreased U.S. credit worthiness
such that Congress must enact substantial austerity measures,
it will be low-income Americans who bear the greatest burden.
Higher taxes, resulting in shrinkage of the economy, will harm
economically vulnerable Americans through rising unemployment.
Second, reductions in federal spending will most harm those
who most depend on that spending, such as Medicare and Medicaid
beneficiaries. Hence, it is essential that Congress consider
ways to pay for the recent COVID relief packages and also avoid
further destabilizations of the federal budget.
One rising concern is how COVID-19 is affecting different
racial and ethnic populations. The latest data from CDC
indicates that Blacks represent a greater share of COVID deaths
than they do of the general population, even when adjusted for
the fact that COVID is more prevalent in cities. Mortality
rates are also higher, as has been noted by others, in Native
American communities, especially in Arizona and New Mexico.
What may be surprising is that whites are also dying of
COVID at higher-than-predicted rates. On the other hand,
Hispanics and Asians represent a lower share of COVID deaths
than would be implied by their geographically adjusted share of
the U.S. population.
The likely reason for these differences is that morbidity
and mortality from COVID-19 is most common among the elderly.
Eighty-one percent of all COVID deaths in the U.S. have
occurred in people aged 65 or older, and whites are the oldest
racial group in the U.S., with a median age of 44. Asians have
a median age of 37; Blacks, 34; Hispanics, 30. Hence, we should
expect to see higher fatality rates in whites versus Asians and
Hispanics, due to their age. And we do. On the other hand,
African-Americans are also relatively young, but we are still
seeing higher mortality among Blacks.
Some of you are familiar with our research on the tragedy
taking place in our nursing homes and assisted living
facilities: 0.6 percent of Americans live in long-term care
facilities. And yet, within this 0.6 percent of the population
lies 43 percent of all deaths from the novel coronavirus, 43
percent. As you know, nursing homes are residential facilities
for medically vulnerable seniors who have challenges with
activities of daily living, such as taking a shower or getting
dressed. Nursing homes are disproportionately poor, non-white,
and enrolled in Medicaid.
The nursing home tragedy has a bronze lining, if you will,
because it means that the risk of death from COVID for the rest
of the population is considerably lower than we may have
thought. We can use that information to reopen the economy and
reduce the harm we are imposing on hundreds of millions of
Americans of all colors.
Thank you.
[The prepared statement of Avik Roy follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. Thank you for your testimony, Mr. Roy.
Thanks once again to all the witnesses for their testimony.
And we will begin our question-and-answer period right now.
As a reminder, Members can submit written questions to be
answered later in writing. Those questions and the witnesses'
answers will be made part of the formal hearing record. Any
Members who wish to submit questions for the record may do so
by sending them to the clerk electronically within seven days.
As is our custom, the Ranking Member and I will defer our
questions until the end. So I now recognize the gentleman from
New York, Mr. Higgins, for five minutes.
[Pause.]
Chairman Yarmuth. Please unmute.
Would you like the staff to unmute you? Please nod.
Mr. Higgins.
[Nodded.]
Thanks, I think you are good to go.
Mr. Higgins. All right, thank you very much, Mr. Chairman,
and thank you, panel.
Just a couple of thoughts here, first and foremost, and
that is that 120,000 Americans are dead, and we have a
government lockdown of the American economy because federal
government failed to protect the American people.
We have a highly infectious, contagious disease that
attacks the lung, the liver, and the heart. And the best thing
that our fragile health care system can do for people suffering
through the symptoms of COVID-19 is to provide them with
Tylenol to help break their fever and to help them with their
pain. The United States is the richest country in the world. We
pay more for health care than any other country, and we have no
treatment and we have no vaccine.
Dr. Harris, I think this is an appalling set of
circumstances for our country. And what has been done to the
African-American community with the higher than--the percentage
of their population, cases of COVID-19, whether it is in
Buffalo or any other city in this country, is very revealing,
and exposes the acute fragility of the American system.
Now, I have heard Dr. Fauci, who probably is the most
credible public health official, say that he is optimistic
about the possibility of a vaccine at the end of this year.
That is about eight months from when we discovered this. From
what I can tell, the quickest development of a vaccine was by
Merck in response to Ebola, which was five years.
Do you, as a medical professional, the formal head--the
former head of the American Medical Association, share my
concerns that what Dr. Fauci is saying and what people hear are
two different things?
I am concerned when he advances that optimistic view,
perhaps overly, of having a vaccine by the end this year, what
people hear is that they can become complacent about the things
that we are doing now, social-physical distancing, face masks,
and personal hygiene. I would like to get your thoughts on
that.
[Pause.]
Chairman Yarmuth. Please unmute, Dr. Harris. There.
Dr. Harris. Yes, yes, sorry about that.
Thank you, Congressman. And let me first say that, of
course, Dr. Fauci is the foremost expert on infectious diseases
in our country.
And look, I want to parse a little bit what I hear Dr.
Fauci saying, as well. And I do think that there is certainly
nothing wrong with being optimistic. But when Dr. Fauci--and
you are right, that an end-of-year timeframe is optimistic and
ambitious. But certainly when you have an all-hands-on-deck
approach, I know it is possible.
But I also hear Dr. Fauci saying that a vaccine could
perhaps be developed by the end of the year. And I think what
this body knows is that is just the first step, is development.
Then you have to manufacture. Then you have to distribute. And
you have to, of course, make sure that the vaccine is
ultimately equitably distributed.
So certainly, Dr. Fauci is--has information that I don't
have, and certainly I would follow his lead when it comes to
his timeline. But I also know that it will be important not
just to develop the vaccine, but also get it distributed. And
we have to make sure that there is a diverse population who is
included in the clinical trials.
Mr. Higgins. OK. Thank you. And just a final thought. It is
like a tale of two countries.
I represent Buffalo on the Canadian border. And the United
States' federal response to coronavirus, COVID-19 was late,
sloppy, and adversarial. The Canadian Federal response was
early, strong, and united. I am trying to help get the U.S.-
Canadian border opened up, and, you know, we have been
unsuccessful. I am doing this with Elise Stefanik, who is my
co-chair on the Northern Border Caucus.
Here is why. The entire province of Ontario that includes
Toronto, has 250 cases of COVID-19 for every 100,000
population. New York City has 2,576 cases for every 100 (sic)
population, 10 times more. The reason we can't get the border
open is because the Canadians in Ontario don't want Americans
over there, because, given our high numbers, we are super-
spreaders. And again, I just think that underscores--I love
optimism, but I want reality, as well. And unless and until we
develop an effective treatment in vaccine, there is no
normalcy, not in terms of our health care, and not in terms of
our economy.
With that, I will yield back, Mr. Chairman.
Chairman Yarmuth. I thank you. The gentleman's time has
expired. I now recognize the gentleman from Georgia, Mr.
Woodall, for five minutes.
Please unmute.
Sorry, hold on. I think Rob dropped out. I now recognize
the gentleman from Ohio, Mr. Johnson, for five minutes.
Mr. Johnson. Well, thank you, Mr. Chairman. I appreciate
your holding this hearing--and Ranking Member Womack. I think
it is an important hearing.
You know, over the past few months we have seen the
devastating impacts of the COVID-19 pandemic on our
communities, and we have also seen the positive power of
deregulation when it comes to removing barriers to health care
and stimulating our economy.
And as we continue the long road to recovery, we must
recognize the importance of deregulation and the need to
continue removing unnecessary regulations that may inhibit
economic recovery.
I know in my district we are already seeing the benefits of
deregulation, especially when it comes to reducing barriers to
telehealth access. The deregulation of telehealth during the
COVID-19 pandemic has not only improved access to health care
for my constituents in eastern and southeastern Ohio, but it
also provided invaluable care for those in under-served rural
areas across the nation. Deregulation has helped change the way
health care is delivered. We saw it play out over the past few
months.
It is my hope that Congress will embrace more regulatory
flexibility that will ultimately help in our economic recovery,
and lead to greater access to quality, affordable health care.
So there is no question that this crisis has exposed the
need for more health care reform. But the solution is certainly
not to expand the Affordable Care Act, which has resulted in
fewer choices and higher health care costs. The American people
deserve better than a continuation of the ACA's broken
promises, most notably the broken promise that it would reduce
insurance costs, the broken promise that it would improve
access, and the broken promise that it would increase patient
choice.
Future health care reform must be patient-centered.
Americans need more choices when it comes to health care. And
Congress should do everything in its power to prioritize a
patient-centered, consumer-controlled health care system,
rather than an inefficient, expensive government-run health
care system. The American people deserve patient-centered,
market-based reforms that will strengthen the patient-doctor
relationship, and give patients the ability to choose how best
to meet their health care needs.
And I look forward to working with my colleagues on these
important issues as Congress takes additional steps to mitigate
the impacts of the COVID-19 pandemic.
So, Dr. Roy, prior to the COVID-19 pandemic, the federal
budget was unsustainable, with the debt rising uncontrollably.
In your opinion, what effect does the rising federal debt have
on low-income Americans?
Mr. Roy. Well, as I mentioned in both my written and oral
remarks, Mr. Johnson, I am very concerned that both the
spending of the CARES Act and related legislation and also the
declining tax revenue from the economic lockdowns creates a
perfect storm, which is going to massively increase the
deficit. And then that is going to push forward--meaning closer
in time to us today--the fiscal reckoning that is sure to come
with runaway federal debts.
We are almost already at the point in which the interest on
the federal debt exceeds what we pay for national defense. And
when we get to a point where we have to cut back spending on
Medicare and Medicaid because our bondholders leave us no
choice, who is going to be most harmed? It is the people who
most depend on those programs. Those who have high incomes, who
can afford private insurance will be fine. It is those that
can't who will be most harmed.
Mr. Johnson. Yes, I agree. You know, continuing with you,
Dr. Roy, according to your research, what have been the public
health impacts of the lockdowns and the extended lockdowns on
low-income and minority communities?
Mr. Roy. Well, that is an excellent question and one that
doesn't get asked enough, Mr. Johnson. And what I would say is
that it is going to take us years to really know what the
effects are. But what we can certainly expect is that there are
going to be people who didn't get their mammogram or their
prostate exam during the lockdown. And as a result, when their
cancer does get diagnosed, it is too late to do something about
it.
There are going to be people who had a heart attack, but
that heart attack went untreated. But we know that because the
number of people who have gone into hospitals reporting heart
attacks has declined precipitously during the lockdown. I could
go on and on. But there are many, many different areas of
public health where we ought to be concerned.
And then there is just the overall effects of massive
unemployment for a prolonged period of time, and the effect
that has on life expectancy and other public health measures.
Mr. Johnson. Yes, OK. Well, I have other questions. I will
submit those for the record, Mr. Chairman, but thanks and I
yield back my time.
Chairman Yarmuth. Absolutely. The gentleman's time has
expired. I now recognize the gentlelady from Connecticut, Ms.
DeLauro, for five minutes.
Ms. DeLauro. Can you hear me?
Wonderful. Oh, my gosh. I have become a technological
genius in all of this. Thank you so much. Thank you so much,
Mr. Chairman, Mr. Womack, for this hearing, and to our
panelists.
Dr. Deaton, I wanted to ask you, along with my colleague,
Suzan DelBene, and Senators Michael Bennet and Sherrod Brown, I
have introduced the American Family Act that would take our
Child Tax Credit and essentially turn it into a child allowance
by extending full eligibility to one-third of all children and
families who earn too little to get the full credit. It
increases its value and it delivers it monthly.
The Child Tax Credit is our nation's largest expenditure on
children, and the recent data shows that the American Family
Act would cut child poverty, that rate, by about two-fifths;
the Black child poverty rate in one-half; and the Hispanic
child poverty rate by 41 percent. What we do in the House-
passed Heroes Act, it contains a one-year version of this
policy that would provide $300 a month for young children and
$250 for older children. In essence, the credit is fully
refundable, you get $3,600 for young children under 6, $3,000
for older children ages six to 17. It is monthly installments
indexed to inflation.
My question is, you have spoken about the importance of
family allowances when you were a young father. Help us--and
can you please talk, I guess, what it meant to you, what it
might mean for families and for children in the United States
in the short term and in the longer term, as we look to deal
with the issue of inequality, of poverty, and those whom are
essentially the most affected about this today?
Dr. Deaton. Thank you. Thank you very much. I would tend to
defer to some of my colleagues on child poverty in the United
States, but I know it is a huge problem.
Ms. DeLauro. It is.
Dr. Deaton. And a great scandal. And it really is
important, not just for the suffering it engenders now, but the
suffering it engenders in the future. There is really good
evidence that children who grow up in poverty tend to suffer
throughout their lives as a consequence.
You asked me of my own experience. I grew up in Britain,
and I was a young widower when I was 29, and the child
allowances that were paid to my two kids made the real
difference for me between being able to go on and having enough
money to put food on the table and look after my kids.
I think it is not just children, but, I mean, I think one
of the things that Anne Case and I talk about in our book is
that the social safety net in America, compared with what has
happened in Europe, is very frayed in many, many places. And,
you know, people on the other side--and I, too--would say,
well, you know, how are you going to finance that?
And I think it is long past time for Americans to think
seriously about a value added tax, which they have in Europe.
It is a tax that people don't mind paying very much. It also
generates a lot of revenue. It is somewhat regressive in who
pays it, because everybody pays it. But the net effect, when it
goes to things like child credits, and child tax credits, and
so on, and child benefits, is that it is extremely progressive.
It also means that, when you have something horrible happen
like this happened here, that kicks into place immediately in a
way that it just doesn't in this country at all, so that we
have a sort of automatic set of responses to bad times when we
come. So I am very much in favor of that sort of expansion, and
in using a value added tax to try to pay for it.
Ms. DeLauro. I would--just would say with the just
remaining few seconds that I have, Dr. Deaton, I think we are
looking probably--it is unlikely that we are going to deal with
a value added tax. But I believe that what we can do is to look
at--and the child poverty rates, and to take a look at how a
child tax credit, where we have got one-third of kids today,
mostly African-American kids and Latino kids, who are not
eligible because their families make too little, but to try to
do something that we might in a positive way move forward on,
because it is already in existence and we are just adding it--
to it.
Thank you so much, and thanks to all of you for your
testimony.
I yield back.
Chairman Yarmuth. The gentlelady's time has expired. I now
recognize the gentleman from North Carolina, Mr. Holding, for
five minutes.
Mr. Holding. Thank you----
Chairman Yarmuth. Please unmute.
Mr. Holding [continuing]. very much, Mr. Chairman. I
appreciate that.
As pointed out, this virus and the statewide closures we
used to contain it have highlighted several inequities in
access to child care and nutrition services. And not only are
minority children more likely to depend on school food
programs, but they are also more likely to have parents who
work in the services industry, and are unable to stay at home
when schools close.
And as we have seen, disparities in nutrition access are
not just short-term problems. Over time they lead to higher
rates of comorbidities and chronic conditions that make
minority communities especially vulnerable to viruses like the
COVID-19.
From the beginning of this crisis, non-profits like the
YMCAs in Raleigh and Charlotte have stepped up to address the
nutrition and child care gap and support under-represented
communities in their time of need. And over the past few weeks,
the YMCA of the Triangle has served almost 50,000 meals to
families across the region, and provided child care programs to
over 1,700 health care workers. In Garner, North Carolina, in
my district, the Poole Family YMCA has set up day camps for
children, and runs blood drives to assist the health care
community. These assistance programs played an essential role
in providing stability to minority communities that have been
disproportionately affected by this national emergency.
But despite the tremendous work that the YMCAs have done
throughout the country, they have been left out of the federal
assistance programs they desperately need. Under the Paycheck
Protection Program, which Congress enacted specifically to help
groups like this, affiliated organizations like the YMCA of
Charlotte and the YMCA of the Triangle cannot access funds if
they collectively employ over 500 people. And, as a result,
these two YMCAs have furloughed over 95 percent of their
staffs, and continue operating at a loss.
So, without immediate federal assistance, YMCAs across the
U.S. will no longer be able to provide these invaluable
community services. I am strongly urging all of my colleagues
to support an adjustment in our next round of the Paycheck
Protection Program to ensure non-profits like the YMCA continue
to serve those in need.
So my question to you, Dr. Roy, can you speak to the
potential long-term effects of irregular access to food and
child care in low-income communities, and how the federal
government can best work with the private sector and non-
profits to bridge that gap?
Mr. Roy. Well, this is--there is a lot of things to say
about this topic. Let me highlight one thing that I mentioned
in my written testimony, sir, which is that the closure of
schools is a big disruptor in the delivery of nutrition to low-
income children because so many low-income children get their
lunch through the federal school lunch program.
So this is a way the school closures interact with a lot of
federal assistance which flows through public schools, and
why--one of the reasons why it is important to reopen schools
where it is prudently possible to do so. And we at FREOPP are
putting out a plan very soon on how you can reopen schools in a
way that is consistent with public health.
Mr. Holding. Excellent. Thank you very much.
Mr. Chairman, I yield back.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentlelady from Illinois, Ms. Schakowsky, for
five minutes.
Please unmute.
Ms. Schakowsky. Here I am. Thank you very much, Mr.
Chairman.
And when I look at the name of this hearing, ``Health and
Wealth Inequities in America: How COVID-19 Makes Clear the Need
for Change,'' this could not be a more important moment to have
this--the discussion. We have seen so many--and you listed some
of them--inequities that have really come to light because of
this.
I want to talk about one of the things that I worry about.
Thirty-four million Americans know someone who has died from
not being able to afford their prescription drugs. But while 10
percent of white Americans know someone who has died because of
that, 20 percent, twice as many of non-white Americans, know
someone who has died from being unable to afford treatment.
Similarly, people of color are twice as likely as white
Americans to consider high drug prices to be among our most
pressing issue today. This was even before--you know, well
before we had COVID-19 this was the problem.
And yesterday, Representative Doggett and Representatives
DeLauro and DeFazio, and Representative Rooney--bipartisan--and
I introduced what we call the MAP Act, H.R. 7296, and H.R.
7288, which is called the TRACK Act, to prevent price gouging
at this time of the COVID-19 virus, and prohibiting monopolies
that no one company can control the remedies for the vaccines,
and to ensure transparency on taxpayer-funded COVID-19 drugs.
So Dr. Harris and Dr. Jones, I wonder if you could discuss
why people of color, and Black Americans in particular, may be
severely or even fatally impacted by high drug prices, and if
this is something that you see in your practices, in your
lives.
Dr. Harris. Am I unmuted? Can you hear me?
Ms. Schakowsky. Yes.
Dr. Harris. Thank you. This is absolutely a critical issue,
and that is why everyone needs to have access to affordable,
meaningful health coverage. And that does include the ability
to get help to pay for prescription medications.
You ask about my own experience, and I have, over the
course of my career--for those who had insurance, I spent a
great deal of my career working with children in the foster
care system, or adults in the substance--with substance use
disorders who relied on Medicaid or our state mental health
system to pay for their services. And if they were able to
access that, they were often not able to access the medications
that I wanted to prescribe.
And so, as we move forward on making sure that everyone has
access to affordable, meaningful coverage, of course, the
affordability of prescription drugs has to be a part of that
equation.
Ms. Schakowsky. Thank you. So you wrote prescriptions
sometimes that weren't filled, probably, right?
Dr. Harris. Yes. That is a significant problem.
Ms. Schakowsky. Yes. Dr. Harris, did you want--I mean, Dr.
Jones, did you want to respond?
Dr. Jones. Yes. Well, I would just add briefly that, you
know, another dynamic is that Black people in the United States
and other people of color are less likely to have health
insurance coverage. And so that is definitely going to
introduce an additional barrier.
And in terms of prescription drug prices, I think another
thing to look at is how to make things more competitive. So how
quickly can generic drugs be provided that can help to bring
down the price of those prescription drugs, once they are made
available?
Ms. Schakowsky. Thank you. You know, we are working on--we
have introduced legislation that would stop price gouging
during this pandemic, because the pharmaceutical companies are
prone to try and take advantage of a situation, but also to
guarantee that any therapy or any vaccine that is discovered is
affordable--and sometimes that may mean free--so that all
Americans have access to that. I think we have to all accept
that challenge, and make sure all people will have access to
the vaccines and therapies.
So thank you very much. I yield back.
Chairman Yarmuth. The gentlewoman yields back. I now
recognize the gentleman from Pennsylvania, Mr. Meuser, for five
minutes.
Mr. Meuser. Thank you, Mr. Chairman. Thank you all to the
witnesses, I appreciate it. It is an important hearing.
Our economy was in a good place, a very good place, up
until February of this past year. It had many benefits to the
vast majority of Americans.
Mr. Roy, let me ask you--the economy, the data from where
we were come--the beginning of 2020.
The wage increases, levels of unemployment for all segments
of the economy, for low income, for minorities, for rural
areas, or for our cities always can be better. But would you
say that we had some pretty positive trends that were
beneficial to solving various inequalities that may have
existed before?
Mr. Roy. There is no doubt, Mr. Meuser. And as I mentioned
in my opening remarks and also in my written testimony, where I
go into this in a lot of detail, the disparity between white
and Black unemployment, the disparity between white and
Hispanic unemployment reached record lows in late 2019. So we
had made remarkable progress in reducing some of these
disparities. And obviously, the economic lockdowns have
reversed a lot of those gains. And so the sooner we can get out
of lockdown, get the economy back going again, maybe we can get
back on that plane.
Mr. Meuser. Yes. And, you know, I am a Republican, but I am
always interested in a better plan. This might be a difficult
question, but are you hearing anything so far in this hearing
on health and wealth inequities that you think would be a--
pursuable for solving the inequity issue?
Mr. Roy. Well, the most important thing we can do to reduce
inequities is drive economic growth. That is both in terms of
reopening the economy and in general. Pro-growth policies--a
rising tide does lift all boats. That is what we have seen
throughout the last several decades of the American economic
experience. The better and stronger our economy is, the better
it is, particularly for economically vulnerable populations. So
I would highlight that, in particular.
Mr. Meuser. There was a $3.3 trillion Heroes Act proposed
exclusively by the House Democratic Caucus. No input from
Republicans, whatsoever. Was there anything in that that would
help this, these levels of inequality for health and wealth?
Would you see election law changes as something that is
dealing with this crisis?
Do you think allowing state and local taxes being able to
be deducted for over $10,000 is something important for--to
create better equality within the society, particularly now, as
we are recovering from this crisis?
Mr. Roy. Well, I can't say that I have read the Heroes Act
line by line, so you will have to forgive me for that. But I am
aware of several provisions that I have looked at more closely.
One that I am concerned about is a provision that would
basically be a lottery for the trial lawyers to sue on behalf
of anyone who was somehow connected, no matter how tenuously,
to COVID-19, to sue their employer, sue the federal government,
effectively, get some sort of federal slush fund relief for
injuries that may or may not be related to COVID-19. I was very
concerned about that.
And I am also concerned about the restoration of tax breaks
for high-income individuals living in states with high state
and local taxes. I don't understand why that is good policy.
Mr. Meuser. Yes, neither do I. You are not alone.
Would you think that we can help solve this problem by
opening up our schools come September?
Mr. Roy. I think that is very important. And, I mean, we
would argue, actually, at FREOPP--and we have put out some work
on this, and we are going to put out more--we argue that,
actually, the school year should start earlier than September
to make up for lost time. It is essential for low-income
parents and families to be able to get their kids back in
school because the disparities in educational outcomes, let
alone economic and public health outcomes that come from poor
educational attainment, are incredibly important.
And the good news is children are not vectors of infection.
At least we have a lot of evidence that they are not very
infectious. We don't understand exactly why. There are
theories.
Mr. Meuser. Right.
Mr. Roy. But there is good reason to believe that reopening
schools is the most--the safest thing we can do among all the
re-opening tools we have.
Mr. Meuser. That is why liability coverage that the schools
talk about is essential for their opening.
Mr. Roy. Yes, and for all employers. I think liability
coverage protection, that is the most important thing Congress
can do. A lot of reopening decisions are at the state and local
level, but Congress can take action on liability protection.
Mr. Meuser. I agree. Thank you, Chairman. I yield back.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentleman from Michigan, Mr. Kildee, for five
minutes?
Mr. Kildee. Well, first of all, thank you, Chairman
Yarmuth, for hosting this very important hearing.
As you know, I am from Flint, Michigan. The residents of my
home town are dealing with back-to-back crises, the ongoing
water crisis and now the coronavirus pandemic. Both of these
crises have disproportionately impacted people of color.
Michigan currently ranks ninth among the states with the
most coronavirus cases in the country. Genesee County, where my
hometown of Flint is located, where I am right now, has had 258
COVID-19 fatalities. In Genesee County African-Americans
account for 47 percent of the fatalities, despite making up 20
percent of the county's population. This kind of disparity is
heartbreaking.
We are also experiencing the loss of social interactions,
those interactions that help us cope with--during times of
stress. We are also seeing record levels of unemployment,
causing many to wonder how they will pay their own bills,
maintain access to health care, and feed their families.
And on top of this, of course, people in Flint don't have
access to water that they trust or that is affordable, many
having to leave home just to get bottled water.
Because of these compounding stressors and traumas, I am
concerned that there may be an additional crisis on the
horizon, a mental health crisis that disproportionately impacts
our already hard-hit communities.
The House-passed Heroes Act, which contained policies to
help address inequities like creating an ACA special enrollment
period for uninsured Americans, and also increased Federal
Medicaid payments, and $3 billion to support mental health
during this challenging time, that was what was included in the
Heroes Act.
I have also introduced legislation--again, which was
included in the Heroes Act--that would extend unemployment
benefits to help millions of Americans who are out of work.
With that as a background, Dr. Harris, I wonder if you
might comment on why a special enrollment period and increased
access to health coverage is so important to address the
resulting racial inequalities, particularly mental health
impacts of COVID-19, and what other health care policies are
important for Congress to consider as we go forward.
Dr. Harris. Well, thank you, and I will make a couple of
quick points.
But we know that people without health insurance will live
sicker and die younger. We also know that Medicaid expansion,
and the expansion through the Affordable Care Act marketplace,
has allowed so many individuals who would not have been able to
access mental health services to do so. And certainly, it is
important to have this coverage so that you can get this
coverage.
You also mentioned issues around the water in Flint, and we
know that environmental toxins are another determinant of
health. And we have to make sure that we look at those issues.
And I want to make one more point about language that we
use. And one of the reasons that we use ``inequities'' is
because we want to talk about avoidable differences, those
differences that can be prevented. And, of course, we have
mentioned those structural determinants of health, as well,
that have driven us to these social determinants of this ill
health.
So--and I remember, as a child psychiatrist in training, we
used to always check for lead, because so many--I have trained
in Atlanta at Emory, a large African-American population--and
so many children have been exposed to lead. This is several
years ago, but now--because of where they lived.
And so, all of these issues are critical if we are to
address these health inequities. And clearly, the ability to
have insurance is one.
You mentioned expanding the enrollment period for Medicaid,
special open enrollments, the Affordable Care Act. We could
also help folks retain their COBRA benefits. We could also
support employers to offer temporary subsidies to preserve
their health benefits. So those are just a few solutions that
we would offer.
Mr. Kildee. I really appreciate your comments. My initial
career was in the child welfare system, working with children
who had been traumatized. And I have a particular concern,
particularly for the kids of Flint, who are experiencing a
trauma on top of a trauma, not to mention the daily trauma that
they see because of their conditions. So I really appreciate
the perspective that you bring to this conversation.
And thank you so much to all of you for your testimony.
With that, Mr. Chairman, I yield back.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentleman from Texas, Mr. Crenshaw, for five
minutes.
Mr. Crenshaw. Thank you, Mr. Chairman. Thank you for
holding this hearing. I will, of course, say again--will state
the obvious, and it has been said many times throughout this
hearing--that economic lockdowns, in essence, choosing the
costliest, most extreme possible option before we went through
a series of other options to mitigate the spread of the virus
and save our hospital system, that overwhelmingly hurt working-
class people.
And while a bunch of city-dwelling, teleworking--I am sure
very nice--people advocated for safety, and saving lives, and
continuing to lock down the economy because, God forbid,
anybody chooses themselves to go out to a restaurant, or
chooses themselves to go to work, God forbid, that hurt the
people that we are talking about today, overwhelmingly. And
yes, they are hurt by COVID-19 as well, disproportionately, as
all the data points to.
Of course, the data, of course, it doesn't even come close
to our elderly population. And I hope we do have a hearing
about that, too, and question why Governors such as the
Governor of New York could actually implement policy which
harmed the elderly population the most by forcing infected
patients back into nursing homes. That has been conveniently
ignored.
Because we should always be looking for specific policies
that actually help the disparity that we are talking about,
things we can actually affect. And I have heard a lot of
talking out of both sides of the mouth in much of this. On the
one hand, the economic devastation of lockdowns harms
minorities' communities. It does.
I just interviewed a Black-owned business owner of--a Black
business owner here. And their main problem right now is that
they can't get their workers to come back. Why? Well, because
their workers are getting paid more on unemployment than they
were back at work.
I can't get a single Democrat to cosponsor a bill that
would do a simple fix for that. Not take away benefits,
actually, let them keep the bonus while the program is still
going, keep that $600-a-week bonus, even if you come back to
work. It seems like a win-win. I can't get a single Democrat on
it. I don't know why, because I don't think there is any actual
desire to solve problems here, and that is really frustrating
if we actually care about really helping people we want to
help.
Mr. Roy, is there any data comparing minority incomes
between states that are still in lockdown or came out of
lockdown later and those that came out of lockdown earlier?
Mr. Roy. Mr. Crenshaw, there is preliminary information on
that score. What we do see is that, for example, as I was
citing in my written testimony, the stuff around how minimum
wage or--hourly wage jobs excuse me--hourly wage jobs have been
cut significantly, there is significant state variation. In the
states that have reopened, hourly wage jobs are coming back at
much higher rates. And in states that have continued to lock
down--the New Yorks, the Virginias--the hourly wage reduction
in employment and in hours and wages is massively lower.
Mr. Crenshaw. So I have heard over and over again that the
only reason that--and the only solution, I mean, that we could
possibly have to solving the disparities in health outcomes
with something like COVID-19 is a single-payer health care
system. It has got to be the only solution, right?
But do countries with a single-payer health care system
such as England, have health outcome inequalities, as well? I
have heard they are almost exactly the same as here.
Mr. Roy. Well, it is interesting that you mention this, Mr.
Crenshaw, because just today at FREOPP we published a ranking
of the 31 wealthiest countries in the world on the basis of
their pandemic response: mortality per million residents; the
economic stringency of their lockdowns; and the relative
isolation of their economies relative to other countries.
And what we found is, just as you said, there are some
countries with single-payer health care that did well. Taiwan
has single-payer health care. They come out No. 1 in our
ranking. But Italy comes in second to last, if I recall
correctly, and they are--they also have single-payer health
care. The UK has single-payer health care. Their mortality is
far higher per million residents than the United States----
Mr. Crenshaw. But--and it is also far higher for
minorities, too.
Mr. Roy. Yes, that is true, yes.
Mr. Crenshaw. The same disparities that we do, and yet they
have single payer. We just have to point these--out these
facts. If we are going to just jump to a single solution, we
have to at least agree on the--a common set of facts.
Also, what are the public health impacts of lockdowns,
especially with low-income and minority communities? Aside from
economic and job loss, what about public health?
Mr. Roy. This is a really important question, and, you
know, I mentioned it a bit earlier in one of my other
responses.
A lot of this is going to be difficult to measure, because
we don't actually--some of these effects are going to be long
term. The person with chronic disease that didn't have it
managed over this period of time, the manifestations of that--
--
Mr. Crenshaw. By the way, the uptick in cases is that, it
is not their lungs being inflamed. I realize that I am out of
time, and sorry to interrupt you.
But thank you, Mr. Chairman, for--and I yield back.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentleman from California, Mr. Panetta, for five
minutes.
Mr. Panetta. Thank you, Mr. Chairman, Mr. Womack, and I
appreciate both of you holding today's hearing on the
inequalities and dealing with the COVID-19 pandemic. And of
course, thank you for the witnesses, for all of their
expertise, all of the preparation and their time for coming to
talk about, hopefully, not just the problems, but some
solutions that we can have, going forward in this pandemic and
addressing the inequalities in our nation.
As many of you know, over the last three months what has
been highlighted are those inequalities, from health care to
wealth, education, to justice and, yes, to housing, as well.
And they have collided, clearly, with one of the deadliest
pandemics the world has faced in a century or more. But
unfortunately, what we are seeing is that the lower income--
and, yes, the communities of color--have borne the brunt of
this pandemic.
And we see it right here in where I represent, where I
live, where I grew up, on the central coast of California, as
my friend, Mr. Kildee, likes me to say, here in the salad bowl
of the world. Obviously, we have a lot of agriculture, but we
have a unique sort of agriculture that doesn't take machines,
it takes human beings to harvest. And so we have a large--
thankfully, a large immigrant community that has contributed so
much to our economy, to our community, and to our culture, who
we are.
In Monterey County alone, look, I will be the first to
admit we are not a hotbed at this point. We only have about--as
of yesterday, about just over 1,200 cases of COVID-19, and we
have endured 12 deaths, unfortunately, because of the disease.
But within that number, 80 percent of the COVID-19 cases have
been found in the Latinx community, and nearly 40 percent have
been farm workers.
And so, unlike some parts on the central coast, this
community has not had the option to work from home, as you
know. It is our farm workers that continue to work through the
pandemic, put food on all of our tables across this country,
not just here on the central coast, and, yes, provide this
country with the food security that is so needed, especially at
this time--and even now, as cases spike up in California.
And so, Dr. Harris, I want to address questions to you, if
that is all right. As you probably know, 25 percent of
undocumented farm workers in the United States have health
care, health insurance. That is only 25 percent of undocumented
farm workers, which--unfortunately, I think we know there are a
significant number of undocumented farm care--farm workers.
What do you feel are the ways that we can ensure that farm
workers get health--the health care that they need, despite the
obstacle of uninsurance?
And are there changes, solutions, like I said, that
Congress can make, can put forward to help undocumented
immigrants gain access to health care providers, Dr. Harris?
[Pause.]
Mr. Panetta. Your microphone. The----
Dr. Harris. Yes, thank you. Certainly I leave it up to the
wisdom of this body, your colleagues in the Senate, to the how.
But I can tell you that it is important for everyone to have
access to insurance because, just like this virus that may have
impacted first others in other countries, you know, we say the
pandemic or an epidemic anywhere certainly impacts us here in
the U.S.
And so illnesses don't respect state boundaries, county
boundaries. They don't know who is here, and who is documented,
who does not have proper documentation. And so it is really
important we--the AMA made a strong statement about making sure
that children had access to vaccinations and quality care from
their pediatrician.
And so I will just say it is important for everyone to have
access to appropriate health care.
Mr. Panetta. Understood. Now, obviously, we have heard from
a couple of my colleagues--and I am seeing it here on the
central coast--telemedicine has been helping. Yet there are
some difficulties, obviously, with foreign-born or non-English-
speaking population. Dr. Harris, are there ways that we can
improve that for rural areas and communities of color?
Dr. Harris. Absolutely. Telemedicine certainly--and many,
many of us--I know I used telemedicine pre-COVID, but certainly
COVID did accelerate that use, and we appreciate the relaxation
of the regulations.
But we need to look at issues around broadband, actually in
both urban areas and rural areas. We need to look at the issue
of whether or not there is a computer or more than one
computer. And confidentiality, you know, we are talking about a
private medical need. So these are all needs that need to be
addressed, as we move forward with telemedicine.
Mr. Panetta. Thank you, Dr. Harris.
Thank you again, Mr. Chairman. I appreciate the
opportunity. I yield back.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentleman from Tennessee, Mr. Burchett, for five
minutes.
Mr. Burchett. Thank you, Mr. Chairman, and thank you all
for being here--Mr. Ranking Member. If I could take a personal
privilege, I hope we all remember our colleague, Andy Barr, in
our prayers. He lost his wife and two beautiful little girls
lost their mama, and that is just--to me, it is just
heartbreaking. My wife was a widow, and I married her and
adopted a little girl, so I know--and she has talked to me
about the impact of that. So I hope we all remember Andy in our
prayers.
And I appreciate the opportunity to be here.
And Ms. Harris, I would ask of you, when you started to
talk about telemedicine, I was up in Claiborne County, and I am
sure you know what Claiborne County is--nobody does. It is a
very small county. It is about 2 percent of my district. But
they actually utilize telemedicine. And I would encourage you
all to reach out to them and some of the folks up there,
because they had some great success with that up there,
especially during this outbreak of the virus.
But Mr. Roy, I was wanting to know, you have studied and
published some of the failures of Medicaid to improve our care
for low-income Americans. How can we leverage some of that to
create and contain and prevent the spread of the coronavirus?
And how will the solution actually provide better care to
some of our more vulnerable populations?
Mr. Roy. Well, you know, let me go back to something Mr.
Crenshaw was pointing out, which is that the biggest disparity,
the single biggest disparity when it comes to the impact----
Mr. Burchett. Can I stop you? Can I stop you one second?
Don't ever refer to Dan Crenshaw, because his ego is so big I
don't know if his head is going to fit on screen much more, but
please continue.
Mr. Roy. Fair enough. I respect that, Mr. Burchett, so my
apologies.
The biggest disparity is the fact that 0.6 percent of the
U.S. population lives in long-term care facilities, nursing
homes and assisted living facilities. And that is where 43
percent of all U.S. COVID-19 deaths are occurring. And 81
percent of all deaths from COVID-19 are happening among people
aged 65 or older.
And how does this relate to your question? It is because
Medicaid is one of the biggest drivers of this problem, because
if you are medically vulnerable, and you need help with
activities of daily living, and you are in Medicaid, you have
to go to a nursing home to get the care you need. You are not
allowed to use Medicaid dollars to get that care in your own
home. That is one of the things about Medicaid that is
incredibly inflexible, and that has led to an enormous
distortion in the way we deliver nursing home care, and it has
also put the Medicaid population in disproportionate--
disproportionately in harm's way.
Mr. Burchett. Let me ask you also--I know you have done
some research on the economy prior to the coronavirus. What
would you suggest that we can do when state, federal, and local
elected offices and--I guess just the bureaucracy can make this
thing work out better and provide better health care for our
country?
Mr. Roy. Well, I think the most important thing we can do,
and as you may know, we have a plan that we have put out at
FREOPP called Medicare Advantage for All. And the basic idea is
that everyone should own their own health insurance, and they
should be able to take it from job to job.
And the way you do that is by reforming the market for
people who buy insurance on their own, the one that Obamacare
made so much more expensive, and improve that market so people
really have choices that are high-quality coverage, but also
affordable; that allow them, if they lose their job, to then
buy insurance that they can keep and then take wherever they
go.
Mr. Burchett. I will yield back the rest of my time, unless
Jimmy Panetta wants to discuss anything else.
Chairman Yarmuth. The gentleman yields back the rest of his
time. I now recognize the gentleman from California--from New
York, Mr. Morelle, for five minutes.
Mr. Morelle. Thank you, Mr. Chairman, very much. And thank
you, once again, for holding a series of important hearings to
talk about the pandemic and the impact that it has had.
I do just want state for the record that if the President
of the United States had demonstrated half the leadership of my
friend, the Governor of New York, thousands of Americans might
not have contracted COVID-19 in the first place. But I will
leave that to another day. But I do want to defend my friend
from New York.
I do want to talk about, obviously, the wealth and health
inequality in America. And the devastation that has occurred in
the wake of this crisis has been made all the worse by the
deep-seated inequalities that have plagued our country for
decades.
Racial and wealth disparity were at the root of our
nation's academic achievement gaps before COVID-19. I don't
have to tell any of you that; we know that health and education
are intrinsically linked, and economically marginalized and
segregated neighborhoods are more likely to have less access to
resources that help children and adults lead healthier, safer
lives. And the resulting and persistent cycle of systemic
disadvantage, whether it is academic achievement gaps, health
care disparities, and unjust wage differences for Black
Americans compared to their white peers, has made it near
impossible to gain equity in this country.
The pandemic has not only shined a glaring spotlight on the
lack of investment in resources available to Black communities
and schools, it has exacerbated the health and educational gaps
to a breaking point. So as we begin to rebuild our communities
and regain our footing, we have a very real opportunity and a
responsibility to take intentional and preemptive actions to
safeguard these communities against further fallout, and to
address the underlying social deterrents to health that we have
seen reflected in other diseases for decades.
And deep-seated inequalities have played our community--in
my community. We have seen a four-times rate of infection, over
a five-times rate of hospitalization, and a two-and-a-half time
mortality rate among Black Americans in the Rochester, New York
community. So I know that we are not alone; that is being
experienced around the country.
I want to ask Dr. Harris--how has the COVID pandemic
worsened pre-existing racial inequities in neighborhood quality
and in the built environment, as well as access to community
health support services for people of color?
Dr. Harris. I think three overarching areas, and thank you
for the opportunity to answer the question.
I think, first of all, again, the pre-existing conditions,
again, that were already there before COVID-19, the
disproportionate impact of diabetes, hypertension, asthma,
obesity.
Second was you had more members from communities of color
who were working those essential jobs. It has been noted they
didn't have the privilege of staying at home. They had to go
out and work. Actually, so many of us who had the privilege
could have the food security. And, of course, that increased
their risk of exposure.
And third, you know, I think it is the misinformation, the
disinformation that has been out there.
And then we really have to talk about 401 years of racism
and discrimination and bias that have led us. Here in Atlanta I
was working with the group, and we were looking at the
discriminatory housing policy of redlining. And we could line
up those neighborhoods with the zip codes now that we see with
severe health inequities.
I do want to say something. I do respect Dr. Roy and, of
course, respect a marketplace of ideas. I do want us to have a
closer look to the rising tide lifts all boats. That is true,
but that is not sufficient. I think we need to dig deeper,
because it may lift all boats, but it may not lift everyone
up--may not lift every boat up to where it needs--everyone can
get an equitable opportunity for health. So I think, as we
think about that, we have to--at least I would worry about
these--sort of these one-size-fits-all solutions.
Mr. Morelle. Thank you. I want to ask Dr. Deaton--and any
of the other panelists might comment, as well--but how can we,
as we get--begin to move forward, rebuild our economies and our
communities in a purposeful way that prevents the further
deepening of the academic achievement gap, particularly as we
head into the summer months? Do you have any thoughts on that,
sir?
Dr. Deaton. Sorry, sorry, I didn't hear a question. Was
that directed----
Mr. Morelle. Yes, I just want to know, as we sort of--and I
may be running out of time, so--I just want to--any thoughts
you had on rebuilding our----
Chairman Yarmuth [continuing]. give you more time.
Mr. Morelle [continuing]. communities in a purposeful way
to prevent the further deepening of the academic achievement
gap, particularly as we head into the summer months, when many
students are not in school.
Dr. Deaton. Yes, I think that is going to be one of the
hardest problems that we are going to have to deal with,
especially, as the lockdown of schools, which was probably not
a very good idea, has widened these gaps enormously. So I am
very much with that.
Mr. Morelle. I yield back my time. Thank you, Mr. Chair.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentleman from Texas, Mr. Flores, for five
minutes.
Mr. Flores. Thank you, Mr. Chairman. I appreciate the
opportunity to participate in today's hearing. My broadband
service has been a little bit spotty today, so I am hopeful
that everybody can hear me, and that I don't drop off in the
middle of this, in my middle of my five minutes.
Mr. Roy, in previous testimony you said, ``The association
is clear. A strong economy most benefits minorities, and a
worsening economy most hurts them.'' House Democrats have made
known their desire for heavy top-down structural changes in our
economy.
And so my question is this. In your view, is this top-down,
heavy-handed approach the best policy direction for helping
minorities, or would you recommend policies more focused on
strengthening the economy, thus providing greater opportunities
for minorities?
Mr. Roy. Well, leaving aside the party piece of it, I mean,
I would just say, definitely, that economic growth is
incredibly important, and we have to be extremely mindful of
policies that would not only suppress economic growth, but
suppress job growth. You know, we have talked a little bit
today about the $600 bonus that is leading people to basically
not get back into the work force, and that is retarding the
economic recovery.
So I am very concerned that I hear the Congress is thinking
about renewing or restoring or extending that policy. That is
going to make it a lot harder for employers to get back on
their feet, and we are going to see--we already have seen
100,000 or more small businesses close because of lockdowns.
That number could increase considerably if that feature of the
CARES Act is extended.
Mr. Flores. One of the related features that has come out
of the pandemic--and not only in terms of economic impact, but
it has a follow-on economic impact--is the fact that we have
several regulations that were found to impede our ability to
respond to the pandemic, things like hand sanitizer guidelines,
truck driving limits, things like this.
So I have a question for all of the panelists, starting
with Dr. Deaton. Are there any regulations that you think of
that have hindered the ability to respond to challenges of the
pandemic?
And are there any regulations you can think of that
disproportionately harm minorities and low-income communities?
Dr. Deaton. Well, I am someone who feels that one of the
greatest disasters in America these days is the health care
system, and much of that is to do with regulation. I have a
different view, though, that I think removing regulations is
not the right way to go. I think that what we need is a system
that automatically insures everyone from birth. I think we have
to have a system that controls costs, which is very important.
It is true that our health care system has not done any
worse in this pandemic than other countries' health care
systems, and it is too much, really, to ask any health care
system to deal well with something that only happens--only
happened 100 years ago before. But----
Mr. Flores. I have just a few minutes----
Dr. Deaton. Every other country----
Mr. Flores. Dr. Deaton?
Dr. Deaton. Sorry?
Mr. Flores. Excuse me, can I go to Dr. Harris?
The regulations question.
Dr. Harris. Well, I think we chatted earlier about the
regulations regarding telehealth, and I think that was very
important.
And I will say this from a broader perspective regarding
substance use disorder, not necessarily just communities of
color, it was important to reduce a lot of those regulations so
that patients who had an opioid use disorder could get the
medications that they needed, and we didn't have the dose limit
or the time limit. So those were very helpful, as well.
And there was some loosening of regulations regarding prior
authorizations for services and medications, and those were
helpful, as well, during this time.
Mr. Flores. OK, thank you.
Dr. Jones, can you give me 30 seconds in terms of
regulations that have hindered the ability to respond to the
pandemic, and regulations that disproportionately harm minority
communities?
Mr. Roy, we will get to you when we have got about 30
seconds left.
Dr. Jones. At the moment, I--there are no specific
regulations that are coming to mind to me, so I will pass.
Mr. Flores. OK, Mr. Roy, you----
Mr. Roy. Well, I would love, Mr. Flores, for Congress to
make permanent some of the regulatory relief that has been
temporary around telemedicine, telehealth, practicing medicine
across state lines, allowing your license to be used if you
move states without having to get recertified. Those are some
of the simple things we could do, not just for physicians, but
also for nurses.
Mr. Flores. Right.
Mr. Roy. Broadly speaking, I should mention that the
regulatory reforms of the last several years are a big driver
of the record low unemployment that we enjoyed prior to the
pandemic. That is worth noting, as well.
Mr. Flores. Right, and I appreciate it, and I agree with
you. I think the regulations that we have modified in light of
this pandemic should be extended permanently.
I yield back, Mr. Chairman.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentleman from Nevada, Mr. Horsford, for five
minutes.
Mr. Horsford. Thank you, Mr. Chairman and to the Ranking
Member, for holding this hearing, and to all of our panelists
for joining us today.
Dr. Harris, it is great to see you again. Thank you for
your tremendous leadership over the years at the American
Medical Association and in your practice.
As many of you may be aware, Nevada, my home state, is the
hardest-hit state, economically, in our nation and has the
worst unemployment rate, at over 25.2 percent as a result of
the coronavirus pandemic. Few places were hit harder than Las
Vegas, where a full one-third of the Las Vegas economy is in
the leisure and hospitality industry, more than any other major
metropolitan area in the country. Most of those jobs cannot be
done from home.
The New York Times did an article back in April that was
titled, ``How Las Vegas Became Ground Zero for the American
Jobs Crisis.'' And they brought to light the devastating
impacts that this virus has on African-American families and
those Latinx and other communities throughout southern Nevada.
The article highlighted how Mr. and Mrs. Anderson both lost
their jobs at a restaurant and a call center, respectfully
(sic), and immediately began to worry about how they would pay
rent and provide food for their daughter. This is one of the
many examples as to how COVID-19 has dramatically impacted
African-American households.
In 2018 the poverty rate for African-American families was
more than two-and-a-half times the poverty rate for whites. And
the poverty rate for Latinx families was more than twice that
of whites.
Disparities in the child poverty rate are even more stark.
The child poverty rate for African-Americans in 2018 was more
than three times the child poverty rate for whites, up from
about two-and-a-half times the rate for whites in 2013.
But none of this is a coincidence. The inequities we see
today were not caused by COVID-19. They are a result of
systemic racism that has impacted every aspect from health,
education, financial, housing, and other institutions, and it
has affected the opportunities across the board.
Now, there is data that I just read yesterday from the
Center on Poverty and Social Policy that indicates how the
child poverty rate could be cut in half if Congress would
approve the American Family Act, which expands the Child Tax
Credit that would provide $3,600 for kids under six years of
age, and $3,000 for older kids. That poverty rate among Black
children would drop by 52 percent and among Latinx children by
41 percent.
Dr. Harris, what long-term effects might the COVID-19
pandemic have on children, and how might it affect their
physical and mental health, as well as their economic potential
in the long term?
Dr. Harris. Well, certainly, many areas there, but let me
just highlight one or two, and the first is the issue around
trauma. We have bourgeoning evidence that trauma experienced
early in childhood--many may be familiar with the adverse
childhood experience survey--leads to both short-term and long-
term health impacts, and not just mental health, not just
psychological health, but also long-term cardiovascular health,
diabetes, and some of these other issues.
We certainly think about abuse and violence as typical
trauma. But certainly the day-to-day traumatic experience of
racism, and perhaps living in poverty, and some of these other
issues can also have a cumulative effect. It is known in some
papers as ``weathering effect'' on African-Americans.
And so again--and earlier I talked about previous housing,
discriminatory--discriminatory housing policies. So all of
these impact both short and long-term health.
Mr. Horsford. Thank you.
Dr. Jones, briefly, how does structural racism affect
health care outcomes in the United States, and how does it
affect the quality of care that people of color receive, some
of the health behaviors relating to housing and food
availability and other social determinants?
Dr. Jones. Yes. I think that there are a number of ways in
which structural racism can affect these health outcomes.
I think that, when we look at the United States and
compared it to other countries in terms of health outcomes, we
have relatively higher rates of maternal mortality, for
example, during childbirth. And some of this could be linked to
discrimination and biases among doctors and how they view, for
example, Black women.
And so these deep-seated issues of racism, they are
prevalent when doctors are being trained, among--it feeds into
the composition of doctors that we have, and then it can spill
over into the types of services that are delivered. That is
just one example.
Mr. Horsford. Thank you very much. And I yield back.
Chairman Yarmuth. The gentleman yields back. I now
recognize the gentlelady from Texas, Ms. Jackson Lee, for five
minutes.
Ms. Jackson Lee. Thank you very much, Mr. Chairman. I am in
the office with one or two staff. I will take off my mask as,
obviously, in Texas we have been hitting a spike of enormous
proportion. Our hospital beds are now overwhelmed. Our
emergency rooms are overwhelmed with COVID-19. And I think this
is certainly an appropriate hearing, as it deals with wealth
inequality in America and really, as I have been listening, the
lack of access to health care.
So I am going to, if I might, Dr. Harris, if I might focus
on you, and my focus will hopefully be an area that you have
had some exposure to, just by hearing the word, but I am going
to articulate it in a more definitive manner.
And I would really like--first of all, let me congratulate
you, Dr. Harris, for your leadership of the American Medical
Association and, really, the innovative work that you have been
doing as relates to health care disparities. It is very
distinguished and well appreciated.
So I would like to, as well, comment on this inequity in
wealth. I heard someone attacking the Affordable Care Act. If
all of the states, the red states, had accepted the Medicare
expansion, we would have included more persons. If we had
allowed the Affordable Care Act to take its will and to be able
to develop the body politic and to include young people, we
would have had a very strong health care system. But it has
been attacked and stripped and strained, and it is an outrage.
I do believe that Medicare should be modified to include
the opportunities for individuals to be in their homes and
still have the ability to have care, as persons who are in need
of care.
But my question to you is that we have experienced over the
last couple of weeks the recognition by many of systemic
racism. We have introduced the legislation for over 30 years
called the commission to develop proposals for reparations and
proposals (sic). It is a thoughtful, articulate expression of
addressing the question of systemic racism, and presenting a
commission that will look at the issues of health care, the
economy, psychological issues, sociological issues, scientific
issues. And I think we have a vehicle that can address what we
are trying to do piecemeal, meaning that we have people focus
on the over 200 years of slavery that have, obviously, had an
impact in the denial of wealth, the inability to transfer
wealth.
So you are a doctor. I would appreciate your commentary on
looking at it through the eyes of the commission to deal with
and develop real proposals on the question of the plight of
African-Americans as relates to any number of issues. And you
may speak to the issue of access to health care.
I believe another witness is Dr. Jones from the Chicago--
University of Chicago. But Dr. Harris, could you please answer
the question?
Dr. Harris [continuing]. issues that you mention and that
might be addressed in that legislation are critically important
issues.
For many years I think we looked at health through a narrow
lens, and now we really have to open up that lens. And when we
are talking about these health inequities, we do have to go
back to the 400 years of slavery, and Jim Crow, and all of
those issues.
I will say something that the AMA has done regarding
reconciliation. Many of the audience and many of the Members of
Congress may know that for decades the AMA did not allow Black
physicians to belong to the AMA. And we do believe that that
probably impacted where we are today. So we are looking
internally, as we move forward.
But in 2008 the AMA went on record to apologize for that.
Now, that was a necessary step. Not sufficient. And we have
done things since then. We have a new center for health equity.
But critically, an important note in reconciliation is
admitting your past mistakes.
Ms. Jackson Lee. So you understand reparations is repair,
and is different from reconciliation. So I am talking about
H.R. 40.
Dr. Harris. I do.
Ms. Jackson Lee. And do you believe we need reparations,
repair, and restoration, as well?
Dr. Harris. Well, I have to say I am here representing the
AMA today. I don't think we have taken an official position,
but I am a Black woman in this country, and I do think we need
to look at that issue seriously, and particularly how those
issues impacted health.
Ms. Jackson Lee. Thank you. Is Dr. Jones there, Dr. Damon
Jones?
Thank you very much, Madam President.
Hello?
Dr. Harris. Thank you.
Dr. Jones. Yes. Yes.
Ms. Jackson Lee. Could you respond to that, as well?
Dr. Jones. Yes. So I think that, as I mentioned, I think
that that--we should move forward with that bill to create a
committee.
One of the steps has to do with reconciliation and, again,
getting closure. But as you mentioned, there is also redress
for what has happened in the past. And so material reparations,
I think, as well, should be included. Both of those are
important, because we continually see ourselves back at the
same point with racial strife in this country. And so we are
not going to get past that without looking deeply into this
country's history, and trying to repair some of those problems.
Ms. Jackson Lee. I commend H.R. 40 to both of you, in terms
of looking at it from your perspective on health care. The
commission, appointed by Members of the U.S. Congress
leadership and the President of the United States, would then
be tasked with a repairing and restoring of the seismic impact
of slavery, the original sin, on African-Americans who don't
have the inherited wealth, who are impacted by health
disparities in a very severe manner, and are impacted more
severely by COVID-19, both economically and health-wise. We
need a systemic change dealing with systemic racism. And I
think, as we look at it from the budget perspective, all of our
committees should look at this extensively.
And I am just going to you, Dr. Jones. I know I have a
second or two. But we have to look at it holistically, and----
Chairman Yarmuth. No, you----
Ms. Jackson Lee.--is a way to do so.
Dr. Jones?
Chairman Yarmuth. No, you are way over time. You are way
over time.
Ms. Jackson Lee. All right, well----
Chairman Yarmuth. I am sorry. The gentlewoman's time has
expired.
Ms. Jackson Lee. Thank you.
Chairman Yarmuth. I now----
Ms. Jackson Lee. Thank you, I yield back.
Chairman Yarmuth. I now yield five minutes to the gentleman
from Virginia, Mr. Scott.
Mr. Scott. Thank you. Thank you, Mr. Chairman. And Mr. Roy,
let me ask Mr. Roy a question first.
And I thank you for testifying on the Education and Labor
Committee yesterday. When you say liability protection on
coming back and reopening, are you talking about liability
insurance coverage so that victims can get covered, or are you
are talking immunity, where the victim is stuck with his own
bills?
Mr. Roy. Well, I don't know if I am exactly talking about
either of those things. What I am talking about is employers
are very reluctant to reopen their workplaces, because they are
concerned that if a single worker at their place of employment
eventually gets COVID-19, and that COVID-19 was contracted
somewhere else but----
Mr. Scott. Well, yes, yes----
Mr. Roy [continuing]. outside the workplace----
Mr. Scott. They--but who would--people get sick, and the
employer could pay under present law.
Mr. Roy. Oh, well, that is different, right? So if the
employer is paying for their health insurance, then the health
insurance should cover COVID-19, of course.
Mr. Scott. Yes. OK. So when you talk about liability
protection, are you talking about an insurance company to cover
the liability, or are you talking about immunity, where the
employer is home free?
Mr. Roy. Well, I am talking about legal protection for
employers, so that they are not at risk of bankruptcy due to
someone who contracts COVID-19----
Mr. Scott. And you could do----
Mr. Roy [continuing]. outside the workplace----
Mr. Scott. You could do that with insurance.
Mr. Roy. You could do that----
Mr. Scott. So it--yes.
Mr. Roy. But the employer pays for the insurance, right? So
if the employer pays for the insurance, that increases the cost
of employment.
Mr. Scott. OK, well, I don't think you had an answer to
that.
Let me ask Dr. Harris a question. We have heard a lot of
disparaging remarks about the Affordable Care Act. Dr. Harris,
you are aware that when the Republicans tried to replace the
Affordable Care Act, their replacement was scored by the CBO,
and it concluded that the cost would go up 20 percent the first
year, 20-some million fewer people would have insurance, those
with pre-existing conditions would lose their insurance, and
the insurance you get is worse than what you got.
Can you say--so we know that ACA--repeal and replace, but
repeal just generally--and Medicaid expansion, could you just
say how Medicaid expansion would be helpful to reduce the
disparities, and how ACA repeal would be harmful, and make the
disparities worse?
[Pause.]
Mr. Scott. Dr. Harris?
Dr. Harris. Can you hear me? Thank you.
Mr. Scott. Yes, I can hear you now.
Dr. Harris. Thank you. Yes. And as you know, the American
Medical Association did support the Affordable Care Act.
Certainly, it was not a perfect piece of legislation, but it
did move us further in reducing the number of uninsured in this
country. And at this point, we believe that the best path
forward is to strengthen and enhance the Affordable Care Act,
and that does include the expansion of Medicaid.
Certainly, I know so many--and I am a psychiatrist--but in
all disciplines of medicine so many previously uninsured
patients were able to gain access to health care through the
Affordable Care Act.
And we also know that if you don't have insurance--and, of
course, for other--many other reasons, lack of access, all of
the social determinants of health--you live sicker and die
younger.
And so we at the AMA continue to support strengthening and
enhancing the Affordable Care Act. We continue to support a
bipartisan and bicameral solution to getting us to a point
where everyone has affordable, meaningful coverage in this
country.
Mr. Scott. Thank you. And I will ask our other witnesses--
we can talk about the problem, or we can come up with
solutions. We are talking about a lot of solutions about income
and wealth inequality. Some of the things we are working on are
increasing the minimum wage; making it easier to form a union
so you can negotiate for higher wages; investments in
education, particularly higher education and making that
affordable; housing andj home ownership initiatives, because
that is where most middle-class families get their wealth; and
fighting discrimination, everything from employment to business
loans to housing, so that equally postured people will get--the
minorities will not be worse off.
Can you say anything about which of those initiatives are
most important, or anything else that we ought to be actually
working on?
Dr. Deaton. This is Angus Deaton here. Yes. I mean, I think
I made a case for all of these in some of my writings.
The one I would emphasize that you didn't emphasize is I
think we have to somehow rein in the cost of health care. The
cost of entitlements, as we have heard, are bankrupting the
nation. But the cost of entitlements are so large because
health care costs so much, and we have got to bring those costs
down. The waste in health care is 50 percent more than we spend
on national defense, and that is just a completely crazy
number. And other countries manage to do this not necessarily
any better than we do it, but they do it at less than half the
cost.
And that would stop the--of employment for less skilled
Americans, for African Americans. And it would give us a chance
to get back a reasonable chance of prosperity for less
fortunate Americans who have really been suffering over the
past 50 years. It is OK to say the economy was doing pretty
well up until February, but people were dying in droves, and
there were 158,000 deaths of despair last year. That is not
something that happens in a well-functioning economy. Thank
you.
Chairman Yarmuth. Thank you. The gentleman's time has
expired. I now recognize----
Mr. Scott. I----
Chairman Yarmuth. Oh, sorry. I now recognize the Ranking
Member, Mr. Womack, for 10 minutes.
Mr. Womack. Thank you, Mr. Chairman. And thanks to all of
our panelists today.
Let me begin with part of my thesis. When I opened in my
opening remarks in talking about deficits and debt and the need
for certainty, the need for--I didn't talk necessarily about
budget reform, but the Chairman and I have a long history on
promoting some kind of reform so that we can get to the
business of doing the people's work without CRs, omnibus
packages, and those kinds of things. I just kind of put all
that in the category of bringing certainty to the governmental
process.
But in my thesis I talk about the pressure that deficit and
debt and, in particular, the net interest on the debt, which is
rising exponentially, and the impact it is going to have on
programs that benefit, largely, the vulnerable population, and
whether it is in the minority communities, or vulnerable
seniors, or this sort of thing.
So here is my question for each of the four panelists. And
be very brief in your response, because I don't have a lot of
time, and I am--and I hope not to use all of my time. But we
will start with Mr. Deaton.
Does deficit and debt matter, and is it a concern of yours?
Because we have had a lot of proposals thrown out in this last
couple of hours. All of them have a price tag to them. Do
deficits and debt matter? And if so, when should we be serious
about it?
Dr. Deaton. I think deficits and debts do matter. They
matter in a somewhat complicated way, and it is a very lively
topic of discussion among my colleagues.
But let me go back to something I said a minute or two ago.
Before COVID came--and COVID is a whole special case, because
we have never had budget deficits, we have never had a pandemic
like this before. Before COVID, all the red ink out into the
future is driven by the high cost of medical care. If we can
bring that under control, then we wouldn't have this problem.
So this problem is important, and that is the key to getting it
under control.
Mr. Womack. Dr. Jones?
Dr. Jones. Yes, I would say that it is important to think
about deficits and debt. I don't think now is the time to place
the most weight on that. I think we are in an emergency
situation, we are in a crisis, and that is the time where you
draw into the deep pockets of the federal government to bail
people out, because there are people in deep need, and they are
in need of relief.
I think that if interest rates were rising, or if we
thought that there was not enough capital flowing around for
people to borrow, then you may think more about these things.
But I don't think that that is the case right now.
Mr. Womack. Dr. Harris?
Dr. Harris. I don't feel qualified to talk about deficits
and debt. But I do want you to know that, as physicians in the
physician community, we do think that we need to continue to
have fair-minded debates around the cost of health care, the
value of health care, and health care financing. So I can
commit that I will be a part of that conversation, and I will
leave it to the economists for the deficits and debt.
Mr. Womack. OK. So, Dr. Roy, as you get ready to answer the
question--and I am paging through some of your testimony, but
you said early on, if I can--and I may not be able to find it,
but you said--you made a case early on in your testimony, in
your opening remarks, about the impact of deficits and debt and
the pressure it is going to have on all of the programs,
particularly the social safety net programs, but in addition to
a lot of other programs that affect specific communities that
we are talking about here today. So I am assuming that you
believe that deficits and debt do matter.
Mr. Roy. Absolutely. I completely agree with what you were
describing earlier about how a fiscal reckoning will
particularly harm economically vulnerable populations. And I do
describe that in my testimony.
One thing I should mention is that we have actually put out
a comprehensive plan called Medicare Advantage for All that
involves universal private insurance like that in Medicare
Advantage for everyone. And there is actually a bill that has
been introduced in Congress by one of your colleagues from
Arkansas, Bruce Westermann, that is based on on that bill.
And one thing I should mention that we talk about
extensively in that report is how to reduce the high cost of
U.S. health care.
One thing I should mention in this hearing in particular is
the fact that one of the ways--the way in which Medicare pays
physicians for their care, and the prices that Medicare pays
for that care, are determined by physicians. There is a secret
committee of specialty societies called the RUC Committee that
basically determines what prices the taxpayer pays through
Medicare for those services. It is one of the most egregious
examples of conflict of interest in the federal budget, and it
is something that I hope Congress can revisit as it tries to
find ways to reduce the high cost of health care.
Mr. Womack. Well, and back to your testimony, I subscribe
to the notion that deficits and debt do matter, because
eventually we are going to become a credit risk. And when you
become a credit risk you are going to be paying more in
interest for the people that are buying your paper.
And if that is the case, then the more interest you pay--
and, let's face it, I don't know what the deficit or the debt
is today. I know the deficit we are going to rack up is
somewhere in the vicinity of $4 trillion. But the net interest
on the debt that we are going to pay for--and I am an
appropriator, too, so I can speak to this--is going to put a
lot more pressure on our ability to fund a lot of the things
that most of the panelists, all of the panelists, my colleagues
on this panel, believe are important to our country on the
discretionary side. It is going to put an enormous amount of
pressure on that. We are going to pay more in net interest. And
I believe that, eventually, net interest on the debt is
probably going to exceed what we spend on national security,
which would be unheard of, in my opinion.
So I subscribe to the notion that deficits and debt do
matter, and we have got to be careful when throwing around a
whole lot of other programs that are going to cost an
extraordinary amount of money, not necessarily intent on
raising the revenue that would need to go to support it.
I said in my opening statement that before COVID this
country was clicking along at a pretty good pace, and
specifically to our minority communities: Black, Hispanic,
Asian unemployment, 5.4, 3.9, 2.1 percent, respectively. Now
they have gone higher because of COVID. It makes sense to me,
Dr. Roy, that when we climb out of this COVID hole, that we
need to go back to the policies that had us on track and had
historic lows of unemployment and economic prosperity before
COVID hit. Would you agree?
Mr. Roy. Well, there is no doubt that the quicker we can
get back to that policy mix, that would be great. I am very
concerned that we won't, and I am very concerned that Congress
is on the verge of making it worse, because if Congress gives
states a powerful incentive to stay locked down, then that is
going to continue to retard the recovery, retard the ability of
those lower-income, economically vulnerable populations to get
back to work.
Mr. Womack. In my remaining time, one of the things that an
emergency like COVID forces a country to do is to become less
dependent on the way we have always done things, and start
looking for innovative ways.
And so, in the area of--particularly of health care and
education, we have had to rely a lot more on what we are all
doing on computers, kind of like what we are doing here today.
And so I would assume I would get an affirmative response from
every single one of you that in a future infrastructure package
the ability for this country to get rural broadband--and maybe
I shouldn't just say rural broadband. I think one of you said
earlier even on the inner city we have some connectivity
issues. But this country does have the capacity to become very
innovative in the way we teach, in the way we do research, and
in the way we do particularly telemedicine, using these devices
that we are all on here today.
Do you agree with that, Dr. Deaton?
Dr. Deaton. Yes, I do. I mean, I am not sure I would--we
would agree on all the details. But, for sure, fast Internet
access for everybody is incredibly important. And then we can
let this grow from there.
Mr. Womack. Dr. Jones----
Dr. Deaton. And----
Mr. Womack. Dr. Jones, would you not agree that one of the
things that we could be doing to boost the opportunities for
particularly--for everybody, but particularly the minority
community, is get Chromebooks or iPads or the connective
devices attached to the worldwide web for the express purpose
of helping educate and better treat people with underlying
medical conditions? Would you not agree that broadband is
important?
Dr. Jones. I would agree that it is important, especially
now, when we need to be socially distant, when we need to
replace our usual interactions with Internet access. That
access is uneven for a number of reasons, and making broadband
widely available would be----
Mr. Womack. Dr. Harris, from the AMA perspective,
obviously, we have come a long way with telehealth, and
probably could go a lot further, could we not?
Dr. Harris. Absolutely. And broadband is critical and so is
innovation.
Mr. Womack. Dr. Roy?
Mr. Roy. Agreed.
Mr. Womack. All right. Chairman Yarmuth, I am going to
yield back. It looks like I am down to zero, so I have nothing
to yield back to my friend from the Commonwealth.
Chairman Yarmuth. All right.
Mr. Womack. Thanks to all of you. I appreciate it. Thank
you so much.
Chairman Yarmuth. I thank the Ranking Member.
Before I get into my questioning, I ask unanimous consent
to submit statements from America's Essential Hospitals and the
Campaign for Tobacco-Free Kids into the record.
Without objection, so ordered.
[The information referred to follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Yarmuth. I now yield myself 10 minutes.
First of all, let me once again thank all of our panel.
Your responses have been very helpful and insightful, and your
prepared statements, as well. I enjoyed reading all of them,
and there is a lot of real good food for thought in all of the
statements.
One of the things that I have been doing a lot of recently,
and I think probably most people who are in this hearing have,
is what happens after we get through this current challenge.
What happens when we are on a more stable economic footing? And
what happens once we can at least control the coronavirus?
And it seemed to me that there are a couple of things that
we probably have learned, or are learning. And one of those is
that there are a lot of jobs in this economy that nobody really
gave much thinking to, but now have become pretty important
jobs.
And I was on a phone call several weeks ago with a group of
union members--and, Professor Deaton, I really appreciate your
discussion of unions in your testimony, and the importance of
revitalizing unions.
But anyway, there was a guy on the phone call named Greg.
And I don't know whether Greg was Black or white. Greg is a
maintenance worker in one of the public high schools in my
district. And it occurred to me that six months ago there was
not a person in the country who would have given any thought to
Greg. But now, as we start thinking about sending our kids back
to school, and worrying about their safety, all of a sudden
Greg is a very important person, as are the people who stock
the grocery shelves, and the people who drive the buses, and a
lot of people who have never really been valued and compensated
as commensurate with the role that they play.
And so it occurs to me that one of the things that is going
to happen as, again, as we get through this--and we know,
particularly, if there is a Democratic Senate and a Democratic
president after this next election, that there is going to be a
serious conversation about universal basic income. There is
going to be a very serious conversation, as has been mentioned
here before, about reparations. There are going to be very
serious discussions about Medicare for all, or some kind of
single-payer system. And there--all of these programs
absolutely do come with a cost.
On the other hand, as I think we all recognize--and I am
getting to a question for you, Professor Deaton--is that
programs by themselves are not going to end systemic racism. A
federal government, no matter what we do, is never going to end
that. It is the responsibility of the entire society. Corporate
America has a role, and so forth. But the idea that the only
way to--the primary way to address the systemic racism and
inequities in the country is to create a stronger economy
that--where the ships all rise seems to me to be--to defy
history. We basically relied on that theory for a long time,
and it has not really helped.
Could you elaborate, and could you comment on that,
Professor?
Dr. Deaton. I would love to. Thank you very much, Chairman.
It is certainly true that growth is good. I mean, we would
all like more economic growth than less economic growth. And
when growth is high, there is--you can give someone to
everyone--something for everybody. And it is much easier to
deal with social conflict. I think those days have, by and
large, gone.
And while there has been a lot of growth in the American
economy over the last 30 years, it is not equally distributed.
And--but I don't really care that much about inequalities. I am
saying a horrible thing here. But what I really care about is
the people, the large number of people, who have been left
behind by this economic growth, and this economic growth is
going to the top, it is not going to the bottom, whether you
are talking about African-Americans, or whether you are talking
about less educated whites.
And, you know, for a long time people were saying, ``Well,
the numbers aren't really right. People are getting a lot more
economic growth than the government is measuring, you should
use these measures rather than those other measures.'' But, you
know, that is not really right. And when you see people
actually destroying themselves in huge numbers--158,000 people
who destroyed themselves through drug addiction, through
suicide--we are the only rich country in the world whose
suicide rates are actually rising. Everybody else in the
world--and all those people who are killing themselves, who are
doing away with themselves, are the less educated Americans.
And it is true that our wages were rising up until
February. The unemployment was the lowest it had been for a
very long time. But they are still worse off than any time they
were in the 1980's. And this economy is just not delivering for
them. I mean, it may be rising, but it is only raising the
boats at the top--and it is very hard for me to see how anyone
with serious straight face can continue to talk about trickle
down, and how, if the economy goes up, everyone goes with it.
The factual record is just 100 percent against that.
Thank you.
Chairman Yarmuth. Yes. It seems like we also have a very
recent experience with kind of the systemic disadvantages that
Blacks face in this country. When the PPP program came out in
CARES, and one of the first things that we realized after--and
it got off to a rocky start, but that was understandable. We
didn't have agencies that were prepared to deal with millions
of applications.
But one thing we found out was none of this money was going
to Black entrepreneurs, Black business owners, very little of
it, and partially because they didn't have banking
relationships significant enough to get help. They didn't have
an opportunity to go out and get legal counsel to help them
navigate through it. And so we actually set aside some more
money in the Heroes Act to go specifically to Black and women-
owned and minority-owned businesses.
But to me, that seems to me--one of the big arguments
against relying on economy-wide initiatives to actually attack
the inequities, because there are these fundamental
disadvantages that many people in the country largely--and
most--many of them are Black--face in trying to even deal with
the systems that we set up that might help them if we can--if
they had access to them.
One of the things I want to talk about briefly, and I hate
to get into health care debates because you can talk about it
forever, but Mr. Roy talked about Medicare for All that was
transferable and encouraged mobility. And one of the things
that occurs to me is that employer-based insurance--and we are
the only country in the world that has that, the only
industrialized nation that has employer-based insurance--also
exacerbates the disparities, because you have so many people in
the category in Black America and poor whites and so forth who
are working in jobs where there is no coverage through their
employer, or they are the first ones that are going to be let
go and lose their coverage, or the coverage is so expensive
that they get no growth in their wages.
Now, I would love to see Dr. Harris, Dr. Jones, if--how you
think about--if you see that as a huge problem, the idea that
employer-based insurance is a problem with exacerbating
inequities.
Dr. Jones. Yes, I--maybe if I can comment first, I would
just say a couple of things on that.
I think that right now, as we are going into a recession,
we are seeing that there is a huge cost to having your
insurance tied with your employer. There are a lot of people
who are losing their job, and that is going to provide--that is
going to create a break in the continuity of their care, and
their access to health care.
I also think that the other thing is that when I talk about
the labor market and workers' bargaining power, a lot of what
you are seeing in terms of workers not being covered by health
insurance is related to their inability to have collective
bargaining, and to command better compensation and benefit
packages from their employers.
So in the meantime, I think that increasing the ability for
people to collectively bargain is going to allow them to have
higher quality jobs and compensation.
Chairman Yarmuth. I appreciate that. I apologize, I
attributed the union comments to Professor Deaton; they were
yours in your testimony.
Well, my time is running out. So I just want to close and
say I think Fed Chair Jay Powell had it best--said it best when
he acknowledged that those least able to withstand the downturn
had been affected the most. And the impact of this virus on the
health and economic security of the American people has been
brutal, and it has hit Black and Latino families particularly
hard.
And we can't move forward with a full recovery without
addressing the underlying racial inequities in our system. I
think we do have the fiscal space right now and, I believe, the
public will to make those systemic and long-overdue changes. We
have some bold policies that are ready to go, like the Heroes
Act and the George Floyd Justice and Policing Act that we will
vote on later this week.
And if we are going to reunite this country and come out on
the other side of this crisis as a better nation, Congress must
ensure that our recovery efforts include proactive policies to
spur not only an inclusive recovery, but inclusive growth and
opportunities for all.
And with that, I will thank the panel once again for your
time, and your insights, and your expertise. And if there is no
further business before the Committee, this hearing is
adjourned.
[Whereupon, at 4:47 p.m., the Committee was adjourned.]
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