Freedman Consulting, LLC | Briefing for July 6-9, 2021 on COVID-19 and Low-Income Communities
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Briefing for July 6-9, 2021 on COVID-19 and Low-Income Communities

Briefing for July 6-9, 2021 on COVID-19 and Low-Income Communities

We are struck that one of the few certainties about the coronavirus outbreak is that low-income communities and workers in low-income, service sector occupations will be disproportionately impacted — likely in devastating fashion.

One step in combatting this will be to share information about what is happening and what can be done. That’s why we are offering a daily news service summarizing relevant stories, which you can read below.

If you would like to receive a daily briefing, feel free to email schumitz@tfreedmanconsulting.com to subscribe.

Briefing for July 9, 2021



Kids and tax cuts — why Dems need a sales pitch to seal a major Biden win: Politico reports: “Democrats pushed through a landmark new anti-poverty policy just months ago. Now they have to make sure they get credit — and get the whole thing to last. Their victory, which represents monthly checks for 90% of American parents, faded from view as Congress launched a summertime battle over infrastructure, but President Joe Biden and his party are one week away from it coming to fruition. That enormous expansion in the child tax credit got tucked into March’s huge coronavirus aid bill. It’s one of the most ambitious elements of Biden’s first major law, and Democrats are hustling to put their fingerprints on an enormously popular program that many hope will help them hang onto their House majority next November. But that’s not the only challenge they face. The party’s first task is to remind voters of the benefits they’ll be getting, a central focus for Speaker Nancy Pelosi and her leadership team in recent weeks. The California Democrat is personally encouraging her members to participate in the messaging campaign, and many are using the July Fourth recess to step up their outreach with local events and town halls — some of their first in-person appearances since the start of the coronavirus outbreak. ‘It’s our job to articulate that literally, I’m the only one in Iowa who voted for’ the expanded child credit, said Iowa Rep. Cindy Axne, one of seven Democrats who prevailed last fall in a district that former President Donald Trump claimed. ‘In my book, I’m the only one who voted for working families.’” 

The need for continued bipartisan momentum on paid leave: Writing for the Bipartisan Policy Center, Adrienne Schweer, a BPC fellow who leads the Paid Family Leave Project, and Abby McCloskey, founder of McCloskey Policy LLC and a member of the AEI-Brookings Paid Leave Working Group, make the case for why national paid leave should be part of the post-pandemic recovery: 

  • Paid leave would help people to return to work. “According to a Bipartisan Policy Center–Morning Consult poll that we led together: ‘Nearly two out of three workers (63%) say they would be somewhat (29%) or very (34%) likely to return to work sooner if they knew they had access to paid family leave.’” 
  • There remains a significant gap in paid leave coverage, especially among vulnerable workers. 
  • Paid sick leave helps to flatten the curve. “A study by Pichler et al. (2020) found that states where workers gained access to paid sick leave because of FFCRA had 400 fewer confirmed COVID-19 cases per day, per state.” 
  • Paid leave could help close the gender equity gap from the pandemic. 


Should therapy be free for everyone? Richard Reeves of the Brookings Institution offers suggested changes to national mental health policies. The goals are adapted from Reeves and Isabel Sawhill’s 2020 A New Contract with the Middle Class

  • Better mental health screening: “Mental health problems typically present early in life, with three quarters of lifetime mental health conditions beginning by the age of 24. Yet an average of 11 years elapses between the onset of symptoms and diagnosis.” 
  • Real parity between mental and physical health: “While laws are in place to require insurance plans to cover mental and physical health care on equal terms, that does not always occur in practice — in part because the legal framework has significant gaps.” 
  • Free universal cognitive behavioral therapy: “When it comes to the provision of mental health treatment, a simple step in the right direction would be enabling universal access to cognitive behavioral therapy (CBT). CBT is a ‘problem-focused, empirically based psychotherapy that teaches patients to detect and modify thought patterns and change behavior to reduce distress and promote well-being.’”  


Mayors for universal basic income: Los Angeles Mayor Eric Garcetti, St. Paul (MN) Mayor Melvin Carter, and former Stockton (CA) Mayor Michael Stubbs give an update in Time magazine about their efforts to enlist other mayors in a movement to try pilot programs offering a Universal Basic Income to parts of their cities. “We were all mayors of major cities during the height of the pandemic last year, and saw first-hand the need for ongoing aid. We also knew that the problems of the pandemic were not new — that poverty and inequity run deep. That’s why we launched Mayors for a Guaranteed Income in the pages of TIME. Our goal was two-fold: add to the body of data proving cash works through pilots across America, while also advocating for a federal guaranteed income policy. In addition to solving for our communities’ immediate needs, we were driven by a moral imperative to build an economy that works for everyone. Last year brought an inspiring wave of protests across the country, and the world, demanding equity for people of color — particularly Black Americans who have been historically excluded from economic gains. With its roots in racial and gender justice history, guaranteed income is the ideal tool to combat both the racial injustice and economic precarity brought to the fore in 2020 and that we continue to see today. MGI was founded on the belief that in the richest country in the world, no one should live in poverty. We operate based on the truth that financial instability is not the failure of individuals, but rather policies. Our progress over the last year has included important work at the local, state, and federal levels. We’ve grown our ranks from 11 to 58 mayors, and scaled up our pilots from one to more than two dozen. We worked with state leaders, resulting in $35 million in guaranteed income pilot funding included in the California budget, a first in the country. We kept the heat on Congress to provide more stimulus checks, and we got them. As we look to the work of our next year, we recognize that now is not the time to take our foot off the gas. We will work with the administration and Congressional leaders to ensure the CTC is made permanent. The research from our pilots will continue to feed into the evidence base proving that cash works. We will also invest in narrative efforts to show that the economy is not numbers on a graph, it’s the financial reality of people in our communities.” 

The crisis of senior poverty: From MarketWatch: “If 40 million Americans were suffering from the same severe problem, you might think it would be the subject of considerable media attention, a host of government programs, infusions of business capital, and a hot topic of national conversation. That is certainly what I thought several years ago when I began researching the reality that nearly half of all people of over 55 — one in seven Americans — had no money saved and risked heading into poverty or certainly into dire conditions that would make their lives desperate for decades to come. Well, of course, attention and resources of all kinds were being focused on this, weren’t they? No, they were not. I was shocked, because this is truly an enormous problem yet very little was being done to address it. And that’s still the case. Many of these older Americans in, or near, poverty, are likely to live another 20, 30, or 40 years, but will have few prospects to earn meaningful income or the skills suited to the economy of the 21st century. Sadly, they will become less, not more, able to function in the economic marketplace as they age.” 

Briefing for July 8, 2021



The real toll from COVID prison cases may be higher than expected: The New York Times identified a number of inmate deaths due to COVID-19 that were not reflected in official tallies. “More than 2,700 people are reported to have died of COVID-19 in connection to U.S. prisons, jails, and immigration detention centers, but the additional cases raise the prospect that the known toll on incarcerated people falls far short of providing the full picture. Concerns about how coronavirus deaths are documented have emerged throughout the pandemic, including a finding that the toll among nursing home residents in New York State was far higher than known because thousands who died in hospitals had not been included. A surge in deaths across the country last year that went beyond the known COVID-19 toll has health experts suggesting that some virus cases went undiagnosed or were misattributed to other causes. There have also been inconsistencies and shifting guidance regarding which deaths should count as coronavirus deaths. Public health officials say the prospect of overlooked virus deaths tied to the nation’s prisons, jails, and immigration detention centers carries particular risks. It is challenging, the experts say, to prepare prisons for future epidemics without knowing the full toll. For now, the publicly known death totals connected to incarceration largely come from the facilities themselves.” 

Dealing with the unending grief from COVID deaths: The Associated Press looks at the long-lasting emotional repercussions from the more than 605,000 dead of COVID-19 in the United States. The pandemic has created a tidal wave of prolonged grief, the kind of mourning that experts say can prevent people from moving beyond a death and functioning normally again. “Natalia Skritskaya, an expert on grieving, said it’s too early to say whether prolonged grieving, also known as complicated grief, will be a major complication from the pandemic — it isn’t yet over, with thousands still dying daily worldwide, including hundreds in the United States. Many mourners have yet to pass the one-year anniversary of a loss, and few studies have been published so far on the psychiatric fallout, she said. But prolonged grief is both real and potentially debilitating, said Skritskaya, a research scientist and clinical psychologist with the Center for Complicated Grief at Columbia University in New York. She noted that it can be treated with therapy in which participants talk through their experience and feelings. ‘The core of it is kind of helping people face the reality of what happened,’ she said. ‘It’s not an easy treatment. It’s intense.’” 

A tsunami of long-term disability is coming as a result of long COVID: Scientific American reports: “Even as U.S. policy makers and business leaders seek to put the COVID pandemic in the rearview mirror with the help of highly effective vaccines, a fundamental policy and planning gap is looming. Many who survive the initial viral illness suffer debilitating long-term sequelae. Unlike the common cold or even influenza, this virus causes a bewildering array of symptoms that persist long after the acute illness is resolved and can render some affected unable to resume their usual activities. As scientists and clinicians continue to delineate the “long-haul” course of COVID-19, policy makers and planners must anticipate and prepare for the impact of this new cause of disability, including its implications for federal and private worker’s compensation and disability insurance programs and support services. Consider the numbers we know. At least 34 million Americans (and probably many more) have already contracted COVID-19. An increasing number of studies find that greater than one fourth of patients have developedsome form of long COVID-19. (In one study from China, three quarters of patients had at least one ongoing symptom six months after hospital discharge, and in another report more than half of infected health care workers had symptoms seven to eight months later.) Initial indications suggest that the likelihood of developing persistent symptoms may not be related to the severity of the initial illness; it is even conceivable that infections that were initially asymptomatic could later cause persistent problems.” 

The true cost of health care: Child care policy experts like Simon Workman have long felt there was a child care crisis in America. The experience of the pandemic has made that crisis — the twin difficulties of providers being able to make a decent living and families finding affordable care — much more visible. Workman has a new paper out that looks at the true cost of child care and offers updated data from a tool the Center for American Progress has used to gauge child care prices since 2018. Workman spoke with Spotlight on Poverty and Opportunity recently

Dangerously low blood supplies endanger surgeries across the U.S.: From CBS News: “Blood centers in some U.S. cities are down to a one-day supply, forcing hospitals to postpone surgeries. The blood shortage is yet another fallout from the pandemic, experts say. OneBlood, the Southeast’s largest blood center, is scrambling to manage the blood shortage crisis. ‘It’s a 24/7 operation,’ said OneBlood’s Susan Forbes. ‘The donors are not in the traditional locations anymore. We lost large corporations, religious organizations, movie theater drives, festivals that were taking place ended.’ Before COVID-19 shutdowns, schools accounted for 25% of collected blood. Now, demand for blood products is up 10% nationwide. Some hospitals have had to delay scheduled surgeries. At NYU Langone Health in New York City, surgeon-in-chief Dr. Paresh Shah said they came close to doing the same. ‘There’s this huge backlog of operations that really needed to get done,’ Shah said. ‘We were down to such a low inventory of blood that if we had one major transfusion event, we would have been depleted completely.'” 

New Jersey expands Medicaid to cover undocumented children: NJ Spotlight News reports that New Jersey Gov. Phil Murphy (D) “announced his intention to expand New Jersey’s Medicaid program to cover the state’s nearly 90,000 uninsured children — including those who are undocumented — as part of his budget address in February. He highlighted his ‘cover all kids’ pledge again in late March at an event in Passaic with U.S. Rep. Bill Pascrell (D-9th) and a half-dozen state legislators and administration staff. Last Tuesday, Murphy privately signed a revised ‘cover all kids’ bill — which eliminates waiting periods and out-of-pocket costs for most families and provides $20 million to help cover the state’s additional costs — with no statement or fanfare. It was one of eight spending measures that officials said needed his OK before he approved the state’s $46.4 billion spending plan for the 2022 fiscal year, which began Thursday. While the changes to Medicaid, also known as NJ FamilyCare, will benefit tens of thousands of low-income families, it is not clear how much — or how soon — it will truly help immigrant children. Advocates estimate there are at least 53,000 uninsured kids in New Jersey who qualify for the program economically but are not enrolled, and more than 18,000 of those children are undocumented. Advocates say the number of undocumented children could be much higher because no one is exactly sure how many are living in New Jersey.” 

Briefing for July 7, 2021



Who gets left behind as we ‘return to normal’: The New Republic examines “an emerging constituency of Americans left behind by the supposed ‘return to normal,’ as mask requirements are loosened and workplaces that had gone remote plan to reopen. Some of these people… are unsure if their bodies responded sufficiently to the vaccine. Others have disabilities and chronic illness. And thousands suffer from ‘long haul’ COVID-19, diminishing their ability to work or go about daily life. All of them are now navigating a country that’s telling them to move on from the pandemic. When the Centers for Disease Control and Prevention announced new recommendations in May that vaccinated people no longer need to wear masks in most indoor settings, many were taken aback. Some health experts have expressed concern that relaxing the mask guidance was premature, given that we haven’t reached herd immunity; there are many unknowns about immune responses among different immunosuppressed and immunodeficient groups; and children under 12, who will be or are already attending in-person school again, aren’t yet eligible for vaccinations. It’s left many parents in limbo.” 

Why a focus on mental health is essential for students returning to school in the fall: ABC News looks at some of the preparations school districts are making to help students rebound from a school year filled with stress and turmoil. “It’s been a school year like no other in recent memory — combining the challenge of remote and hybrid learning for millions with the agony and strain of a pandemic that has killed more than 600,000. Mental health has taken a toll on many students and staff alike. So as districts prepare for the fall after the first full year during the coronavirus pandemic, many are looking at ways to help best address the mental health needs of students, especially those who may have experienced trauma, anxiety, or social isolation. One Ohio school district will welcome back students with more counselors and social workers on hand. Hilliard City Schools in Columbus has added seven new school counselors, up to 42, and 10 more social workers, for 15 total, Director of Student Well-Being Mike Abraham told ABC News. ‘Anxiety has always been high with this generation,’ Abraham said. ‘With the pandemic, some students have become very comfortable with isolation, not having to deal with the anxiety that school might bring or their peers bring. That’s what all districts are dealing with coming back now that these kids are together — giving them strategies to be able to deal with their anxiety, to deal with whatever mental health issues that they’re struggling with.'” 

The health care system is shortchanging non-English speakers: Pooja Chandrashekar, Managing Assistant Editor at Healthcare: The Journal of Delivery Science and Innovation, writes in Scientific American that the pandemic ‘has demonstrated the innumerable ways our health care system can rise to the challenge — and also how we fall short in caring for our most vulnerable patients. In March 2020, as cases of COVID-19 began to climb, I spoke with staffers of the Family Van, a mobile health clinic that provides preventive health services in some of Boston’s most underserved neighborhoods. They emphasized the difficulty of finding multilingual COVID-19 information and how this made it difficult for non-English speaking patients to protect themselves. At the time, neither the CDC nor the state health department had released COVID-19 information in languages other than English, Spanish, and Chinese, leaving community health organizations scrambling to pull together multilingual information on short notice. Over a year later, this continues to be a problem. Many state governments provide limited information about the vaccine in languages other than English, and some offer no language assistance at all on their vaccine-finder websites. It should come as no surprise that rates of COVID-19 infection are several times higher among non-English speakers, a disturbing pattern that mirrors previous epidemics.” 

Texas students of color returned to in-person classes at a lower rate: The Texas Tribune looks behind new data showing Texas students of color returned to in-person school at a lower rate to find some reasons why. “When districts gave parents a choice between in-person and remote classes during the past year, according to data from the Texas Education Agency, students of color in Texas returned to in-person learning at lower rates than their White counterparts. As of January, about 56% percent of Texas students on average returned to on-campus instruction during the school year, including 75% of White students, about 53% of Black students, 49% of Hispanic students, and 31% of Asian students. In an emailed statement, the TEA cited ‘COVID-19’s disproportionate economic and public health effect on communities of color’ as a reason for the lower in-person attendance and engagement rates among students of color. Experts say it’s necessary to consider the intersection of circumstances that could lead to such rates: Students may live in a multigenerational household and worry about infecting family members, or they could be tasked with extra responsibilities during the pandemic — such as taking care of siblings or supplementing family income — that make remote learning more conducive to their needs. ‘There’s mostly quite a bit of fear and economic uncertainty. All of those things play a role in wanting to continue remote learning,’ said Hector Bojorquez, director of operations and educational practice at the Intercultural Development Research Association, a nonprofit that seeks to ensure equal opportunities for children in public education. ‘Everybody’s lives [were] thrown into chaos during the past year. People whose lives are already precarious economically are even more frightened of taking certain risks.’” 

New study blames structural racism for pandemic’s unequal toll on communities of color: From the Rochester (N.Y.) Times-Union: “A new study from the University at Albany found structural racism is to blame for the unequal toll the coronavirus pandemic has taken on New York’s communities of color and implores policymakers to act to prevent more harm to these communities going forward. The finding was the result of a study commissioned by Gov. Andrew M. Cuomo last spring when early evidence suggested Black and Hispanic New Yorkers were being infected, hospitalized, and killed by the virus at much higher rates than others. UAlbany, which has an entire center dedicated to the study of minority health disparities, was tapped to lead research into why. In a report published Thursday, UAlbany explored not just the physical impacts the virus had on these populations, but the social and economic hardships that resulted from the pandemic and subsequent government interventions. ‘COVID-19 did not create disparities in health outcomes but rather exposed and exacerbated them in ways policymakers cannot ignore,’ the research team wrote. ‘Systemic racism has produced, and continues to produce, deeply entrenched differences in health care and the social, economic, and environmental conditions that account for inequities in longevity and the likelihood of disease. This was true long before the first case of COVID-19 was diagnosed… and will remain true unless the resources and will exist to make systemic changes.’” 

Briefing for July 6, 2021



Frontline health workers aren’t feeling a summer of post-COVID joy: The New York Times reports that while the holiday weekend marked a joyful turning of the page for many people in the nation, “the summer is turning out to be fairly joyless in places like CoxHealth Medical Center in Springfield, Mo., where nurses, doctors, and respiratory therapists have been grappling with a resurgence in coronavirus cases that forced the hospital to reopen the 80-bed COVID-19 unit it had shuttered in May. Dr. Terrence Coulter, a critical care specialist at CoxHealth, said he and his colleagues were stunned to find themselves back in the trenches after the briefest of respites. ‘With everyone masked, you learn to read the emotions in your co-workers’ eyes,’ he said. ‘They’re weary and they’re also disappointed that the country has started the end zone dance before we cross the goal line. The truth is we’re fumbling the ball before we even get there.’ America’s health care workers are in crisis, even in places that have had sharp declines in coronavirus infections and deaths. Battered and burned out, they feel unappreciated by a nation that lionized them as COVID-19 heroes but often scoffed at mask mandates and refused to follow social distancing guidelines. Many of those same Americans are now ignoring their pleas to get vaccinated. Doctors and nurses are also overworked, thanks to chronic staffing shortages made worse by a pandemic that drove thousands from the field. Many are struggling with depression and post-traumatic stress; others are mourning at least 3,600 colleagues who won’t be around for the celebrations. ‘People don’t realize what it was like to be on the front lines and risking your own safety without adequate protective gear while dealing with so much death,’ said Mary Turner, a registered nurse in Minneapolis who was unable to comfort her own father as he lay dying alone of COVID-19 in a nursing home in the early days of the pandemic.” 

The race is on to get rental assistance out and avoid eviction: The Associated Press reports that states are rushing “to distribute nearly $47 billion allocated by Congress for emergency rental assistance before a federal eviction moratorium ends July 31, putting millions at risk of losing their homes. The historic amount — more than the Department of Housing and Urban Development’s annual budget — was allocated in December and March. Housing advocates blame the slow rollout partly on the Treasury Department under President Donald Trump that they say was slow to explain how the money could be spent. The criteria, while clearer under the Biden administration, was still criticized for a burdensome process that seemed more focused on preventing fraud than helping tenants. Advocates also said states made things worse — some waited months to set up programs and others created bureaucratic hurdles. As a result, little money has gone out. According to data released Friday from the Treasury Department, only $1.5 billion was provided to about 350,000 households by May 31. That’s less than 4% of the money allotted. Missouri Rep. Cori Bush, a Democrat who has herself experienced eviction, said her office has received calls from families ‘who either don’t know how to apply for the funds or who say the application is confusing and stressful.’ ‘It’s unconscionable that millions of dollars are sitting in the state’s bank account, while families… across Missouri are struggling to stay in their homes,’ she said.” 

Biden’s housing dilemma — how to slash costs for low-income buyers: From Politico: “President Joe Biden’s move to fire the top U.S. mortgage regulator is triggering calls from fellow Democrats to use the agency to expand access to loans for lower-income people, who have struggled to buy homes since the financial crisis. That’s setting up a clash with Republicans over how far the government should go in shaping an industry that makes up one-fifth of the U.S. economy. A long-awaited Supreme Court decision last month gave Biden the ability to remove the Trump-era leader of the Federal Housing Finance Agency, and he wasted no time. The president installed as interim director an agency veteran who says she’ll make affordable housing and combating discrimination a top priority, but who has underwhelmed those on the left, who say she is a mere caretaker. Progressives are concerned that Biden will be too timid in changing course at the powerful agency overseeing Fannie Mae and Freddie Mac, the two companies that stand behind half of the $11 trillion U.S. mortgage market. Top Democrats are calling on Biden to quickly name a permanent leader — a position that Senate Banking Chair Sherrod Brown’s spokesperson said is ‘vital to the Administration’s goals of building an equitable economy and must be filled quickly.’” 

Pandemic wave of automation may be bad news for workers: From the New York Times: “An increase in automation, especially in service industries, may prove to be an economic legacy of the pandemic. Businesses from factories to fast-food outlets to hotels turned to technology last year to keep operations running amid social distancing requirements and contagion fears. Now the outbreak is ebbing in the United States, but the difficulty in hiring workers — at least at the wages that employers are used to paying — is providing new momentum for automation. Technological investments that were made in response to the crisis may contribute to a post-pandemic productivity boom, allowing for higher wages and faster growth. But some economists say the latest wave of automation could eliminate jobs and erode bargaining power, particularly for the lowest-paid workers, in a lasting way. ‘Once a job is automated, it’s pretty hard to turn back,’ said Casey Warman, an economist at Dalhousie University in Nova Scotia who has studied automation in the pandemic.” 

Post-COVID, newsrooms should also report what’s going well in Native lands: Kyle Edwards, managing editor at Native News Online and a 2021 Nieman Visiting Fellow at Harvard, writes in Nieman Reports that Native American communities got rare national press attention during the worst days of the pandemic — and that spotlight should continue when there is a more positive story to tell. “Much has been lost in our communities, this is true. When workplaces open up again and the first beat of a live in-person powwow sounds off, there will be many who are not there with us — family, friends, relatives, cousins, aunties, elders, tribal leaders, knowledge keepers, and historians. As part of my Nieman Visiting Fellowship, I’m creating an online memorial to remember the Indigenous elders we have lost to COVID-19. The loss of these citizens — the bearers of our languages and traditional ways — due to coronavirus has impacted all of our communities, both culturally and emotionally. The goal is to share their stories and the impact their absence will have on their communities and the people closest to them. For so many national news outlets, the reopening will mean the job is done. Their reporters will move on until the next existential crisis strikes our lands. They are there when the ship in Indian Country capsizes and sinks but are absent when it’s finally dragged out of the water, rebuilt, and made even stronger. At this point, every newsroom across America has an opportunity to do things differently, to bypass a harmful industry trend. Every journalist should be asking themselves: What’s next for Indian Country, and how do I tell that story?” 

Postpartum depression rose during the pandemic, particularly for women of color: The Los Angeles Times reports: “Although the California Department of Public Health has not released figures on the number of women with postpartum depression since 2018, experts say that an increase in calls from women asking for help from local nonprofit organizations, along with lengthening hospital waiting lists, indicate that postpartum depression cases may have increased dramatically over the course of the COVID-19 pandemic. Women of color continue to be among the most affected, in part because many do not have health insurance or their insurance covers little or no therapy, said Misty Richards, one of the directors of the Maternal Outpatient Mental Health Services program at UCLA. Evidence suggests that some Latina mothers may hesitate to seek help because of stigmasassociated with mental illness, as well as cultural expectations surrounding motherhood and the traditional roles of women in Latin societies.” 

Unemployed people can get free or low-cost health insurance: CNBC reports: “Anyone who is receiving — or already received — unemployment benefits in 2021 could discover they now qualify for no-cost or low-cost private health insurance. As of Thursday, zero-premium health plans that come with minimal or no cost-sharing — i.e., deductibles and copays — are available through the Affordable Care Act marketplace to individuals collecting unemployment at any point this year. The financial help was authorized in the $1.9 trillion American Rescue Plan Act, which was signed into law in March by President Joe Biden. ‘People who have been unemployed at any point this year essentially can get very generous or free health coverage,’ said Cynthia Cox, a vice president at the Kaiser Family Foundation and director of its Affordable Care Act program.”   

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