Two pandemics upended our nation this year. The novel coronavirus (COVID-19) continues to sicken, kill, and reshape the lives of people everywhere, and is also testing our nation’s healthcare, public health, education, and social protection systems like never before. The second pandemic is one that has been with us since well before our nation’s founding but has come into much sharper focus this past year. Like a virus, it has infected virtually every aspect of our society including our laws and policies, a central focus of the Policies for Action (P4A) research program: systemic racism and its attendant social, economic, and political injustices. Although this time last year, the need for sound policy research was clear – especially in light of growing inequality in health and wealth, and the conditions that drive and are shaped by these – 2020 made these needs more visible and more urgent. As P4A enters its sixth year, a strong and growing community of policy researchers across the country, supported by a stellar National Advisory Committee, are generating a host of research findings crucially needed at this moment.
Recovery from these twin pandemics – both of which need to be tackled with urgency and through effective, evidence-based policies and practices – are likely to dominate policy debates and decisions for many years to come. P4A is making significant contributions to these debates, thanks to strong science-based research methods grounded in real-world policy and practice. This past year, the program welcomed two new cohorts of researchers and research projects, one devoted to advancing equity, diversity, and inclusion in policy and law research with early career investigators and another focused on research on housing policies that promote equity. We are currently reviewing proposals devoted to public policy research to advance racial equity and racial justice. This set of research projects will be announced in summer 2021 and work will begin shortly thereafter. All of P4A’s work is critical in light of COVID-19, systemic racism, and the ripple effects both are having across the nation, but especially among those people and places that have been subject to systematic marginalization, exclusion, and disinvestment over many years.
In 2020, P4A released 30 publications, and P4A research appeared in 10 peer-reviewed journals, including the American Journal of Preventative Medicine, Health Affairs, JAMA, and Milbank Quarterly. P4A researchers participated in 5 panel presentations at interdisciplinary conferences, including those operated by the Association for Public Policy Analysis and Management, the Population Association of America, and the Interdisciplinary Association for Population Health Science. Additionally, P4A research was cited by top tier media outlets including CNBC, CNN, Forbes, the Hill, New York Times, the Wall Street Journal, and the Washington Post.
We know that policy research has a long shelf life and can be instrumental in informing policy debates and related activities for years to come. Among the research that attracted widespread attention this year was:
Medicaid work requirements. Investigators from Harvard University found that Arkansas’ requirements for adults ages 30–49 to maintain Medicaid health coverage (including working 20 hours a week, participating in “community engagement” activities, or qualifying for an exemption) led to coverage losses and were associated with increases in medical debt and decreases in affordability of care. They also found that the work requirements did not increase employment, the principle goal of the program.
State and local housing voucher protection laws. Investigators from the Urban Institute introduced a new dataset that provides a comprehensive catalogue of state and local laws that prohibit discrimination against voucher holders, detailing including key legal features that may influence their effectiveness, and introducing a new scoring system to estimate the relative strength and weaknesses of the laws based on these features. An accompanying brief shows the share of voucher holders covered by these protection laws has grown steadily in recent years to roughly half of all voucher holders nationwide.
Paid sick leave in the context of COVID-19. P4A researchers found that the emergency sick leave provision of the bipartisan Families First Coronavirus Response Act (FFCRA) helped to slow the spread of COVID-19. Relative to the pre-FFCRA period, states that gained access to paid sick leave through the provision saw around 400 fewer confirmed cases per state per day – an estimate that translates into roughly one prevented case per day per 1,300 workers who had newly gained the option to take up to two weeks of paid sick leave.
Medicaid expansion. Researchers from New York University evaluated whether increased access to health insurance under the Affordable Care Act Medicaid expansions affected ten preconception health indicators. Among low-income women associated with Medicaid expansion, researchers found significant improvements in preconception health counseling, pre-pregnancy folic acid intake, and postpartum use of effective birth control methods.
Racial disparities and the pandemic. Researchers from the Urban Institute found that Black, Native American, and Hispanic/Latinx workers were more likely than white workers to have jobs that placed them at greater risk of exposure to and transmission of the coronavirus. They also found that Black, Native American, and Hispanic/Latinx workers who must work in person and close to others have lower incomes than white workers in these jobs and are less likely to have health insurance.
Income support programs. The P4A team released a summary of our body of work examining how income supports can improve health and well-being. The research illustrates the multiple ways that minimum wage increases, the Earned Income Tax Credit, and supplemental security income improve the health of people receiving these benefits.
The year ahead
P4A has always been committed to supporting policy research that is both needed and actionable, and that reflects the best of what the field of policy research can provide. The twin pandemics of COVID-19 and systemic racism, especially anti-Black racism, make our work and similar policy research all the more urgent. And P4A’s ongoing commitment to expanding and diversifying who, where, and what we fund can only strengthen the quality, relevance, and impact of the research we sponsor. Later this year we will be launching our redesigned website to make it more accessible, and we are especially excited by the cohort of studies looking at policies to advance racial equity and racial justice that will start this summer. We are committed to developing all future calls for proposals with racial equity and justice in mind. The nation deserves nothing less.