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October 8, 2020

Health equity ideas run into wall of state budget woes

Photo | Courtesy of Commonwealth of Massachusetts Massachusetts State House

A panel of public health experts and elected officials is poised to recommend sweeping legislative action to address the COVID-19 pandemic's disproportionate impacts across demographic groups, but their ideas could be clouded by the state's shaky economic footing.

On the same day that the state Department of Revenue projected tax revenues this fiscal year could drop well below collection levels last fiscal year, some members of a legislative task force cautioned that the long list of policy suggestions in its draft report may not all be affordable.

Jeffrey Sanchez, an advisor at Rasky Partners who previously served as chair of the House Ways and Means Committee, urged the task force to make clear which ideas are most achievable when it publishes its report next week, even as he praised its work to identify crucial inequities.

"This end of the year, $700 million in the hole, up to $4 billion going into next year -- so there's not going to be that much money," Sanchez said. "Where's the opportunity to highlight, right now, for Oct. 14, what can we do? From Oct. 14 to the end of the year going into the new year, what can we do?"

The Health Equity Task Force, which the Legislature created under a bill Gov. Charlie Baker signed in June to address disparate health outcomes for underserved or underrepresented populations, plans to file an interim report next week proposing ways to address health inequities.

Throughout the pandemic, infection rates have been significantly higher in communities of color, many of which are in densely populated cities. Older residents have also been far more likely to face death or other serious consequences from the highly infectious virus.

The panel's draft report was not available Wednesday, but a slideshow during its virtual meeting listed nearly two dozen points as priorities that could be achieved through the fiscal year 2021 budget or other legislation.

Among their suggestions, the task force plans to recommend enacting emergency paid sick leave legislation to help any employees not covered by a similar COVID-era federal program, reducing prison populations to limit COVID-19 spread, ensuring state pandemic response resources are available in multiple languages, and continuing funding for "isolation hotels."

Their list also includes language keeping an eviction and foreclosure moratorium, which is currently set to expire on Oct. 17, in place until officials can implement a plan to prevent large-scale housing removals and displacement amid the pandemic.

Specific details about each proposal, including costs, were not immediately available, though the sick leave proposal is based on existing legislation that would allocate $55 million into a pool to start the program.

Several lawmakers including Rep. Russell Holmes asked the task force to develop cost estimates, prompting others to argue that legislators are better equipped to determine fiscal impacts.

Holmes urged medical experts to refine the report both to outline the highest-impact suggestions regardless of price and also to look for "low-hanging fruit that doesn't cost as much."

"I like to deliver stuff. That's what I like to do. I don't like to make promises on all these big things and what I might be able to do in the future," Holmes said. "I need to deliver something. I'm not asking you to go and do my job, I'm just asking you -- it would be nice if you could say, 'hey, here is a lot of bang for the dollar.' That's all I'm asking. If I could have one, two, three of those things, that'd be helpful, and then if people want to go fight for the $100 million things, let them go fight for that stuff."

Massachusetts likely faces a decline in revenue fiscal year 2021, with experts predicting collections might equal fiscal 2020 collections but could fall as much as $3 billion below collections last fiscal year.

The forecast points to the likelihood of difficult debates over how to cut spending or find new revenues.

Sen. Sonia Chang-Diaz pushed back on Holmes earlier in the hearing, noting that "crisp, specific asks" are helpful but warning against the task force limiting its scope based on state finances.

"The charge to this task force is not for the public health experts here to tell us what we can afford as a state. The Legislature stood up this task force in order to get public health advice from public health experts about what it will take to close these disparities," Chang-Diaz said. "The Legislature will have to make those difficult decisions. That's our constitutional obligation. But we look to this task force for public health advice, not fiscal advice."

"It's true that the Legislature does not have the money, but to say that the commonwealth of Massachusetts ain't got no money right now is factually incorrect," Chang-Diaz added. "There's a lot of money in Massachusetts. It's not in the tax coffers of the state, and that also is a fiscal policy question that the Legislature is going to have to grapple with, but we have to remember to look at the biggest version of the picture here."

Over the next week, members will refine a draft version of the interim report, which co-chair and Massachusetts League of Community Health Centers Legislative Affairs Director Michael Curry said will focus on "most urgent" issues.

A second and final report will be published several months later with more comprehensive, longer-term suggestions.

"All the priorities on that list are absolutely important," said Dr. Assaad Sayah, CEO of the Cambridge Health Alliance and the panel's other co-chair. "Our goal at this stage is: we have an opportunity, and we need to maximize this opportunity with items that are very important and items that are highest likelihood to be funded."

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