新冠肺炎从四个方面暴露了美国社会安全网的缺口.

这个观点最初是 appeared in The Conversation. 

观点文章是由保护海港协会的成员从不同的角度撰写的。 所表达的观点仅代表作者的观点，并不代表波士顿大学或公共卫生学院的观点。 We aspire to a culture where all can express views in a context of civility and respect. Our guidance on the values that guide our commitment can be found at 重新审视自由和包容的学术言论原则.

The United States is experiencing its 最急剧的经济下滑 in modern history. Tens of millions of Americans 是否提交了新的失业申请 as the 冠状病毒 shutters businesses and forces companies to lay off staff.

People need support to help them through the crisis in a few key ways —现金以应付即时的财务需要, health care to cover them should they become ill and housing even if they can’t make rent. Despite federal stimulus efforts north of 2万亿美元——到目前为止—it is likely that some of those currently being affected will 从裂缝中跌落.

As scholars who study how 人们参加公共项目 and research 与妇女健康有关的社会项目, we have seen how well-intentioned policies can sometimes fail those they are supposed to help.

We took a deeper look at how difficult it might be for people to navigate their way through the US’s patchwork of social safety net measures as they try to stay afloat during the pandemic and economic downturn. 以下是我们发现的四个差距：

1. 延误，财政援助豁免

Congress passed stimulus measures that are providing some Americans with a 一次性的检查 of up to $1,200 per adult and $500 per dependent child along with a 临时增加 in unemployment benefits. Many received their stimulus through direct deposit, but millions of low-income Americans experienced 问题和延误 receiving payment. As many as 20 million may have had stimulus deposits go to tax preparers who take a fee out of refunds because clients are 太穷了，无法预先支付税务准备. There are a variety of 其他原因 for delays: if individuals haven’t filed their 2019 tax returns yet, if their address has changed recently or if they 没有银行账户.

并非所有人都能从刺激措施中受益。 17岁以上的年轻人，可以被称为受抚养人 will not receive checks, nor will people who jointly filed their taxes with 非公民的移民配偶, even if they are here legally.

Workers in 超过一半的州 will receive, on average, more in unemployment benefits than their normal salaries. But there are challenges to receiving unemployment benefits too, as the rules 各州不同 and labor agencies are 忙着申请失业救济. 还有最低收入的门槛，以及领取失业救济金的时间限制。

2. 免费检测但昂贵治疗？

Congress mandated that private insurance cover 免费测试, but not treatment. 感染了吗? 准备好你的免赔额。 Many will count on Medicaid, which typically covers medical bills retroactively for three months prior to application if you were eligible, but people in states that have broad 对追溯保险的限制 could be left holding the bag. And anyone in the process of getting their 医疗补助计划续保 might be concerned, to say nothing of the nearly 30 million Americans uninsured before the crisis.

A 1000亿美元基金 will help hospitals cover the cost of treating uninsured people affected by COVID-19. But the 关心行为 was unspecific about 多快，到什么地方 the funds will be distributed, and 他们可以用来做什么. That needs to be figured out quickly, as 治疗费用 may be as high as $40,000 per patient.

这些资金甚至都没有用于那些需要持续护理的长期并发症患者。

3. 失业和无保险

失去工作和医疗保险被认为是通过HealthCare.gov或以州为基础的市场注册医疗保险的合格事件，但前提是人们知道他们可以。 The Trump administration has 避免 any broad reopening of enrollment, but 好几个州 have done so. Laid-off employees may have the option of extending their former employer’s health insurance through 眼镜蛇, but this tends to be more expensive and unsustainable.

Two recent studies project that 近2000万美国人 may face disruptions in employer-based health insurance, with as many as 1100万人失去保险. For those newly uninsured, living in a 医疗补助扩张州 like New York or California might mean you are OK. But even before the pandemic, there were already an estimated 2.3 million people living in nonexpansion states like Texas or Florida who fell into the 覆盖缺口—making too much money to qualify for Medicaid and yet not enough to afford coverage.

4. 不会被驱逐，但能坚持多久呢？

呆在家里的命令被视为减缓传播的关键，但它依赖于一个错误的假设，即每个人都能获得安全和稳定的住房。 Some people looking for affordable housing placements in March and April found themselves in limbo, with 文书工作的进展 suddenly stalled. For those with housing, unpaid rent was 上涨50% in April over March. Many large cities and states have temporarily 停止驱逐 and a federal eviction ban covers about a 四分之一出租房屋. 但这只是针对不付款的情况，给房东留下了一个漏洞，他们可以继续以其他原因驱逐房主。 And that one-time stimulus check won’t even cover the 月租金中位数 in a number of states, especially in parts of California and the New York City metro area. 那么，当支票花完了，驱逐令解除后会发生什么呢？

一个解决方案

如果这些安全网项目能更好地整合起来呢？ 想象一下，如果申请失业会触发下一步——要么通过HealthCare.gov提供一系列补贴医疗计划选择，要么让那些符合医疗补助计划条件的人自动注册。 这将有可能减轻行政负担并解决信息方面的差距。 States could use a mechanism like 快速通道资格, which allows officials to use information provided from one state agency to make eligibility determinations for Medicaid, though there are 很好的理由—mostly solvable—why many states haven’t yet.

The US’s social safety net is more a loose patchwork unprepared to handle a crisis like the pandemic, relying on disconnected public programs and 旧的技术. 联邦政府正在依赖针对受危机影响的人的短期措施，但我们认为，这对于解决那些已经处于经济弱势地位的人以及那些在这场大流行之后将长期处于经济弱势地位的人的困境几乎没有作用。

备灾不再仅仅是国民警卫队、个人防护装备和瓶装水。 这次大流行表明，它现在也是一种能力，使人们能够在可能长期和突然的金融危机中保持经济上的生存。

保罗·沙佛 卫生法律、政策与管理助理教授。 塞西尔·琼·阿维拉 是卫生法、政策和管理方面的政策分析师。