BACKGROUND

The Coronavirus Aid, Relief, and Economic Security (CARES) Act provided a $600/week supplement to unemployment benefits which expired July 31. Its extension is controversial. We examined health and social vulnerabilities among those receiving unemployment benefits during the COVID-19 outbreak to inform debate on the consequences of allowing the supplement to lapse.

METHODS

We analyzed the COVID Impact Survey, sponsored by the Federal Reserve Bank of Minneapolis and foundations.1 Surveyors contacted a nationally representative random sample of US households by mail, email, telephone, and field interviews2 between April 20, 2020, and June 8, 2020. We assessed adults 18–64 receiving (or applying for) unemployment benefits during the past week and those reporting working in the past week.

We first analyzed demographic characteristics and three categories of socio-medical vulnerabilities: food insecurity; lacking health insurance; and financial precarity (being unable to cover an unexpected $400 expense without selling possessions or going into debt).

Finally, to assess possible health risks resulting from unemployment beneficiaries’ prematurely returning to work, we examined self-reported health; rates of seven clinical risk factors for severe COVID-193; and the point prevalence of three major COVID-19 symptoms (fever/chills, cough, and dyspnea).

We used STATA/SE and weights provided by COVID Impact.

RESULTS

A total of 643 (weighted n = 26.9 million) of the 3480 non-elderly adults in our sample were unemployment beneficiaries; they were younger, poorer, less educated, and more often people of color than those at-work (Table 1).

Table 1 Characteristics of US Adults 18–64 Years of Age Receiving or Applying for Unemployment Insurance and Those Working, April–June 2020 (n = 3480)
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Table 2 displays measures of socio-medical vulnerability for the two groups. Beneficiaries were more likely to report running out of food because they lacked money (39.0% vs. 17.0%, p < 0.001), or using a food pantry (17.3% vs. 5.1%, p < 0.001) in the past month; being uninsured (20.5% vs. 9.2%, p < 0.001); and being unable to afford an unexpected $400 expense (59.6% vs. 38.2%, p < 0.001). However, a larger absolute number of at-work individuals were vulnerable because many more adults were at-work. For instance, 26.0 million of those at-work reported problems affording food, versus 13.4 million unemployment beneficiaries.

Table 2 Measures of Sociomedical Vulnerability and Health Among US Adults 18–64 Years of Age Receiving or Applying for Unemployment Insurance and Those Working, April–June 2020
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In total, 3.7% of unemployment beneficiaries had all three potential COVID-19 symptoms, versus 1.9% of those at-work (p = 0.057); unemployment beneficiaries were more likely to report fair/poor health (14.2% vs. 9.3%; p = 0.010), heart disease (4.7% vs. 2.3%; p = 0.034), and immunocompromise (8.2% vs. 4.6%; p = 0.020), but not other conditions. A total of 9.9 million unemployment beneficiaries had chronic conditions associated with increased risk of severe COVID-19.

DISCUSSION

Despite the $600/week supplement available to unemployment beneficiaries at the time of the survey,4 many experienced financial precarity, and two factors were believed to compromise clinical outcomes: food insecurity and lack of health insurance. Although rates of these vulnerabilities were lower among those at-work, the absolute numbers affected were larger.

While critics of the supplementary unemployment benefits have argued that it disincentivized work,1 a recent study cast doubt on that contention.5 Even if jobs were available, in the context of ongoing community spread of SARS-CoV-2, forcing individuals back into the workplace under threat of impoverishment may place them, their co-workers, and the community at risk, since nearly 10 million unemployment beneficiaries have chronic conditions, and about one million had a triad of symptoms consistent with respiratory infection.

Our study is limited by the low survey response rate, which could reduce generalizability; however, the number of unemployment beneficiaries identified corresponds to official estimates from the Department of Labor.6 Additionally, symptom data was self-reported, without confirmation by SARS-Cov-2 testing or clinical assessment. Because the triad of COVID-19 symptoms is non-specific, those reporting them may have other illnesses. Our data was cross-sectional, and cannot be used to draw causal inferences about the specific impact of any particular policy, including the $600 supplement. A notable strength of the study, however, is our use of timely, nationally representative data, including on medical conditions and specific symptoms, which, to our knowledge, is not available from any other source.

The economic and medical repercussions of the COVID-19 crisis are interconnected. The supplemental unemployment benefits provided a safety net for the US economy and population well-being. The lapse of the $600/week CARES supplement could inflict further medical and financial harm on millions of American households. Additional policies, however, are needed to strengthen the social safety net during the pandemic and beyond, both for the unemployed and for those at-work.