Health and Social Precarity Among Americans Receiving Unemployment Benefits During the COVID-19 Outbreak
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J Gen Intern Med DOI: 10.1007/s11606-020-06207-0 © Society of General Internal Medicine 2020
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.
Received August 12, 2020 Accepted August 31, 2020
RESULTS
A total of 643 (weighted n = 26.9 million) of the 3480 nonelderly 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 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 atwork reported problems affording food, versus 13.4 million unemployment beneficiaries.
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)
Age 18–24 25–34 35–44 45–54 55–64 Gender Male Female Race White Black Hispanic Other Income Less than $30,000 $30k to less than $60k $60k to less than $125k More than $125k Education No high school diploma High school graduate or equivalent Some college Bachelor of Arts or above
Working (%) (n = 2837)
Unemployment insurance beneficiaries (%) (n = 643)
11.43 26.11 21.95 20.34 20.17
19.58 26.54 22.40 19.37 12.11
53.1 46.90
51.01 48.99
63.59 10.84 15.75 9.82
52.18
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