Last week, only hours before armed but frequently maskless insurrectionists invaded the U.S. Capitol, there was a spot of bright news for Covid-19 relief in Washington. Democrats Reverend Raphael Warnock and Jon Ossoff both won Senate seats in Georgia’s runoff election, creating a narrow majority across both sides of Congress for the political party interested in more aggressive spending on Covid-19 response and relief efforts.
Now, amid rolling headlines of stumbling vaccination efforts, many are understandably wondering what that could mean for fighting the pandemic. “The slim majority in the Senate actually is pretty consequential,” Dr. Jen Kates, senior vice president at the Kaiser Family Foundation, told me. “It just opens up a whole new realm of possibility for the new administration that they didn’t have before the outcome of the Georgia election.… And there were already Republicans that probably had been supportive of some additional Covid relief measures, so this might just make that path a little smoother.”
Congress will likely take up pandemic relief bills immediately, potentially addressing everything from social safety nets to health infrastructure and even the Affordable Care Act: $2,000 stimulus checks are likely at the top of that list—Warnock and Ossoff both ran on the proposal. The issue was “contentious before the election results, and now I think is really within grasp,” Kates said. Democratic members of the Senate and House have also said they want to extend the expired unemployment benefits, and lawmakers could also increase assistance to businesses and staff so they can afford to stay home, rather than remaining open and potentially exacerbating the pandemic.
Crucially, a Democrat-controlled Congress could put more funding toward key public health initiatives: rolling out the vaccine, expanding testing and contact tracing, and creating a national genomic surveillance program for the virus to track possible mutations. The massive spending bill eventually signed by President Trump in late December authorized $8.75 billion for health infrastructure like this. But “it may still not be enough,” Kates said. With that bill, a little more than half—$4.5 billion—was specifically allocated to states, local governments, tribal authorities, and territories. “Certainly the $4 billion is less than states and localities have said they needed,” Kates said. The rest went to the Centers for Disease Control and Prevention, which could potentially send some of the funds to state and local jurisdictions, as needed.
Staffing has been one of the key difficulties for states when it comes to vaccine distribution, from health workers giving shots to software engineers designing enrollment sites. “At least one county in Georgia suspended their Covid testing because they needed to divert that staff for vaccinations,” Kates said. Offering training, expanding the pool of those who could administer shots and Covid tests, and adding contract tracers will likely be another key effort. Even covering the basics, like having enough protective gear for those on the front lines of these initiatives, has been a struggle. “The fact that states and localities, up until now, have been operating pretty much on a shoestring to carry off testing, contact tracing, the most massive vaccination effort ever undertaken—it has put them behind,” Kates said, emphasizing the need for communities to be able to operate testing, tracing, and vaccination efforts at the same time.
States have also struggled to get people signed up for the vaccine, with labyrinthine online applications that exclude those without internet connections, and long lines, sometimes overnight, that could serve as superspreader events. Streamlining the signup process, reaching out to those who need help navigating it, and coming to people at nursing homes and job sites via mobile units would help in the next phase of the rollout. Training health workers to answer questions on the vaccine’s rapid development and safety and conducting public campaigns to address vaccine hesitancy will also be important, experts say. All of that would be easier with federal funding or even a nationwide, rather than state-based, system.
Protecting and expanding existing health services will also be easier in this Congress. Even with the slim majority, Democrats in Congress can take certain actions to make moot the challenges to the Affordable Care Act being heard by the Supreme Court. Most likely, they will amend the wording of the mandate, which is currently being contested in the Supreme Court, in the course of passing pandemic relief legislation, said Katie Keith, a research professor of health law at Georgetown University. “It’s a wide-open opportunity for them as long as they can get that bill through a very narrow House and Senate,” she told me. If that doesn’t work, they could make some changes through the budget reconciliation process, although that would take longer and limit what they’re able to do.
Maintaining health insurance during the pandemic is particularly important, Keith said. “We do not want people putting off care. This is the time where we want you to get tested or we want you to actually take action. Outside of this pandemic, it’s quite frequent that folks are afraid of the cost of care, that it causes them to delay care. That is exactly the opposite outcome you want during a pandemic.” Insurance not only makes people more likely to seek prompt medical attention—it also offers financial protection from the ravages of the pandemic. “The last thing you want is somebody coming out of the hospital with tens, if not hundreds, of thousands of dollars in medical bills,” Keith said.
Beyond the ACA, Congress may also expand other important health assistance, from Medicaid to the Children’s Health Insurance Program. “Everything should be on the table,” Keith said. Early in the pandemic, lawmakers expanded the federal government’s Medicaid contribution to states by 6 percent—but at least twice that amount was needed. Now that figure could double or increase even more, as people continue to lose their jobs and sources of income.
Just as previous bills have made testing and vaccinations free, Congress could make it cheaper for people to access Covid-19 treatment—even for the uninsured. Provisions like these were included in a previous bill, the Heroes Act, which didn’t make it out of the legislature. But, Kates said, “since we’ll be living with the impact of Covid for so long, the basic framework of health coverage and access will be essential.”
Prioritizing these issues will be hard. What do you put in which bill? How big or small should the bill or bills be? And “how many shots at the apple are you going to have to try to get something passed?” Keith asked. Those questions will be incredibly challenging to answer, particularly after last week’s chaos, which has also put impeachment and conviction back on the agenda.
But before Congress even takes up bills, experts say, nominations for officials to lead agencies like Health and Human Services and the U.S. Food and Drug Administration should move through the confirmation process quickly, so that leaders of those agencies can begin setting policies and taking measures to slow the virus’s spread. And the administration itself can take key actions even without Congress. Dr. Celine Gounder, a top Biden adviser on Covid-19, has said he will invoke the Defense Production Act to scale up everything from masks and ventilators to vaccine production.
Ultimately, some of the most important conversations are the broad ones, Kates said. “What does the United States do to fix what has been a broken system?” That means thinking creatively and expansively about how to prioritize health and increase preparedness going forward. Epidemiologists have been warning about upticks in these kinds of crises for years, particularly as climate change has already begun worsening our health and increasing the risks of another virus spilling over from animals to people. It may seem unthinkable now, Kates said, but “we have to be prepared for the next pandemic,” which “could be worse.”