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Allocation of COVID-19 Relief Funding to Disproportionately Black Counties

Educational Objective
To understand how the distribution of COVID-19 relief funds are affecting disproportionately Black counties
1 Credit CME

The Coronavirus Aid, Relief, and Economic Security (CARES) Act and Paycheck Protection Program together designated $175 billion for coronavirus disease 2019 (COVID-19) response efforts and reimbursement to health care entities for expenses or lost revenues.1

The most important factor driving funding allocation is past revenue. However, revenue is an imperfect measure of need because it is also influenced by prices, overuse, payer mix, and market consolidation.2 Moreover, non-White and indigent populations generate lower revenues, due to underinsurance and undertreatment,3,4 and hospitals caring for them may receive less relief despite confronting a greater burden of COVID-19.5

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Article Information

Corresponding Author: Ziad Obermeyer, MD, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94704 (zobermeyer@berkeley.edu).

Accepted for Publication: July 24, 2020.

Published Online: August 7, 2020. doi:10.1001/jama.2020.14978

Author Contributions: Ms Kakani and Dr Chandra had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Kakani, Chandra, Obermeyer.

Drafting of the manuscript: Kakani, Chandra, Obermeyer.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Kakani, Chandra, Obermeyer.

Administrative, technical, or material support: Chandra.

Supervision: Mullainathan, Obermeyer.

Conflict of Interest Disclosures: Dr Chandra reported serving on the Congressional Budget Office’s Panel of Health Advisors as well as serving as an advisor to SmithRx, Kyruus, and Health Engine and being an academic affiliate of Analysis Group. Dr Obermeyer reported having equity interest in Berkeley Data Ventures, a consultancy that applies machine learning to health care problems, including ways to expand testing for severe acute respiratory syndrome coronavirus 2. No other disclosures were reported.

Funding/Support: This project was supported by the National Institute on Aging grants P01-AG005842 (all authors) and T32-AG000186 (Ms Kakani).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Coronavirus Aid, Relief, and Economic Security (CARES) Act, Pub L No. 116-136.
2.
Schwartz  K , Damico  A . Distribution of CARES Act funding among providers. Kaiser Family Foundation. Published May 13, 2020. Accessed July 5, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/distribution-of-cares-act-funding-among-hospitals/
3.
Institute of Medicine.  Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.
4.
Lillie-Blanton  M , Hoffman  C .  The role of health insurance coverage in reducing racial/ethnic disparities in health care.   Health Aff (Millwood). 2005;24(2):398-408. doi:10.1377/hlthaff.24.2.398PubMedGoogle ScholarCrossref
5.
Dowling  MK , Kelly  RL .  Policy solutions for reversing the color-blind public health response to COVID-19 in the US.   JAMA. 2020;324(3):229-230. doi:10.1001/jama.2020.10531PubMedGoogle ScholarCrossref
6.
Khullar  D , Bond  AM , Schpero  WL .  COVID-19 and the financial health of US hospitals.   JAMA. 2020;323(21):2127-2128. doi:10.1001/jama.2020.6269PubMedGoogle ScholarCrossref
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