The 99-page report makes numerous recommendations related to the immediate COVID recovery, from promoting vaccine equity to budgeting federal recovery money with an eye toward equity. But it also branches out into the “social determinants of health,” including such factors as housing and food access that contribute to a person’s health. The report said these factors account for 80 percent of a person’s health status, with access to health care making up only 20 percent.
“The disparities in COVID-19 morbidity and mortality are the direct result of long-standing inequities in access to opportunities and resources for Black, LatinX, and diverse communities of color,” the report’s introduction states. “These inequities have manifested through racist policies such as those that banned Black people from owning property and limited educational, social, political, and economic opportunities. The stress of living with systemic racism has a dramatic and measurable impact on health and longevity, contributing to higher rates of disease.”
The focus on policies not directly related to health raised some concerns among Republican appointees. Of 15 committee members, three voted against the final report, including Hirak Shah, Senate Minority Leader Bruce Tarr’s legal counsel; Beverly Stables, House Minority Leader Brad Jones’s health care policy analyst; and Rep. Donald Wong, a Saugus Republican who chairs the Asian-American legislative caucus. Shah, in an interview, said he felt some recommendations were going beyond the commission’s charge – particularly recommendations that lawmakers allow drivers’ licenses for undocumented immigrants and limit the role of state and local police in enforcing federal immigration law. The recommendations were made to make immigrants feel more comfortable seeking medical attention,.
“Overall, I thought that a lot of the stuff in the report was good, but with these items I felt like it was going over the charge of the task force,” Shah said.
Stables voiced similar sentiments in an email. “The final report contains some sweeping policy recommendations that go far beyond the purview of the task force’s charge to address health disparities,” she said. “While I strongly support the vast majority of the recommendations the task force has put forth, the inclusion of language effectively endorsing the Safe Communities Act and the Work and Family Mobility Act prevented me from endorsing the final report in its entirety.”
Wong was asked during the public meeting why he voted against the report but declined to give a reason and said he would explain his vote to committee members privately.
Task force co-chair Dr. Assaad Sayeh, CEO of Cambridge Health Alliance, acknowledged the disagreement. But, he said, “There are no perfect reports out there. If our goal is to wait for the perfect, we’d be doing this indefinitely, and we cannot let the perfect be the enemy of the good.”
Some recommendations relate directly to COVID-19. The task force is suggesting an “after-action review” of the state’s response to the virus with an eye toward equity, to evaluate what worked well and what can be improved.
As vaccinations continue, the report recommends putting more money toward vaccine initiatives in hard-hit communities, like mobile and local clinics and education campaigns; continuing developing ways to vaccinate seniors and people with disabilities; and funding research on the long-term impacts of COVID-19.
Many recommendations are far broader. The report envisions creating a cabinet-level position of Secretary of Equity, with equity-focused offices throughout state government. It says more data collection is necessary on race and ethnicity, and it recommends that all policies be analyzed with an eye toward equity. With Massachusetts seeing an influx of billions of dollars in funding from the American Rescue Plan, the report recommends distributing that money with an eye toward equity.
There are recommendations regarding almost every aspect of health care. Among them: The report suggests lawmakers enhance insurance reimbursement rates for safety net hospitals; continue to promote telehealth; support workforce training initiatives for community health centers; build more inpatient mental health beds; increase behavioral health care reimbursements; teach police officers how to interact with people with mental illness; reactivate a commission examining licensing for foreign-trained medical professionals; train medical professionals in implicit bias; extend MassHealth coverage to more postpartum care; limit the costs MassHealth can recoup from a dead person’s estate; and strengthen local public health boards. The report backs a bill that would eliminate copays for care to manage chronic conditions.
But the recommendations go far beyond health care. Proposals include simplifying the application for food assistance, making internet access and digital devices affordable and accessible, supporting universal free school meals, giving more money to food banks, increasing cash welfare grants, expanding rental assistance, and providing legal counsel in eviction and foreclosure cases.
At a virtual meeting Thursday, committee members stressed the need to focus on implementing the plan. Former state representative Jeffrey Sanchez, a lecturer at Harvard’s TH Chan School of Public Health, said the pandemic “exposed what all of us already know… that there’s fundamental cracks in the health care system.”