Unsanitized and Unfair: How COVID-19 Bailout Funds Refuel Inequity in the U.S. Health Care System.

Grogan, Colleen M; Gusmano, Michael K; Lin, Yu-An

CONTEXT The CARES Act of 2020 allocated provider relief funds to hospitals and other providers. We investigate whether these funds were distributed in a way that responded fairly to COVID-19-related medical and financial need. The U.S. health care system is bifurcated into the "haves" and "have nots." The health care safety net hospitals, which were already financially weak, cared for the bulk of COVID-19 cases. In contrast, the "have" hospitals suffered financially because their most profitable procedures are elective and were postponed during the COVID-19 outbreak. METHODS To obtain relief fund data for each hospital in the U.S., we start with data from HHS posted on the CDC website. We use RAND Hospital Data to analyze how fund distributions are associated with hospital characteristics. FINDINGS Our analysis reveals that the "have" hospitals with the most days of cash on hand received more funding per bed than hospitals with fewer than 50 days of cash on hand (the "have nots"). CONCLUSIONS Despite extreme racial inequities, which COVID-19 exposed early on in the pandemic, the federal government rewards those hospitals that cater to the most privileged in the U.S., leaving hospitals that predominantly serve low-income people of color with less.