Public Support for Social Safety-Net Policies for COVID-19 in the United States, April 2020

Abstract

Objectives. To examine public support for health insurance, income support, and unemployment policies during the initial phase of disease transmission and economic distress following the coronavirus disease 2019 (COVID-19) outbreak and to assess varying public support based on beliefs about the role of government.

Methods. We fielded a nationally representative survey of US adults (n = 1468) from April 7, 2020, to April 13, 2020.

Results. Of US adults, 77% supported paid sick leave, and a majority also supported universal health insurance, an increased minimum wage, and various unemployment support policies. Public support for an active government role in society to improve citizens’ lives increased by 10 percentage points during this initial pandemic response relative to September 2019. Belief in a strong governmental role in society was associated with greater support for social safety-net policies.

Conclusions. During the initial phase of the COVID-19 pandemic in early April 2020, most US adults favored a range of safety-net policies to ameliorate its negative health and economic consequences. For most safety-net policies, public support was highest among those favoring a stronger governmental role in society.

The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed major vulnerabilities in the US social safety net. In the initial 4 weeks following the coronavirus outbreak, an unprecedented 22 million individuals filed for unemployment benefits,¹ and of these individuals, an estimated 9.2 million lost their employer-based health insurance.² The US Congress moved rapidly to pass the Families First Coronavirus Response Act on March 18, 2020, including paid sick days and leave benefits.³ We conducted a national survey of US adults in early April 2020 to assess public support for a range of safety-net policies in the initial phase of the pandemic.

METHODS

We fielded the COVID-19 Civic Life and Public Health Survey between April 7, 2020, and April 13, 2020. This national opinion study was administered via the National Opinion Research Center’s probability-based AmeriSpeak Panel, which is designed to be representative of the US adult population. The panel is sourced from National Opinion Research Center’s area probability sample and from a US Postal Service address-based sample covering 97% of US households. Surveys were administered online, and panel respondents were encouraged to participate via cash awards. The final sample included 1468 adults aged 18 years or older (Appendix A, available as a supplement to the online version of this article at http://www.ajph.org), and the completion rate was 70.4%.

Respondents were asked about their support for 11 safety-net policies (Appendix B, available as a supplement to the online version of this article at http://www.ajph.org). Health-related policies included 2-week paid sick leave, universal health insurance, single-payer health insurance, publicly funded paid sick leave, and publicly funded paid leave to care for a sick family member. Income support polices included an increase in the federal minimum wage to $15 per hour and universal basic income of $1000 per month for adults aged 18 years or older. Unemployment policies included expanded unemployment benefits, tax credits for businesses to retain and hire workers, public spending on construction projects such as building roads and highways, and employment education and training to help people change careers.

Respondents also were asked, “Where would you rate yourself on a scale of 1 to 5, where 1 means you think the government should do only those things necessary to provide the most basic government functions, and 5 means you think the government should take active steps in every area it can to try and improve the lives of its citizens?” We compared responses to this same question asked with identical wording in a Gallup survey⁴ conducted in September 2019 (n = 1527).

Finally, we compared support for each safety-net policy among those favoring a strong role with those favoring a weak role for government, as well as among those in the areas hardest hit with those in the areas least hard hit by the pandemic in its initial phase, by examining the 15 US states with the highest and lowest case-fatality rates during survey data collection in early April 2020.⁵ The 15 US states with the highest case-fatality rates on April 11, 2020, a midpoint in our survey data collection, were New York, New Jersey, Louisiana, Michigan, Connecticut, Massachusetts, Washington, Illinois, Indiana, Colorado, Rhode Island, Pennsylvania, Georgia, Nevada, and Vermont (n = 542). The 15 states with the lowest case-fatality rates were Idaho, Maine, Texas, North Carolina, Arkansas, New Mexico, Utah, Nebraska, Hawaii, North Dakota, South Dakota, Montana, Alaska, West Virginia, and Wyoming (n = 198). State case-fatality rates came from the New York Times virus tracker.⁵

RESULTS

In early April 2020, during the initial phase of the COVID-19 pandemic, most US adults supported 7 of the 11 social safety-net policies. Of the health-related policies, 77% of adults supported employer-guaranteed 2-week paid sick leave, and 60% supported universal health insurance. There was less support for single-payer health insurance (47%), publicly funded paid sick leave (39%), and publicly funded paid leave to care for a sick family member (47%). Among the income support policies, a majority supported an increased federal minimum wage (58%), but fewer supported universal basic income (39%). All of the unemployment policies had majority support, including expanding unemployment insurance benefits (52%), tax credits for businesses to retain and hire workers (66%), employment education and training programs (68%), and public spending on construction projects (71%).

When asked to gauge the role of government in society, 34% of the respondents favored the government taking “active steps in every area it can” relative to only 24% of the respondents in the 2019 pre-COVID-19 Gallup survey⁴ that used identical question wording.

Across all but 2 social policies, support was higher among those favoring a stronger governmental role in society relative to those favoring a weaker governmental role (Figure 1). For 2 unemployment policies—tax credits to businesses and public spending on construction projects—support was equally high for both. Other than these 2 policies, differences in support based on beliefs about the appropriate role of government persisted even in analyses including measures of political party affiliation (results not shown). We did not identify significant differences in support when comparing those living in states with the highest and the lowest case-fatality rates in early April 2020 (results not shown).

FIGURE 1—

Public Support for Health Insurance, Income Support, and Unemployment Policies: United States, Civic Life and Public Health Survey Wave 1, April 7–13, 2020

Note. The sample size was n = 1468. Percentages were calculated based on the sample of individuals who responded to the question about the role of government in society. The missing data rate for each question was < 2%. Policy support question responses on a 5-point Likert scale collapsed, so “strongly favor” and “somewhat favor” were coded as supporting the specific policy. Belief in a strong role for government was coded based on responding to the following question with a 5 or 4: “Where would you rate yourself on a scale of 1 to 5, where 1 means you think the government should do only those things necessary to provide the most basic government functions, and 5 means you think the government should take active steps in every area it can to try and improve the lives of its citizens?” Belief in a weak role for government was coded as 3, 2, or 1.

P ≤ .01; statistically significant difference between respondents endorsing a strong vs weak role for government.

DISCUSSION

National survey data indicated that most US adults supported various social safety-net policies during the initial phase of the COVID-19 pandemic in early April 2020. Public support was highest for guaranteed 2-week paid sick leave for all workers. Support for an active governmental role in society to improve citizens’ lives increased by 10 percentage points in the era of COVID-19 in April 2020 relative to 2019, and support for most policies was higher among those endorsing a strong governmental role in society. If public embrace of a strong governmental role continues to tick up as the pandemic progresses, it could lead to higher support for policies to bolster the safety net.

Some of the policies we examined have been the focus of an initial set of laws enacted by Congress to respond to the pandemic. The Families First Coronavirus Response Act passed in March 2020 included federally funded paid sick days and up to 12 weeks of paid leave to care for children, provisions that will end in December 2020.³ Some of the most important groups left out of the Families First Coronavirus Response Act included health care providers and emergency responders, companies with at least 500 employees, and small businesses with 50 or fewer employees who seek a federal exemption.³ Although the law covers 12 weeks of paid leave to care for children, it is limited to 10 sick days for an employee who falls sick or who needs to care for a parent or spouse sickened by COVID-19. To support worker retention, the Coronavirus Aid, Relief, and Economic Security (CARES) Act included a tax credit of up to 50% of wages, with certain restrictions, for the period of March 12, 2020, through January 1, 2021. Employers are eligible to receive the tax credit if they suspended operations or experienced a drastic reduction in revenue because of COVID-19.⁶ In addition, the CARES Act had increased unemployment benefits by an extra $600 per week to workers affected by the pandemic. However, this provision expired on July 31, 2020, and expanded eligibility to self-employed individuals and others will expire at the end of 2020; efforts by the US Congress to extend these expanded unemployment benefits have stalled.

A limitation of this study is that most survey questions were not directly comparable to the period before the pandemic because of different question wording or sampling approaches in previous surveys. When comparisons were possible, they did not imply major increases in support for safety-net policies. For example, in 2010, the National Opinion Research Center and the Public Welfare Foundation partnered to study public support for paid sick leave. They used slightly different question wording and found that 75% of the respondents supported a 2-week paid sick leave policy, a support level nearly identical to that in this survey. As the negative consequences of the pandemic stretch over months or even years, it will be important to track shifts in public support for safety-net policies. Second, survey items did not include a “don’t know” option. We expected that most respondents would have a basic familiarity with the policies surveyed, and experimental research by Krosnick et al.⁷ suggested that the quality of attitude reports was not compromised by the omission of no-opinion options.

PUBLIC HEALTH IMPLICATIONS

As American society moves into a more extended phase of the pandemic, our social safety net will be under increased strain. A defining feature of the US health care system is its strong ties to employment; approximately half of US adults purchase health insurance through their employer.⁸ As unemployment rates soar, many US adults have experienced the dual blows of job loss and health insurance loss. As the rapidly escalating economic crisis requires additional governmental responses, ongoing tracking of public opinion on policy can provide some direction for policymakers.