Expert Commentary

Tracking coronavirus policies by state: Q and A with health policy expert Julia Raifman

State policy responses to the coronavirus pandemic number in the hundreds and vary widely in their details. Boston University's Julia Raifman is keeping track of them all.

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State policy responses to the coronavirus pandemic number in the hundreds and vary widely in their details. Some states have imposed many restrictions on restaurants, bars, churches, gun stores and other places people spend money and gather. Other states have ordered few restrictions — in some states, none at all. Across the U.S. in recent months, state economies have closed, opened and then re-closed as coronavirus cases have spiked. All of that can be a lot to track for journalists, researchers and state residents.

That’s where Julia Raifman, an assistant professor of health law and policy at Boston University, comes in. Raifman and a phalanx of volunteer graduate students began documenting state-level pandemic response policies in March, when the nation first experienced wide-scale economic shutdowns due to the coronavirus.

Since then, they have documented roughly 100 types of policies across every state and the District of Columbia, along with original sources for each policy. Raifman and her team focus on state-wide executive orders or directives, not guidance, recommendations or proposals. They track policies on face masks, medical procedures, the operation of bars and restaurants, evictions, unemployment benefits and more.

It’s not the only project capturing how states are responding to the pandemic. For example, Documenting COVID-19 at The Brown Institute for Media Innovation is a repository of state-level documents and official communications obtained through public records requests. The National Conference of State Legislatures tracks pending and passed coronavirus-related legislation by state across a range of issues, and the Kaiser Family Foundation tallies a variety of health-related pandemic policies by state.

Beyond the source documentation, what makes Raifman’s COVID-19 U.S. State Policy Database — CUSP — particularly useful for journalists on deadline is that it’s a quick way to find out when a state policy started, ended and possibly re-started. I called Raifman last week to chat more about how journalists and researchers can use the CUSP database, and her observations of the U.S. policy response to the coronavirus.

“There is a ton of coverage of closing and reopening and reclosing policies,” Raifman says. “I’ve noticed a lot less coverage of state policies pertaining to some of the other important topics we’ve tracked, like unemployment insurance and evictions. As most of the COVID response is being left to the states, I think there is a lot more room to cover state policies.”

Learn more about the CUSP database from our conversation, which has been lightly edited for clarity.

Clark Merrefield: For journalists and researchers new to CUSP, how would you recommend they start diving in and what should they look for?

Julia Raifman

Julia Raifman: Certainly evictions and unemployment insurance programs are going to take on increased significance in the coming months as federal programs end.

One thing that’s surprised me is how much the unemployment insurance programs vary both in terms of the proportion of people who receive unemployment insurance and the eligibility policies in our spreadsheet. I haven’t seen anyone make that link between the proportion of people benefitting and the amount people are receiving. It varies from $240 maximum per week in Arizona to more than $800 in Massachusetts. That makes a difference as to whether it’s enough for people to live off of or not. Similarly, the duration of unemployment insurance varies from a low of 12 weeks in Florida to 26 weeks in most states.

If I were to point people to an underexplored area, it would be the unemployment insurance policies and the housing and food security policies. I think those are really important topics. One big question for journalists and researchers to investigate is, how do hurdles to unemployment insurance affect disparities and exacerbate existing disparities? In the housing category in our database, we also track policies related to utilities. We’re about to add more detail on specific utility freezes. I’ve been surprised at the number of states that haven’t put in place a formal utility shutoff freeze. (Editor’s note: 17 states have not enacted utility freezes during the pandemic, according to the CUSP database.)

I started this with my research fellow Kristen Nocka and we learned that students were interested in contributing in some way to the COVID response. My colleague David Jones emailed students in our department and we heard back from 30 people. They’re the ones who really built this database, led by Kristen. They built it overnight. Kristen set up the organization and quality-control process and from there, the database has grown to have about 100 types of policies at this point.

Merrefield: How often is the database updated and how do you do it? Do you scrape state government websites or is it a manual process?

Raifman: Something interesting during the pandemic is that there has been no one place where each state has stored all of their COVID policy information. We have ended up looking around state websites.

One feature of our project that is important is that we provide the source documentation, and we try to source it back to official government websites. We’ve had to look at not just executive orders but department of labor websites and public health departments. There are a range of places where we are finding information. We realize it is really important to be doing this in real time because sometimes information changes. We’re still formalizing updates, but we plan to update policies at the forefront of the COVID and social safety net responses. We plan to update those weekly. Some other types of policies we plan to update monthly. Like substance use disorder or alcohol policies — there were a lot of changes in those in the beginning but not recently.

Our process is to look through government webpages and identify executive orders. If we don’t find anything on government websites, we search for media coverage. For each of these things, we have double data entries. So we have two student volunteers do the data for each state, for each policy. If we can, we try to compare to other policy trackers out there. Others may use different definitions — like, what does it mean to close a bar? Are you closing all the bars or some of the bars, or some combination of indoor dining and outdoor dining? So we try to have a precise definition, which we provide in detail from our GitHub, which is linked on the Google sheet.

Then we have a third person review all of the data that the team entered, because it’s hard to confirm the absence of a policy change. Then we post it online, and we welcome feedback on discrepancies and comments on coding decisions. Most of the time when we receive comments, it’s about definitions. And if somebody wants to look at a specific aspect of outdoor dining that we haven’t checked, they can use the source documentation to track that element themselves.

Merrefield: You mentioned you use media coverage to help populate the database. Anything stand out in the media coverage of these state COVID policies?

Raifman: Mostly, we use media coverage to identify policies we may have missed. Sometimes, we will find that something happened because a governor said it in a press conference. And there’s not a transcript of the press conference, so the only way to find out about it is through the media.

There is a ton of coverage of closing and reopening and reclosing policies. I’ve noticed a lot less coverage of state policies pertaining to some of the other important topics we’ve tracked, like unemployment insurance and evictions. As most of the COVID response is being left to the states, I think there is a lot more room to cover state policies.

Merrefield: I realize you maybe haven’t had time to do this level of analysis, but are there any trends, even anecdotally, that you’ve noticed in the course of collecting these policy responses?

Raifman: The thing that stands out most is that it’s surprising more states aren’t putting in place eviction freezes and preventing utility shutoffs. It’s to everybody’s detriment that people were working hard in February then lost their jobs through no fault of their own because of the pandemic. The unemployment numbers don’t capture to what extent low-income people have been affected. The [Federal Reserve] has a report indicating 39% of people in households making less than $40,000 a year who were working in February are no longer working. That’s a lot of people who were working hard to support themselves and support their family household members who now face housing insecurity and food insecurity.

We won’t necessarily have data on this for a couple of years, but I’ve seen data on mental health and suicidality and I think the risk of suicide is real. People who feel they have nowhere to go and no end in sight, I really worry about that. Some recent research on mental health found low-income people are particularly affected by mental health harms. It’s hard for researchers to ask questions about suicidality because sometimes they won’t be approved by an institutional review board to ask those questions without having processes in place to support people who say they are suicidal. That’s important for protecting research participants and supporting those who need support. It also makes it hard to know how bad things are for people if we can’t collect those data.

Merrefield: Do you plan on doing any mapping or data visualization with the information you’ve collected?

Raifman: We’re in the next stages of planning right now. A lot of the next steps will be: better communication, starting social media accounts, starting to share some maps and starting to get the information to journalists — getting an email list going so we can let people know when we make updates.

Merrefield: You’re a health policy expert. If you could take a step back from the policy weeds for a moment, which I realize is a difficult ask, what are your observations about the policy response in the U.S. to the pandemic?

Raifman: I think there is a really important role for coordination, and sometimes having federal policies in place. Things like a federal eviction freeze, a federal freeze on utility shutoffs and policies like the federal expansion of unemployment insurance. Those are really important to affect a lot of people at once and the federal government can mobilize more resources than states can. Only the federal government can expand unemployment insurance in the way they did.

The ongoing policy discussions are really important. There’s a lot of variation in state policies and we hope states can learn from each other and how their different approaches are affecting COVID. But I think there is a really important role for federal policy. As we’re seeing increasing evidence that face masks and limiting time in indoor spaces are really important for limiting transmission of COVID, those are areas where the federal government could be impactful. High-level polices at the federal or state level shape what happens in a workplace. I have heard workplaces say, “Well, this is what the state says is the minimum number of people in elevators so that’s what we’re doing.” There are so many people involved in the response. But what happens at the highest level is really important in terms of preserving health and well-being.

We want this database to be a resource for the media and the public and researchers, so we’re really excited by users contacting us and letting us know about ideas of policies to add and ways we can make the policy database better. Several users have helped us improve our policy labels and some of our processes. We want the data to be used to inform states and policy decisions to improve health and well-being at a time when things are really hard for everybody.

Putting together the database has made me realize we should have had this the whole time, for a range of topics. A lot of the challenge of doing research on social policy is tracking down when policies changed, and tracking outcomes before and after. And we’re capturing the COVID response policies now. But I think there’s a role to track a wide range of social policies.

Check out the rest of our coronavirus coverage.

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