COVID-19 and state budgets: How do kidney patients factor in?

With some states beginning to reopen after COVID-19 shutdowns, legislators returning to statehouses will likely face difficult questions about their budgets for the remainder of the year. These questions will be especially challenging in the wake of the pandemic because many states are required to balance their budgets. For some states, this may mean cutting new projects or reducing funding for existing programs, halting non-essential services altogether, or even the grim possibility of filing for bankruptcy. All of these options could mean less support from state and local governments for those fighting kidney disease.

While the United States has faced economic downturns before, this one is different. With consumer spending limited due to social distancing and stay-at-home orders, the sales tax revenue that states rely on is plummeting. In some states, sales tax revenue accounts for up to half of their state budget, and it accounts for more than half of the state budgets in Florida, Nevada, South Dakota, Tennessee, Texas and Washington. Retail sales fell a record 16.4% in April, which was more than expected and nearly double the 8.3% drop in March. Even with some states easing stay-at-home orders and restrictions, revenue generated by businesses is still going to be limited, unfortunately continuing to strain the budgets of the states most reliant on sales taxes.

At the same time the sales tax revenue is in sharp decline, states are also seeing income tax revenues decline as more and more people become unemployed. Adding further strain to state budgets are increased unemployment claims, Medicaid expenditures and the burden of securing personal protective equipment for their first responders. Some states are so far underwater financially that it could take years to recover.

Unlike the federal government, which can run a deficit, most states have balanced budget amendments. This means budget cuts—big ones—are likely coming. According to a recent survey, more than 1,000 cities are planning to cut back on services. Which services will be most impacted remains to be seen, but if the past is any indicator the cuts will likely affect services kidney patients rely on most—health care, social services and education.

There is some good news for kidney patients, though. As some state legislatures return to business, they are picking up where they left off on bills, including bills that provide protections for living organ donors. Already this year, hearings have been set to continue to move these lifesaving pieces of legislation forward. While on lockdown, Utah enacted a bill that prevents insurance companies from discriminating against living organ donors by charging higher premiums or refusing to insure them altogether. Kentucky also enacted a bill during lockdown that provides 240 hours of paid leave for state employees to have and recover from organ donation surgery. Both pieces of legislation were spearheaded by the American Kidney Fund.

While the future is uncertain and may look bleak, there are a few rays of light shining through as 16 other states will also be considering bills that would help kidney patients this legislative session. You can view all the upcoming kidney-related bills and take just two minutes to contact your state legislators on our website to ask that they support kidney patients with their votes. Even in times like these, we can continue to work together to improve the lives of those fighting kidney disease.


About the Author

Melanie Kahn

Melanie Kahn is the director of state policy and advocacy at the American Kidney Fund.