Author: bkellaway

An attack ad, which was released in mid-July, states that Montana Gov. Steve Bullock, a Democratic candidate for the Senate, supports a government-run health care program that would wreak havoc on the state’s health care infrastructure.

“Bullock’s health care plan will force rural hospitals to close. Medicare as we know it will change, replaced by a government-run program with fewer doctors and longer wait times,” says the narrator in the dark and grainy advertisement paid for by the National Republican Senatorial Committee (NRSC).

Bullock is running against first-term incumbent Republican Sen. Steve Daines in a race viewed as a toss-up. Given the COVID-19 pandemic, both candidates have been focusing on health issues.

Because this race is critical to determining whether Democrats or Republicans control the Senate, and considering that its themes are likely to be repeated in many congressional campaigns, we thought it was important to check the ad’s validity.

We first asked the NRSC for the evidence on which the ad was based. A spokesperson pointed to Bullock’s support for a “public option” health plan and provided us with a report predicting this proposal’s negative impact on rural hospitals, as well as quotes from both Republicans and Democrats about how the public option could lead to the eventual implementation of a “Medicare for All” program. (Medicare for All refers to the single-payer health system, advocated by Vermont Sen. Bernie Sanders, which would eliminate private insurance and replace it with a government-run health care system.)

We also reached out to the Bullock campaign for its response.

In a statement, Sean Manning, spokesperson for Montanans for Bullock said, “The claims in this ad are false. Montana hasn’t lost one rural hospital under Governor Bullock, and he will continue to support policies that protect rural hospitals while making affordable healthcare available to all Montanans in the Senate.” (According to the University of North Carolina Sheps Center for Health Services Research, no rural hospitals have closed in Montana since 2005.)

Hold Up ― Which Health Care Plan Is the NRSC Ad Talking About?

The ad vaguely refers to Bullock’s “health care plan” but doesn’t say outright what the candidate supports.

According to Bullock’s campaign website, he supports the creation of a public option.

A public option is generally defined as a health plan administered by the federal government that exists alongside and competes with private health insurance plans on the Affordable Care Act exchanges. Public option proposals differ by political candidate, and can take various forms, including Medicare or Medicaid buy-ins as well as a new government-run entity.

Opponents of such plans say that a public option, which would have the scale and regulatory power of the federal government to set lower reimbursement rates to providers, would have a competitive advantage and could put private insurance companies out of business. This would leave Americans with only one choice ― government-backed insurance. But that conclusion is debatable. Some health care scholars argue a public option would increase competition, leading to expanded access to health coverage, lower health care costs and lower premiums for consumers.

In the end, the outcomes from implementing this approach are difficult to predict unless a specific plan is released, said Benedic Ippolito, a health care research scholar at the American Enterprise Institute.

“Things can be radically different based on what the public option looks like,” said Ippolito. “The two big variables are, who is covered? And how does that insurer actually pay health care providers? You can imagine two public options looking totally different.”

The Payment Rate Is Key 

Now to tackle the first part of the ad, which says that “Bullock’s health care plan will force rural hospitals to close.”

This argument stems from the idea that a public option would lead to lower reimbursement rates, based on the model provided by Medicare, which pays less than private insurance. And, because many rural hospitals are already severely financially strapped, lowered payments would do them in, the argument goes.

When we asked the NRSC for the evidence to support this position, a spokesperson provided an August 2019 study conducted by Navigant, a consulting firm. The study was commissioned by the Partnership for America’s Healthcare Future, a health industry coalition including  drugmakers, insurance companies and private hospitals. The organization opposes Medicare for All and a public option.

The study modeled what would happen to rural hospitals if three separate public option approaches were implemented.

While it found that a public option could, depending on the scenario, cause a revenue reduction for rural hospitals of between 2.3% and 14%, the study reached these findings by assuming that the hospitals would be paid at Medicare rates.

Bullock’s campaign website, though, under his rural health care policy proposals, specifically states: “We need a public option that includes higher reimbursements for rural hospitals.”

We asked the Bullock campaign if it could provide us with details about what the “higher reimbursement” rate would be based on. It declined. A campaign staffer told us Bullock would support a public option that pays rural hospitals above Medicare rates. Since the reimbursement rates would be higher than Medicare’s, the assumptions in the Navigant study cannot be applied here.

“If the public option is a reasonably generous payer, that won’t be the end of rural health care,” said Ippolito. “But, you can easily imagine due to budgetary concerns, a public payer could have a lower reimbursement, which would have consequences.”

Some health policy experts argue that a public option would help rural hospitals by increasing the number of people in rural areas who have health insurance.

This would “benefit rural hospitals, since getting virtually nothing from uninsured patients is worse than getting a reasonably good rate from the public option,” said Gerard Anderson, a professor of health policy and management at Johns Hopkins University in Baltimore.

That’s a Big Jump 

Next, we’re on to the NRSC ad’s second claim: “Medicare as we know it will change, replaced by a government-run program with fewer doctors and longer wait times.”

As several experts pointed out, this sentence doesn’t make a lot of sense. Medicare is already a government-run program.

Also, the design of most public option proposals thus far keeps Medicare and the public option as two separate government programs, said Linda Blumberg, a health policy analyst at the Urban Institute, a think tank.

The NRSC clarified its position and told us it was referring to the idea that a public option would stifle competition in the insurance market, eventually leading to only government-run insurance or Medicare for All. The evidence the NRSC provided to support this claim were quotes from a selection of Republicans, Democrats, professors, and experts from conservative think tanks saying that the public option is a stepping stone to this single-payer approach.

But others suggest that’s a big leap in logic.

“I think that analysis is almost surely wrong,” said Matthew Fiedler, a fellow with the Brookings Institution. “In a world where there is a public option, the negotiating dynamics between insurers and providers would change substantially.”

This would likely create an environment in which private insurers could negotiate lower rates and providers would have to respond to that change in revenue with more efficiencies, he added. However, depending on how a public option plan is structured — specifically if providers can opt out of participating — some in-demand providers may choose to stay in private-plan networks where they could negotiate higher payments. This would keep private plans competitive.

“I don’t think it’s reasonable to argue that a public option would drive all other plans out of the market,” Fiedler said.

Again, Ippolito said it all depends on how the public option program is designed, and he allowed that if providers and hospitals were paid at Medicare rates, the public option would have a huge competitive advantage over commercial insurers because it would be paying out less for services and then could charge lower premiums, and “there’s no question in the short run, that it would be disruptive.”

As we noted earlier, the prediction of any outcome is difficult without specifics. Without details of Bullock’s public option plan, it’s misleading to characterize the outcome of the public option as surely leading to Medicare for All.

Why It Matters 

The race between Bullock and Daines is indicative of a trend occurring in campaigns across the country. Republicans often paint Democrats as left of the general public and health care has often been one of the issues the GOP highlights in that effort.

In this case, the NRSC ad links  Bullock to Medicare for All, despite his expressed support for a public option. Sean Manning, Bullock’s campaign spokesperson, said the governor does not support Medicare for All.

Jeremy Johnson, an associate professor of political science at Carroll College in Helena, Montana, said that even before COVID-19 became a major campaign issue, Daines, echoing a Trump theme, had pushed the idea that he stood for freedom versus socialism.

“One of the things [Daines] gives as a symbol of socialism is Medicare for All,” said Johnson. “Because Bullock says he favors a public option, there is a conflation of that on the Republican side to mean Medicare for All.”

But the public option and Medicare for All are not the same program and it’s misleading to lump them together.

Our Rating 

The NRSC claimed in a television ad that Steve Bullock’s support for the public option would cause rural hospitals to close.

While the NRSC did provide us with one study that offered support for its rural hospital claim, the study was industry-funded and based on broad assumptions that don’t accurately reflect positions outlined on Bullock’s website. Thus, this claim doesn’t stand up.

The second part of the ad asserts that the public option would lead to the implementation of Medicare for All. While supporters and critics debate how a public option would affect the private health insurance market and some on both sides consider it a “glide path” to a single-payer health care system, it’s too big of a jump to say it would definitely trigger this outcome.

We rate this False.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

As Xinyi Christine Zhang watched the COVID-19 death toll among health care workers rise this spring, she wanted to find a way to give solace — and thanks — to their families.

The teenager, of South Brunswick Township, New Jersey, joined her church in commemorating members who had died of COVID-19. But she was driven to try to do more, something personal.

“I thought there could be something more meaningful I could do for the families of the doctors who lost their lives fighting the pandemic,” said Christine, 15.

A gifted artist, Christine resolved to draw the fallen U.S. health care workers in colorful memorial portraits, distribute them to their families and post them on her website. She wanted the relatives to know that people appreciated those who were trying to help Americans heal while putting their own lives in jeopardy.

Christine frequently draws portraits for her friends and knew memorial portraits are usually rather expensive. She realized that drawing front-line workers could actually help families and was a better use of her time than drawing her friends — whom she said she’d drawn “like 10 times already.”

According to KHN and The Guardian’s “Lost on the Frontline” project, more than 1,000 health care workers in the United States have died after helping patients battle the coronavirus. The pandemic overburdened many hospitals and led to shortages in protective equipment such as masks and gowns that endangered many of those assisting patients.

Christine found her subjects through that project. She set up a website to upload her portraits and to let families request drawings of their loved ones. Her portraits are free and easily accessible online, Christine said.

She has finished and posted 17 portraits since she started in late April. Each one takes six to eight hours, and Christine spreads that work out over a few days so as not to interfere with her school assignments. Using a close-up image as a reference, she first digitally sketches the proportions of the person’s face with a pencil and then adds unique colors to “really bring life to the portrait.”

Her largest obstacle is getting in touch with the families. She hopes more families will request portraits through her website so she can work with them from the beginning.

One person Christine featured is Sheena Miles, a semiretired nurse from Mississippi who died of COVID-19 on May 1. Christine tracked down her son, Tom Miles, who expressed his gratitude on Facebook.

“When you’re going through a loss like that, like the loss of a mom, to get the email from out of the blue just kind of gives you a profound feeling that there are some good people in this world,” Tom Miles said in an interview. “For her to have such talent at such a young age, and that she really cares about people she doesn’t even know — she is what makes America what it is today.”

This kind of response is exactly what Christine aims for — she wants the families to know that she is thankful for the work of their loved ones.

“Someone they don’t know personally, even a stranger, appreciates what their loved one has done,” she said.

The portraits may be a source of brightness for grieving families, said Christine’s mother, Helen Liu.

“I hope that families who receive these portraits will have a feeling of hope that better times will come,” Liu said. “A memorial is something meaningful and permanent, and I feel her portraits capture the happiness that will forever be with them.”

She hopes to get additional requests for the memorials from families.

In addition to drawing, Christine is a member of the South Brunswick High School’s Science Olympiad team and helps build projects for competitions. She’s interested in exploring engineering or product design as a career. Anything related to building or creating, she said.

She plans to either major or minor in art in college. For now, she wants to continue this project throughout high school — hopefully with help from others who know how to create digital art. She has a form on her website where others with art experience can sign up to help out. She said they can also add “other heroes in our society, such as war veterans or firefighters.”

“There are so many people that need to be honored, but I can’t do it by myself,” Christine said.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

As the coronavirus began to spread through Minneapolis this spring, Health Commissioner Gretchen Musicant tore up her budget to find funds to combat the crisis. Money for test kits. Money to administer tests. Money to hire contact tracers. Yet even more money for a service that helps tracers communicate with residents in dozens of languages.

While Musicant diverted workers from violence prevention and other core programs to the COVID-19 response, state officials debated how to distribute $1.87 billion Minnesota received in federal aid.

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As she waited for federal help, the Minnesota Zoo got $6 million in federal money to continue operations, and a debt collection company outside Minneapolis received at least $5 million from the federal Paycheck Protection Program, according to federal data.

It was not until Aug. 5 — months after Congress approved aid for the pandemic — that Musicant’s department finally received $1.7 million, the equivalent of $4 per Minneapolis resident.

“It’s more a hope and a prayer that we’ll have enough money,” Musicant said.

Since the pandemic began, Congress has set aside trillions of dollars to ease the crisis. A joint KHN and Associated Press investigation finds that many communities with big outbreaks have spent little of that federal money on local public health departments for work such as testing and contact tracing. Others, like Minnesota, were slow to do so.

For example, the states, territories and 154 large cities and counties that received allotments from the $150 billion Coronavirus Relief Fund reported spending only 25% of it through June 30, according to reports that recipients submitted to the U.S. Treasury Department.

Many localities have deployed more money since that June 30 reporting deadline, and both Republican and Democratic governors say they need more to avoid layoffs and cuts to vital state services. Still, as cases in the U.S. top 5.2 million and deaths soar past 167,000, Republicans in Congress are pointing to the slow spending to argue against sending more money to state and local governments to help with their pandemic response.

“States and localities have only spent about a fourth of the money we already sent them in the springtime,” Senate Majority Leader Mitch McConnell said Tuesday. Congressional Democrats’ efforts to get more money for states, he said, “aren’t based on math. They aren’t based on the pandemic.”

Negotiations over a new pandemic relief bill broke down last week, in part because Democrats and Republicans could not agree on funding for state and local governments.

Minneapolis Health Commissioner Gretchen Musicant visits a COVID-19 testing event at Incarnation-Sagrado Corazon Church on Aug. 15, 2020, in Minneapolis. As the coronavirus spread through Minneapolis this spring, Musicant tore up her budget to find money to combat the crisis. It was not until Aug. 5 — months after Congress approved the pandemic relief aid — that her department received $1.7 million, the equivalent of $4 per Minneapolis resident. (AP Photo/Craig Lassig)

KHN and the AP requested detailed spending breakdowns from recipients of money from the Coronavirus Relief Fund — created in March as part of the $1.9 trillion CARES Act — and received responses from 23 states and 62 cities and counties. Those entities dedicated 23% of their spending from the fund through June to public health and 7% to public health and safety payroll.

An additional 22% was transferred to local governments, some of which will eventually pass it down to health departments. The rest went to other priorities, such as distance learning.

So little money has flowed to some local health departments for many reasons: Bureaucracy has bogged things down, politics have crept into the process, and understaffed departments have struggled to take time away from critical needs to navigate the red tape required to justify asking for extra dollars.

“It does not make sense to me how anyone thinks this is a way to do business,” said E. Oscar Alleyne, chief of programs and services at the National Association of County and City Health Officials. “We are never going to get ahead of the pandemic response if we are still handicapped.”

Last month, KHN and the AP detailed how state and local public health departments across the U.S. have been starved for decades. Over 38,000 public health worker jobs have been lost since 2008, and per capita spending on local health departments has been cut by 18% since 2010. That’s left them underfunded and without adequate resources to confront the coronavirus pandemic.

“Public health has been cut and cut and cut over the years, but we’re so valuable every time you turn on the television,” said Jan Morrow, the director and 41-year veteran of Ripley County health department in rural Missouri. “We are picking up all the pieces, but the money is not there. They’ve cut our budget until there’s nothing left.”

Politics and Red Tape

Why did the Minneapolis health department have to wait so long for CARES Act money?

Congress mandated that the Coronavirus Relief Fund be distributed to states and local governments based on population. Minneapolis, with 430,000 residents, missed the threshold of 500,000 people that would have allowed it to receive money directly.

The state of Minnesota, however, received $1.87 billion, a portion of which was meant to be sent to local communities. Lawmakers initially sent some state money to tide communities over until the federal money came through — the Minneapolis health department got about $430,000 in state money to help pay for things like testing.

But when it came time to decide how to use the CARES Act money, lawmakers in Minnesota’s Republican-controlled Senate and Democratic-controlled House were at loggerheads.

Myron Frans, commissioner of Minnesota Management and Budget, said that disagreement, on top of the economic crisis and pandemic, left the legislature in turmoil.

After the police killing of George Floyd in Minneapolis, the city erupted in protests over racial injustice, making a difficult situation even more challenging.

Dr. Jackie Kawiecki stands outside her home on Aug. 15, 2020, her day off from her job at a medical station in Richfield, Minnesota, near the location where George Floyd was killed. “I still don’t think that the amount of testing offered is adequate, from a public health standpoint,” Kawiecki says. (AP Photo/Craig Lassig)

Democratic Gov. Tim Walz favored targeting some of the money to harder-hit communities, a move that might have helped Minneapolis, where cases have surged since mid-July. But lawmakers couldn’t agree. Negotiations dragged on, and a special session merely prolonged the standoff.

Finally, the governor divvied up the money using a population-based formula developed earlier by Republican and Democratic legislative leaders that did not take into account COVID-19 caseloads or racial disparities.

“We knew we needed to get it out the door,” Frans said.

The state then sent hundreds of millions of dollars to local communities. Still, even after the money got to Minneapolis a month ago, Musicant had to wait as city leaders made difficult choices about how to spend the money as the economy cratered and the list of needs grew.

“Even when it gets to the local government, you still have to figure out how to get it to local public health,” Musicant said.

Meanwhile, some in Minneapolis have noticed a lack of services. Dr. Jackie Kawiecki has been providing help to people at a volunteer medical station near the place where Floyd was killed ― an area that at times has drawn hundreds or thousands of people per day. She said the city did not do enough free, easy-to-access testing in its neighborhoods this summer.

“I still don’t think that the amount of testing offered is adequate, from a public health standpoint,” Kawiecki said.

A coalition of groups that includes the National Governors Association has blamed the spending delays on the federal government, saying the final guidance on how states could spend the money came late in June, shortly before the reporting period ended. The coalition said state and local governments had moved “expeditiously and responsibly” to use the money as they deal with skyrocketing costs for health care, emergency response and other vital programs.

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New York’s Nassau County was among six counties, cities and states that had spent at least 75% of its funds by June 30.

While most of the money was not spent before then, the National Association of State Budget Officers says a July 23 survey of 45 states and territories found they had allocated, or set aside, an average of 74% of the money.

But if they have, that money has been slow to make it to many local health departments.

As of mid-July in Missouri, at least 50 local health departments had yet to receive any of the federal money they requested, according to a state survey. The money must first flow through local county commissioners, some of whom aren’t keen on sending money to public health agencies.

“You closed their businesses down in order to save their people’s lives and so that hurt the economy,” said Larry Jones, executive director of the Missouri Center for Public Health Excellence, an organization of public health leaders. “So they’re mad at you and don’t want to give you money.”

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The winding path federal money takes as it makes its way to states and cities also could exacerbate the stark economic and health inequalities in the U.S. if equity isn’t considered in decision-making, said Wizdom Powell, director of the University of Connecticut Health Disparities Institute.

“Problems are so vast you could unintentionally further entrench inequities just by how you distribute funds,” Powell said.

‘Everything Fell Behind’

The amounts eventually distributed can induce head-scratching.

Some cities received large federal grants, including Louisville, Kentucky, whose health department was given $42 million by April, more than doubling its annual budget. Because of the way the money was distributed, Louisville’s health department alone received more money from the CARES Act than the entire government of the city of Minneapolis, which received $32 million in total.

Philadelphia’s health department was awarded $100 million from a separate fund from the Centers for Disease Control and Prevention.

Honolulu County, where COVID cases have remained relatively low, received $124,454 for every positive case it had reported as of Aug. 9, while El Paso County in Texas got just $1,685 per case. Multnomah County, Oregon — with nearly a quarter of its state’s COVID-19 cases — landed only 2%, or $28 million, of the state’s $1.6 billion allotment.

Rural Saline County in Missouri received the same funding as counties of similar size, even though the virus hit the area particularly hard. In April, outbreaks began tearing through a Cargill meatpacking plant and a local factory there. By late May, the health department confirmed 12 positive cases at a local jail.

Tara Brewer, Saline’s health department administrator, said phone lines were ringing off the hook, jamming the system. Eventually, several department employees handed out their personal cellphone numbers to take calls from residents looking to be tested or seeking care for coronavirus symptoms.

“Everything fell behind,” Brewer said.

The school vaccination clinic in April was canceled, and a staffer who works as a Spanish translator for the Women, Infants and Children nutritional program was enlisted to contact-trace for additional COVID-19 exposures. All food inspections stopped.

It was late July when $250,000 in federal CARES Act money finally reached the 11-person health department, Brewer said — four months after Congress approved the spending and three months after the county’s first outbreak.

That was far too late for Brewer to hire the army of contact tracers that might have helped slow the spread of the virus back in April. She said the money already has been spent on antibody testing and reimbursements for groceries and medical equipment the department had bought for quarantined residents.

Another problem: Some local health officials say that the laborious process required to qualify for some of the federal aid discourages overworked public health officials from even trying to secure more money and that funds can be uneven in arriving.

Volunteers work at a medical station on Aug. 15, 2020, near the location where George Floyd died in police custody in Minneapolis. Dr. Jackie Kawiecki organized the effort to help people at the site, an area that at times has drawn thousands of people per day. She says the city did not do enough free, easy-to-access COVID-19 testing in its neighborhoods this summer. (AP Photo/Craig Lassig)

Lisa Macon Harrison, public health director for Granville Vance Public Health in rural Oxford, North Carolina, said it’s tough to watch major hospital systems — some of which are sitting on billions in reserves — receive direct deposits, while her department received only about $122,000 through three grants by the end of July. Her team filled out a 25-page application just to get one of them.

She is now waiting to receive an estimated $400,000 more. By contrast, the Duke University Hospital System, which includes a facility that serves Granville, already has received over $67.3 million from the federal Provider Relief Fund.

“I just don’t understand the extra layers of onus for the bureaucracy, especially if hundreds of millions of dollars are going to the hospitals and we have to be responsible to apply for 50 grants,” she said.

The money comes from dozens of funds, including several programs within the CARES Act. Nebraska alone received money from 76 federal COVID relief funding sources.

Robert Miller, director of health for the Eastern Highlands Health District in Connecticut, which covers 10 towns, received $29,596 of the $2.5 million the state distributed to local departments from the CDC fund and nothing from CARES. It was only enough to pay for some contact tracing and employee mileage.

Miller said that he could theoretically apply for a little more from the Federal Emergency Management Agency, but that the reporting requirements — which include collecting every receipt — are extremely cumbersome for an already overburdened department.

So he wonders: “Is the squeeze worth the juice?”

Back in Minneapolis, Musicant said the new money from CARES allowed the department to run a free COVID-19 testing site Saturday, at a church that serves the Hispanic community about a mile from the site of Floyd’s killing.

It will take more money to do everything the community needs, she says, but with Congress deadlocked, she’s not sure they’ll get it anytime soon.

AP writers Camille Fassett and Steve Karnowski contributed to this report.

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Cuando el coronavirus comenzó a propagarse por Minneapolis esta primavera, la comisionada de salud Gretchen Musicant ajustó su presupuesto y encontró dinero para combatir la crisis. Dinero para los kits de prueba. Dinero para rastreadores de contactos. Dinero para un servicio que ayudara a comunicarse con los residentes en docenas de idiomas.

Cuando Musicant reubicaba a trabajadores de prevención de la violencia y otros programas básicos, los funcionarios estatales debatían cómo distribuir los $1,87 mil millones que Minnesota había recibido en ayuda federal.

Mientras esperaba, el zoológico de Minnesota obtuvo $6 millones en dinero federal para continuar sus operaciones, y una compañía de cobro de deudas fuera de Minneapolis recibió al menos $5 millones del Programa de Protección de Cheques de Pago federal, según datos federales.

No fue hasta el 5 de agosto —meses después de que el Congreso aprobara la ayuda para el coronavirus— que el departamento de Musicant finalmente recibió $1,7 millones, el equivalente a $4 por cada residente de la ciudad.

Desde que comenzó la pandemia, el Congreso ha reservado miles de millones para aliviar la crisis. Una investigación conjunta de Kaiser Health News y Associated Press encuentra que muchas comunidades con grandes brotes han gastado poco de ese dinero federal en los departamentos locales de salud pública para trabajos como pruebas y rastreo de contactos. Otras, como Minnesota, tuvieron respuestas lentas.

Por ejemplo, los estados, territorios y 154 grandes ciudades y condados que recibieron asignaciones del Fondo de Alivio para el Coronavirus de $150 mil millones informaron haber gastado sólo el 25% de ese dinero hasta el 30 de junio, según informes que los destinatarios presentaron al Departamento del Tesoro de los Estados Unidos.

La doctora Jackie Kawiecki posa fuera de su casa el sábado 15 de agosto, su día libre de su trabajo en una estación médica en Richfield, Minnesota, cerca del lugar donde George Floyd fue asesinado. “Todavía no creo que la cantidad de pruebas que se ofrecen sea adecuada, desde el punto de vista de la salud pública”, dice Kawiecki.(AP PHOTO/CRAIG LASSIG)

Muchas localidades han utilizado más dinero desde la fecha límite de presentación de informes del 30 de junio, y tanto los gobernadores republicanos como los demócratas dicen que necesitan más para evitar despidos y recortes en servicios estatales vitales.

Aún así, a medida que los casos en los Estados Unidos superan los 5,4 millones y las muertes confirmadas se elevan a más de 171,000, los republicanos en el Congreso señalan la lentitud del gasto para argumentar en contra del envío de más dinero a los gobiernos estatales y locales para ayudar en su respuesta a la pandemia.

El líder de la mayoría republicana del Senado, Mitch McConnell, dijo el martes 11 de agosto que los esfuerzos de los demócratas del Congreso para conseguir más dinero para los estados “no se basan en las matemáticas. No se basan en la pandemia”.

Las negociaciones sobre un nuevo proyecto de ley de ayuda se rompieron hace pocos días, en parte porque los demócratas y los republicanos no se pusieron de acuerdo sobre la financiación de los gobiernos estatales y locales.

KHN y AP solicitaron desgloses detallados de los gastos a los receptores del dinero del Fondo de Ayuda contra el Coronavirus —creado en marzo como parte de la Ley CARES de 1,9 mil millones— y recibieron respuestas de 23 estados y 62 ciudades y condados. Esas entidades dedicaron, hasta junio, el 23% de sus gastos del fondo a la salud pública y el 7% a la salud pública y a la seguridad de la nómina.

Un 22% adicional fue transferido a los gobiernos locales, algunos de los cuales eventualmente lo pasarán a los departamentos de salud.

La lentitud de la ayuda se debe a muchas razones, incluyendo la burocracia, la política y la falta de personal que dificulta a los departamentos navegar por el sistema.

“No tiene sentido para mí que alguien piense que ésta es la manera de hacer las cosas”, dijo E. Oscar Alleyne, jefe de programas y servicios de la Asociación Nacional de Funcionarios de Salud del Condado y la Ciudad.

Voluntarios trabajan el 15 de agosto, cerca del lugar en donde murió George Floyd bajo custodia policial en Minneapolis. (AP PHOTO/CRAIG LASSIG)

El Congreso ordenó que el Fondo de Alivio para el Coronavirus se distribuyera a los gobiernos estatales y locales en función de la población. Minneapolis, con 430,000 residentes, no alcanzó el umbral de 500,000 personas que le hubiera permitido recibir dinero directamente.

El estado de Minnesota recibió $1,87 mil millones, una parte de los cuales estaba destinada a ser enviada a las comunidades locales. Los legisladores inicialmente enviaron algo de dinero del estado para ayudar a las comunidades hasta que el dinero federal llegara. El departamento de salud de Minneapolis recibió unos $430,000 en dinero estatal.

Sin embargo, cuando llegó el momento de decidir cómo utilizar el dinero del CARES Act, los legisladores de Minnesota no se pusieron de acuerdo.

Entonces la policía de Minneapolis mató a George Floyd, y la ciudad estalló en protestas por la injusticia racial, haciendo la situación aún más difícil.

Finalmente, el gobernador demócrata Tim Walz decidió repartir el dinero utilizando una fórmula basada en la población, desarrollada anteriormente por los líderes legislativos republicanos y demócratas, que no tenía en cuenta los casos de COVID-19 ni las disparidades raciales.

El estado envió entonces cientos de millones de dólares a las comunidades locales. Aún así, incluso después que el dinero llegara a Minneapolis hace un mes, Musicant esperó a que los líderes de la ciudad decidieran cómo gastarlo.

Una coalición que incluye a la Asociación Nacional de Gobernadores ha culpado de los retrasos en el gasto al gobierno federal, diciendo que la orientación final sobre cómo los estados podrían gastar el dinero no llegó hasta finales de junio. La coalición comunicó que los gobiernos estatales y locales habían actuado “de manera expeditiva y responsable” para utilizar el dinero.

Algunas ciudades recibieron grandes subsidios federales, entre ellas Louisville, en Kentucky, cuyo departamento de salud obtuvo $42 millones en abril, lo que duplicó con creces su presupuesto.

Pero a mediados de julio en Missouri, al menos 50 departamentos de salud locales aún no habían recibido el dinero federal que habían solicitado, según una encuesta estatal. El dinero debe fluir primero a través de los comisionados locales del condado, algunos de los cuales no están dispuestos a enviar dinero a las agencias de salud pública que cerraron los negocios.

El condado rural de Saline, en Missouri, recibió los mismos fondos que los condados de tamaño similar, a pesar de que el virus golpeó la zona con especial dureza, con brotes en una planta de empaquetado de carne y en una fábrica.

Fue a finales de julio cuando $250,000 en dinero de la Ley Federal CARES finalmente llegaron al departamento de salud de 11 personas —demasiado tarde para contratar al ejército de rastreadores de contacto que podrían haber frenado el virus en abril, señaló Tara Brewer, administradora del departamento de salud de Saline.

Algunos funcionarios de salud locales dijeron que el laborioso proceso requerido para calificar para alguna de las ayudas federales también es un problema.

Lisa Harrison, directora de salud pública de Granville Vance Public Health en la zona rural de Carolina del Norte, comentó que resulta duro ver cómo importantes sistemas hospitalarios como la Universidad de Duke reciben decenas de millones de dólares en depósitos directos, mientras que su departamento sólo recibió unos $122,000 a través de tres subvenciones a finales de julio. Su equipo rellenó una solicitud de 25 páginas sólo para conseguir una de ellas.

En Minneapolis, Musicant dijo que el nuevo dinero de CARES permitió al departamento hacer pruebas gratuitas de COVID-19 en una iglesia, a una milla del lugar donde tuvo lugar el asesinato de Floyd.

Hará falta más dinero para hacer todo lo que la comunidad necesita, aseguró Musicant; pero con el Congreso estancado, no está segura de que lo consigan pronto.

Smith es periodista de The Associated Press, y Weber, Recht y Ungar son periodistas de KHN. Los periodistas de AP Camille Fassett y Steve Karnowski colaboraron con este informe.

Esta historia es una colaboración entre The Associated Press y KHN, que es un servicio de noticias sin fines de lucro que cubre temas de salud. Es un programa editorialmente independiente de la Kaiser Family Foundation. KHN no está afiliada a Kaiser Permanente.