Category: Rehab News

Dr. Katherine Pannel was initially thrilled to see President Donald Trump’s physician is a doctor of osteopathic medicine. A practicing D.O. herself, she loved seeing another glass ceiling broken for the type of doctor representing 11% of practicing physicians in the U.S. and now 1 in 4 medical students in the country.

But then, as Dr. Sean Conley issued public updates on his treatment of Trump’s COVID-19, the questions and the insults about his qualifications rolled in.

“How many times will Trump’s doctor, who is actually not an MD, have to change his statements?” MSNBC’s Lawrence O’Donnell tweeted.

“It all came falling down when we had people questioning why the president was being seen by someone that wasn’t even a doctor,” Pannel said.

The osteopathic medical field has had high-profile doctors before, good and bad. Dr. Murray Goldstein was the first D.O. to serve as a director of an institute at the National Institutes of Health, and Dr. Ronald R. Blanck was the surgeon general of the U.S. Army. Former Vice President Joe Biden, challenging Trump for the presidency, also sees a doctor who is a D.O. But another now former D.O., Larry Nassar, who was the doctor for USA Gymnastics, was convicted of serial sexual assault.

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Still, with this latest example, Dr. Kevin Klauer, CEO of the American Osteopathic Association, said he’s heard from many fellow osteopathic physicians outraged that Conley — and by extension, they, too — are not considered real doctors.

“You may or may not like that physician, but you don’t have the right to completely disqualify an entire profession,” Klauer said.

For years, doctors of osteopathic medicine have been growing in number alongside the better-known doctors of medicine, who are sometimes called allopathic doctors and use the M.D. after their names.

According to the American Osteopathic Association, the number of osteopathic doctors grew 63% in the past decade and nearly 300% over the past three decades. Still, many Americans don’t know much about osteopathic doctors, if they know the term at all.

“There are probably a lot of people who have D.O.s as their primary [care doctor] and never realized it,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, a philanthropic group focused on community health.

So What Is the Difference?

Both types of physicians can prescribe medicine and treat patients in similar ways.

Although osteopathic doctors take a different licensing exam, the curriculum for their medical training — four years of osteopathic medical school — is converging with M.D. training as holistic and preventive medicine becomes more mainstream. And starting this year, both M.D.s and D.O.s were placed into one accreditation pool to compete for the same residency training slots.

But two major principles guiding osteopathic medical curriculum distinguish it from the more well-known medical school route: the 200-plus hours of training on the musculoskeletal system and the holistic look at medicine as a discipline that serves the mind, body and spirit.

The roots of the profession date to the 19th century and musculoskeletal manipulation. Pannel was quick to point out the common misconception that their manipulation of the musculoskeletal system makes them chiropractors. It’s much more involved than that, she said. Dr. Ryan Seals, who has a D.O. degree and serves as a senior associate dean at the University of North Texas Health Science Center in Fort Worth, said that osteopathic physicians have a deeper understanding than allopathic doctors of the range of motion and what a muscle and bone feel like through touch.

That said, many osteopathic doctors don’t use that part of their training at all: A 2003 Ohio study said approximately 75% of them did not or rarely practiced osteopathic manipulative treatments.

The osteopathic focus on preventive medicine also means such physicians were considering a patient’s whole life and how social factors affect health outcomes long before the pandemic began, Klauer said. This may explain why 57% of osteopathic doctors pursue primary care fields, as opposed to nearly a third of those with doctorates of medicine, according to the American Medical Association.

Pannel pointed out that she’s proud that 42% of actively practicing osteopathic doctors are women, as opposed to 36% of doctors overall. She chose the profession as she felt it better embraced the whole person, and emphasized the importance of care for the underserved, including rural areas. She and her husband, also a doctor of osteopathic medicine, treat rural Mississippi patients in general and child psychiatry.

Given osteopathic doctors’ likelihood of practicing in rural communities and of pursuing careers in primary care, Health Affairs reported in 2017, they are on track to play an increasingly important role in ensuring access to care nationwide, including for the most vulnerable populations.

Stigma Remains

To be sure, even though the physicians end up with similar training and compete for the same residencies, some residency programs have often preferred M.D.s, Seals said.

Traditional medical schools have held more esteem than schools of osteopathic medicine because of their longevity and name recognition. Most D.O. schools have been around for only decades and often are in Midwestern and rural areas.

While admission to the nation’s 37 osteopathic medical schools is competitive amid a surge of applicants, the grade-point average and Medical College Admission Test scores are slightly higher for the 155 U.S. allopathic medical schools: The average MCAT was 506.1 out of 528 for allopathic medical school applicants over a three-year period, compared with 503.8 for osteopathic applicants for 2018.

Seals said prospective medical students ask the most questions about which path is better, worrying they may be at a disadvantage if they choose the D.O. route.

“I’ve never felt that my career has been hindered in any way by the degree,” Seals said, noting that he had the opportunity to attend either type of medical school, and osteopathic medicine aligned better with the philosophy, beliefs and type of doctor he wanted to be.

Many medical doctors came to the defense of Conley and their osteopathic colleagues, including Dr. John Morrison, an M.D. practicing primary care outside of Seattle. He was disturbed by the elitism on display on social media, citing the skills of the many doctors of osteopathic medicine he’d worked with over the years.

“There are plenty of things you can criticize him for, but being a D.O. isn’t one of them,” Morrison said.

KHN reporter Victoria Knight discussed this week’s vice presidential debate with Newsy’s “Morning Rush” on Thursday.

• Click here to watch Knight on Newsy
• Read “In Debate, Pence and Harris Offer Conflicting Views of Nation’s Reality,” by the staffs of KHN and PolitiFact

KHN chief Washington correspondent Julie Rovner discussed Trump’s COVID-19 diagnosis on WFAE’s “Charlotte Talks” on Monday. She discussed the public’s right to know about the president’s health with Wisconsin Public Radio’s “Central Time” on Tuesday.

• Click here to hear Rovner on WFAE
• Click here to hear Rovner on Wisconsin Public Radio

KHN correspondent Rachana Pradhan discussed COVID testing at the White House with Newsy’s “Morning Rush” on Tuesday.

• Click here to watch Pradhan on Newsy
• Read “Inside the Flawed White House Testing Scheme That Did Not Protect Trump,” by Pradhan, KHN Midwest correspondent Lauren Weber and KHN senior correspondent Liz Szabo.

KHN Montana correspondent Katheryn Houghton discussed Seeley Lake’s long-term wildfire smoke health effects on Los Angeles Times’ “Second Opinion” on Oct. 2.

• Click here to watch Houghton on “Second Opinion”
• Read Houghton’s “Wildfires’ Toxic Air Leaves Damage Long After the Smoke Clears”

KHN correspondent Aneri Pattani discussed COVID-19 and herd immunity on Newsy’s “The Briefing” on Oct. 1.

• Click here to watch Pattani on Newsy
• Read Pattani’s “Corralling the Facts on Herd Immunity”

Pharmaceutical giants Regeneron and Gilead Sciences got the kind of publicity money can’t buy this week after President Donald Trump took their experimental drugs for his coronavirus infection, left the hospital and pronounced himself fully recovered.

“It was, like, unbelievable. I felt good immediately,” Trump said Wednesday in a tweeted video. “I call that a cure.”

He praised Regeneron’s monoclonal antibody cocktail, which mimics elements of the immune system, and mentioned a similar drug under investigation by Eli Lilly and Co. The president also took Gilead’s remdesivir, an antiviral that has shortened recovery times for COVID-19 patients in early research.

There is no scientific evidence that any of these drugs contributed to the president’s recovery, since many patients do fine without them. It is also not known whether the president has been “cured,” since the White House has released few specifics about the course of his illness.

Yet as his campaign for reelection enters its final stretch, Trump is not feeling the love in campaign contributions. Regeneron, Gilead, Lilly and the industry as a whole are sending more money elsewhere.

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Reversing a trend in which contributions from drugmakers’ political committees and their employees have gone largely to Republican candidates for president and Congress, so far for 2020 the industry has tilted toward Democrats.

The shift may reflect industry expectations that Democratic presidential candidate Joe Biden will win, said Steven Billet, who teaches courses in corporate lobbying and political donations at George Washington University. Pharma companies may see campaign largesse as leverage if Biden follows through on promises to address high drug prices, he said.

In a year when complaints about high prescription drug prices have been overshadowed by the pandemic, donors with ties to pharma manufacturers have given around $976,000 to Biden, according to data from the Center for Responsive Politics. That’s nearly three times the pharma contributions to Trump, who recently switched his tune from complaining about “rip-off” prescription prices to describing drug firms as “great companies.”

“Traditionally the industry tends to favor Republicans,” said Sarah Bryner, CRP’s research director. “But this cycle, we’re seeing that flipped,” partly reflecting Democrats’ overall greater success in fundraising, she said.

Of $177,000 given so far to 2020 federal candidates by Regeneron’s employees and political action committee, four-fifths have gone to Democrats, including $35,203 to Biden, according to CRP.

Regeneron CEO Leonard Schleifer, a billionaire who has known Trump for years and belongs to the Trump National Golf Club Westchester in New York’s Westchester County, has a long history of giving to Democrats. He gave $5,400 to Hillary Clinton’s 2016 presidential run and $120,000 in 2018 to a political action committee attempting to flip the Senate to Democratic control.

Schleifer has made no registered political donations since last year, when his contributions went mainly to his son, Adam Schleifer, a Democrat running for Congress who lost in a primary this summer.

North Carolina Sen. Thom Tillis, representing a state with a large biotech industry and running for reelection in a tight race, has been the biggest Republican recipient of Regeneron dollars for 2020 races, tallying $5,526 so far.

“This is a company that looks as though they’ve always been committed to Democrats,” said Billet, a former AT&T lobbyist who teaches PAC management. “And my guess is they just have a Democratic culture in this company.”

A spokesperson for Regeneron, which has applied for emergency use authorization to bypass the Food and Drug Administration approval process for its drug, declined to comment on campaign donations and said the company will continue clinical trials.

The drug is expected to cost thousands of dollars per dose. “You’re going to get them for free,” Trump said of the COVID-19 drugs he took. The government has agreed to make initial doses of Regeneron’s antibody treatment “available to the American people at no cost,” the company says.

But details of the contract, including the price, remained secret. In any event, if patients get the drug at no direct cost, “it doesn’t mean they’re not paying for it,” said James Love, director of Knowledge Ecology International, a nonprofit that works to expand access to medical technology. “They’re just paying for it through taxes.”

The government is giving Regeneron $450 million to make and supply the antibody cocktail.

Donors with Gilead ties also lean left, giving two-thirds of their roughly $284,000 in contributions so far this cycle to Democratic candidates for Congress and president, the CRP data shows, including about $36,000 to Biden.

At Lilly, where Health and Human Services Secretary Alex Azar once ran the U.S. division, 54% of the money has gone to Democrats and 46% to Republicans. Lilly employees have given $45,000 to Biden and $13,000 to Trump, according to CRP.

Biden does not accept donations from corporate PACs; all his Regeneron, Lilly and Gilead dollars came from their employees.

Much of this year’s overall pharma shift to Democrats comes in the presidential race. KHN’s Pharma Cash to Congress data tracking sitting members still shows a preference this cycle of pharma PACs targeting congressional Republicans, $6 million so far compared with $4.7 million given to Democrats.

“Joe Biden has Big Pharma — as well as Big Tech and big banks — in his pocket because he’s worked for them for nearly 50 years, rather than the American people,” said Samantha Zager, a spokesperson for the Trump campaign.

On the campaign trail, Biden has focused largely on improving health insurance. But he also proposes letting Medicare negotiate drug prices, tying drug-price increases to inflation and allowing patients to buy imported pharmaceuticals.

Biden “will further reduce health care costs while expanding coverage, end practices like surprise billing, lower premiums and stand up to abuses of power by prescription drug companies,” said campaign spokesperson Rosemary Boeglin.

Before Trump took office, he said pharma companies were “getting away with murder” over the prices they charge. Despite the president’s claims and promises, he has done little to lower prescription drug prices, according to experts and fact-checkers.

A Trump executive order this month would require Medicare to pay no more for drugs than other developed nations, but it starts with a test program and could take months or years to implement.

Pharma companies were among the biggest beneficiaries of Trump’s 2017 tax cut, saving billions by being able to bring home untaxed foreign cash and billions more in lower rates.

KHN data editor Elizabeth Lucas contributed to this report.

The convergence of the coronavirus pandemic and election season has complicated this year’s voting for residents of nursing homes, assisted living facilities and other long-term care centers.

Many seniors who need help to get or fill out their ballots may be stymied by shifting rules about family visits. Voting procedures — whether in person or by mail — are under increased scrutiny, adding to the confusion. Facilities that used to host voting precincts likely won’t do so this year because of concerns about the spread of COVID-19.

“We’re basically not allowed to go out into the public right now, we’re more vulnerable, and our immune systems are compromised anyway,” said Janice Phillips, a 14-year resident of Village Square Healthcare Center, a skilled nursing facility in San Marcos, California. “We’re basically locked in.”

Phillips, 75, who has rheumatoid arthritis, has voted by absentee ballot for years without problems. This year she is encouraging her fellow residents to vote by mail as well. She works with the facility’s activities staff, going resident by resident, to make sure folks are registered. As president of the resident council, Phillips has also raised the issue at community meetings.

Older Americans are a consistent voting bloc courted by both parties.

According to AARP, 71% of Americans 65 and older voted in the 2016 presidential election, compared with 46% of people 18-29. “For many older adults, it’s a point of pride for them that they’ve voted in every election since they were 18,” said Leza Coleman, the executive director of California’s Long-Term Care Ombudsman Association.

But hardly anyone has been allowed inside skilled nursing facilities since the start of the pandemic, except for staff members and the occasional state health official, or family members in certain circumstances. In California and beyond, facilities are beginning to open up in counties with low transmission rates, since federal rules changed in September to allow for more lenient visiting policies.

At the same time, outbreaks continue to plague some senior facilities, despite improved testing of staff and other safety measures. On Wednesday, Santa Cruz County health officials reported a major outbreak at the Watsonville Post-Acute Center, which has infected 46 residents, killing nine of them, and infecting 15 staff members.

California officials are pressing nursing homes and senior centers to give residents who want to vote the opportunity. The Department of Public Health on Oct. 5 sent a letter to all those facilities, explaining they have an obligation to inform and assist residents with voting, including what actions are permissible for staffers to undertake in helping voters. It also includes advice about maintaining a safe environment through the election by limiting nonessential visitors, properly using protective gear such as gloves and handling ballots as little as possible.

In years past, civic groups such as the League of Women Voters would stop by to give presentations on what’s on the ballot. Candidates for local office would hit nursing homes to make pitches. “In the context of a pandemic, we just can’t do it this year,” said Michelle Bishop, voter access and engagement manager with the National Disability Rights Network.

Before the pandemic, nursing homes and assisted living facilities also often served as polling places. Residents could easily access voting booths, often set up in a lobby or community room. That was especially important because nursing homes are likely to be accessible to people with mobility problems, Bishop said.

Otherwise, facilities would often organize bus trips and outings to polling places.

In California, the last day to register to vote online or by mail is Oct. 19, though voters can register in person up to and including Election Day. All registered voters will receive a ballot in the mail, and those postmarked by Nov. 3 will still be counted in California for 17 days after the election. Advocates say it’s important for newer residents at skilled nursing facilities to make sure they’ve registered at their new address or have plans to get their ballot delivered to them from their former homes.

Other states are also sending ballots to all registered voters by mail this year on various time frames. All states permit seniors or people who have trouble reaching polling stations to request an absentee ballot.

Once they have a ballot in hand, some older adults need help from family or staff at their facilities to complete it correctly and send it back to election officials. The federal directive to relax visiting rules could ease some of that pressure, but the situation varies by facility. For people whose relatives cannot help them, it may fall to staff members to set up calls and video chats between residents and their families, or provide the assistance to residents themselves.

Some states don’t allow nursing home staffers to help with ballots to avoid influencing votes. Even if they can assist, employees may be stretched too thin to help. In a year when nursing home staff members are spending an extra hour each day putting on protective gear, there isn’t always extra time to make sure every resident is registered and voting, said Dr. Karl Steinberg, chief medical officer for Mariner Health Central, a nursing home management company in California.

“There’s a perennial workforce shortage in nursing homes and it’s been exacerbated by this” pandemic, Steinberg said. “This year with all the chaos, there may be less staff time available to help people with voting.”

Tracy Greene Mintz, whose business, Senior Care Training, trains senior care workers, is responsible for staffing at 100 nursing homes in California. She said she started ringing alarm bells about voting rights in August.

“Elected officials do not care about nursing homes, period,” Greene Mintz said. “They assume residents don’t vote and don’t make contributions.”

She asked the California Department of Public Health, which surveys skilled nursing facilities every six weeks about COVID-19 infection control, to add a question on how facilities were planning for elections. The department declined.

So she set up webinars with facility administrators and the Los Angeles County Registrar-Recorder/County Clerk to go over information on how to submit and track absentee ballots.

She has also urged state officials to provide a statewide plan that facilities could use as a blueprint. She wrote one herself that was emailed out by a trade group, the California Association of Health Facilities.

Still, California is in better shape than some other states, said Raúl Macías, a lawyer with the Democracy Program at the Brennan Center for Justice, a law and public policy institute. Elsewhere, residents may have to apply for an absentee ballot, and sometimes must provide a reason they can’t vote in person.

California also has the Voter Bill of Rights, which allows individuals to designate someone to help them fill out and drop off their ballot. In some states, such as North Carolina, assistance can come only from designated bipartisan voting assistance teams, which may be harder to recruit during a pandemic, Macías said.

No matter the state, state and county elections officials and facility administrators should draft voting plans, said Bishop, of the Disabilities Rights Network. It will help staff know the proper way to assist residents without influencing their votes, and residents know their voting rights.

“There is a bit of a gray area on whose responsibility this is,” Bishop said. “It’s one of the years when we start asking ‘Whose responsibility is it?’ Who cares? We have to get it done.”

If they can’t get access to ballots or need help, California residents can contact the state’s long-term care ombudsman program, which can investigate complaints, help them resolve the issue and take the problem to the Department of Public Health if it can’t be fixed.

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.

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La convergencia de la pandemia de coronavirus y las elecciones ha complicado la votación de este año para quienes viven en residencias, centros de vivienda asistida y otros espacios de atención a largo plazo para adultos mayores.

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Muchos seniors que necesitan ayuda para obtener o llenar sus boletas podrían sufrir la consecuencias por el cambio de las reglas sobre visitas familiares. Los procedimientos de votación —ya sea en persona o por correo— están bajo un mayor escrutinio, lo que aumenta la confusión. Las residencias, que solían albergar centros de votación, probablemente no lo harán este año debido a la preocupación de que se propague COVID-19.

“Básicamente, en este momento no se nos permite salir, somos más vulnerables, y nuestros sistemas inmunológicos ya están comprometidos”, dijo Janice Phillips, residente durante 14 años del Village Square Healthcare Center, en San Marcos, California. “Estamos encerrados”.

Phillips, de 75 años, quien padece artritis reumatoide, ha votado por correo durante años sin problemas. Esta vez está animando a sus compañeros de residencia a que también voten por correo. Colabora con el personal de actividades del centro, hablando con cada uno de los residentes, para asegurarse de que se hayan registrado.

Como presidenta del Consejo de Residentes, Phillips también ha planteado el tema en las reuniones de la comunidad.

Los estadounidenses mayores son un bloque de votantes consistente, cortejado por ambos partidos.

Según AARP, el 71% de los estadounidenses mayores de 65 años votó en las elecciones presidenciales de 2016, comparado con el 46% de las personas de 18 a 29 años. “Muchos adultos mayores se sienten orgullosos de haber votado en cada elección desde que cumplieron los 18 años”, señaló Leza Coleman, directora ejecutiva de la Long-Term Care Ombudsman Association de California.

Sin embargo, desde el comienzo de la pandemia, a casi nadie se le ha autorizado la entrada en las residencias de mayores, excepto al personal y al ocasional funcionario de salud del Estado, o a familiares en determinadas circunstancias. En California y otros lugares, los centros empiezan a abrirse en condados con bajas tasas de transmisión, ya que las normas federales cambiaron en septiembre para permitir una norma de visitas más indulgentes.

Al mismo tiempo, los brotes siguen asolando algunas residencias de mayores, a pesar de que las pruebas al personal han mejorado, así como otras medidas de seguridad. El miércoles 7, funcionarios de salud del condado de Santa Cruz informaron de un importante brote en el Post-Acute Center de Watsonville, que ha infectado a 46 residentes, matando a nueve de ellos, e infectando a 15 miembros del personal.

Funcionarios de California están presionando a las residencias y a otros centros de mayores para que faciliten el acceso al voto de los residentes. El Departamento de Salud Pública envió, el 5 de octubre, una carta a todos los centros, explicando que tienen la obligación de informar y ayudar a los residentes a votar, e indicando lo que el personal podía hacer para ayudar a los votantes.

También se incluyeron consejos sobre cómo mantener un entorno seguro durante las elecciones, controlando el número de visitantes no esenciales, utilizando adecuadamente el equipo de protección y procurando que se toquen las boletas lo menos posible.

En años anteriores, grupos cívicos como la League of Women Voters les ofrecían  presentaciones sobre lo que figuraba en la boleta. Y los candidatos locales iban a las residencias para incentivar el voto. “En el contexto de una pandemia, este año no podemos hacerlo”, explicó Michelle Bishop, directora de acceso y participación de la Red Nacional de Derechos de los Discapacitados.

Antes de la pandemia, las residencias y los centros de vivienda asistida también solían servir como lugares de votación. Los residentes podían acceder fácilmente a las cabinas de votación, a menudo instaladas en un vestíbulo o en una sala comunitaria. Esto era especialmente importante porque las residencias son más accesibles para las personas con problemas de movilidad, dijo Bishop.

De lo contrario, los centros organizaban viajes en autobús y salidas a los colegios electorales.

En California, el último día para registrarse para votar por Internet o por correo es el 19 de octubre, aunque los votantes pueden inscribirse en persona hasta el día mismo de las elecciones. Todos los votantes inscritos recibirán una boleta por correo, y las que tengan el sello postal antes del 3 de noviembre serán parte del conteo, en California, durante 17 días después de la elección.

Los activistas aseguran que es importante que los nuevos residentes en centros de adultos mayores se aseguren de que se han registrado en su nueva dirección, o que se han organizado para que les envíen la boleta desde donde solían vivir.

Otros estados también envían por correo las boletas a los votantes registrados este año, en diferentes plazos. Todos los estados permiten a los mayores, o a las personas que tienen problemas para llegar a los colegios electorales, solicitar un voto en ausencia.

Una vez que consiguen la boleta, algunos adultos mayores necesitan ayuda de la familia o del personal de sus residencias para completarla correctamente y enviársela a los funcionarios electorales. La directiva federal de flexibilizar las normas de visita podría aliviar parte de esa presión, pero la situación varía según el centro. En el caso de las personas cuyos familiares no pueden ayudarles, correspondería al personal establecer llamadas y videoconferencias entre los residentes y sus familias, o prestar ellos mismos la asistencia a los propios residentes.

Algunos estados no permiten que el personal de las residencias de mayores ayude con las boletas para evitar influir en el voto. Pero aunque puedan ayudar, los empleados tal vez están demasiado ocupados para hacerlo.

En un año en que el personal de las residencias necesita una hora extra, cada día, para ponerse el equipo de protección, no siempre hay tiempo para asegurarse de que todos los residentes estén registrados y voten, señaló el doctor Karl Steinberg, director médico del Mariner Health Central, una compañía de administración de residencias en California.

“Hay una perenne escasez de mano de obra en las residencias de mayores que se ha visto exacerbada por esta pandemia”, añadió Steinberg. “Este año, con todo el caos, el personal puede tener menos tiempo disponible para ayudar a los residentes con el voto”.

Tracy Greene Mintz, cuya empresa, Senior Care Training, forma a trabajadores para el cuidado de las personas mayores, es responsable de dotar de personal a 100 residencias en California. Dijo que empezó a hacer sonar la alarma sobre el derecho al voto en agosto.

“A los funcionarios electos no les importan las residencias de mayores, punto”, expresó Greene Mintz. “Asumen que los residentes no votan y no hacen contribuciones”.

Greene Mintz le pidió al Departamento de Salud Pública de California, que encuesta cada seis semanas a las residencias de mayores sobre el control de la infección por COVID-19, que añadiera una pregunta sobre cómo se planeaban las elecciones en los centros. El departamento se negó.

Así que organizó seminarios web con los administradores de los centros y el Secretario del Condado de Los Ángeles para revisar la información sobre cómo enviar y rastrear las boletas de ausentes.

También ha instado a los funcionarios estatales a que proporcionen un plan que las residencias puedan utilizar como modelo. Ella misma escribió uno que la Asociación de Centros de Salud de California envió por correo electrónico.

Aún así, California está mejor que otros estados, aseguró Raúl Macías, abogado del Programa Democracia en el Centro Brennan para la Justicia, un instituto de leyes y políticas públicas. En otros lugares, los residentes deben solicitar una boleta de ausente, y a veces tienen que explicar la razón que les impide votar en persona.

California también cuenta con la Declaración de Derechos del Votante, que permite a las personas designar a alguien para que les ayude a llenar y entregar su boleta. En algunos estados, como Carolina del Norte, la ayuda sólo puede provenir de equipos bipartidistas de asistencia electoral, que pueden ser más difíciles de reclutar durante una pandemia, explicó Macías.

No importa el estado del que se trate, los funcionarios electorales del estado y el condado, junto a los administradores de las residencias, deben elaborar planes de votación, señaló Bishop, de la Red por los Derechos de los Discapacitados. Esto ayudará al personal a conocer la forma adecuada de asistir a los residentes sin influir en su voto, y a los residentes a conocer su derecho al voto.

“Hay un área un poco gris sobre de quién es la responsabilidad de todo esto”, dijo Bishop. “Es uno de esos años en los que empezamos a preguntarnos: ¿De quién es la responsabilidad? ¿A quién le importa? Tenemos que hacerlo”.

Si no pueden acceder a las boletas o necesitan ayuda, los residentes de California pueden contactar al programa estatal del defensor del pueblo, que puede investigar las quejas, ayudarles a resolver el problema y llevar el caso al Departamento de Salud Pública, si no se puede arreglar.

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Los gigantes farmacéuticos Regeneron y Gilead Sciences obtuvieron el tipo de publicidad que el dinero no puede comprar luego que el presidente Donald Trump tomara sus medicamentos experimentales para tratar su infección por coronavirus, y se declarara completamente recuperado después de dejar el hospital.

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“Fue increíble. Me sentí bien de inmediato”, dijo Trump el miércoles 7 de octubre en un video posteado en Twitter. “Yo llamo a eso una cura”.

Trump elogió el cóctel de anticuerpos monoclonales de Regeneron, que imita elementos del sistema inmunológico, y mencionó un fármaco similar que Eli Lilly & Co. está investigando. El presidente también tomó remdesivir, de Gilead, un antiviral que ha acortado los tiempos de recuperación de los pacientes con COVID-19 en una investigación preliminar.

No hay evidencia científica de que alguno de estos medicamentos haya contribuido a la recuperación del presidente, ya que muchos pacientes se sienten bien sin consumirlos. Tampoco se sabe si el presidente se ha “curado”, ya que la Casa Blanca ha publicado pocos detalles sobre el curso de su enfermedad.

Sin embargo, cuando su campaña para la reelección está en la recta final, Trump no está sintiendo el afecto de las farmacéuticas a través de contribuciones. Regeneron, Gilead, Lilly y la industria en su conjunto están enviando más dinero en otra dirección.

Revirtiendo una tendencia en las contribuciones de las farmacéuticas, que enviaban mucho dinero a los republicanos, en lo que va de 2020 la industria se ha inclinado hacia los demócratas.

El cambio puede reflejar las expectativas de la industria de que gane el candidato presidencial demócrata Joe Biden, dijo Steven Billet, quien imparte cursos de cabildeo corporativo y donaciones políticas en la Universidad George Washington. Las farmacéuticas podrían usar esta “generosidad” a su favor si Biden cumple sus promesas de abordar los altos precios de los medicamentos, agregó.

En un año en el que las quejas sobre los altos precios de los medicamentos de venta bajo receta se vieron ensombrecidas por la pandemia, los donantes vinculados con las farmacéuticas han dado alrededor de $976,000 a Biden, según datos del Center for Responsive Politics (CRP).

Eso es casi tres veces las contribuciones de las farmacéuticas a Trump, quien recientemente pasó de llamar a los altos precios “estafas”, a describir a las farmacéuticas como “grandes empresas”.

“Tradicionalmente, la industria tiende a favorecer a los republicanos”, dijo Sarah Bryner, directora de investigación de CRP. “Pero este ciclo, estamos viendo que cambió”, lo que refleja en parte el mayor éxito general de los demócratas en la recaudación de fondos, explicó.

Las compañías farmacéuticas y sus grupos comerciales tienen un historial de apoyo a Trump y otros republicanos indirectamente a través de organizaciones sin fines de lucro de “dinero oscuro” difíciles de rastrear. Pero esas contribuciones pueden no ser divulgadas hasta mucho después de la elección, si es que alguna vez se conoce.

De los $177,000 que Regeneron ha otorgado hasta ahora a los candidatos federales de 2020, cuatro quintas partes se han destinado a los demócratas, incluidos $35,203 para Biden, según CRP.

Leonard Schleifer, director ejecutivo de Regeneron, un multimillonario que conoce a Trump desde hace años y pertenece al Trump National Golf Club Westchester, en Nueva York, tiene una larga historia de donaciones a los demócratas. Dio $5,400 a la carrera presidencial de Hillary Clinton en 2016 y $120,000 en 2018 a un comité de acción política que intentaba que los demócratas volvieran a controlar el Senado.

Schleifer no ha hecho donaciones políticas registradas desde el año pasado, cuando sus contribuciones fueron principalmente para su hijo, Adam Schleifer, un demócrata que se postulaba para el Congreso y que perdió en una primaria este verano.

El senador de Carolina del Norte Thom Tillis, que representa a un estado con una gran industria biotecnológica y que se postula para la reelección en una contienda reñida, ha sido el mayor receptor republicano de dólares de Regeneron para las elecciones de 2020, con un total de $5,526 hasta ahora.

“Esta es una compañía que parece que siempre ha estado comprometida con los demócratas”, dijo Billet, un ex cabildero de AT&T que enseña administración de PAC. “Y supongo que solo tienen una cultura demócrata en esta empresa”.

Un vocero de Regeneron, que solicitó una autorización de uso de emergencia para eludir el proceso de aprobación de la Administración de Alimentos y Medicamentos (FDA) para su medicamento, se negó a comentar sobre las donaciones de la campaña y dijo que la compañía continuará los ensayos clínicos.

Se espera que una dosis del medicamento cueste miles de dólares. “Los tendrás gratis”, dijo Trump sobre los medicamentos para COVID-19 que tomó. El gobierno acordó hacer que las dosis iniciales del tratamiento con anticuerpos de Regeneron “estén disponibles para el pueblo estadounidense sin costo”, dice la compañía.

Pero los detalles del contrato, incluido el precio, permanecieron en secreto. En cualquier caso, si los pacientes obtienen el medicamento sin costo directo, “no significa que no lo estén pagando”, dijo James Love, director de Knowledge Ecology International, una organización sin fines de lucro que trabaja para ampliar el acceso a la tecnología médica. “Simplemente lo pagan a través de impuestos”.

El gobierno le está dando a Regeneron $450 millones para fabricar y suministrar el cóctel de anticuerpos.

Los donantes con vínculos con Gilead también se inclinan hacia la izquierda, dando dos tercios de sus aproximadamente $284,000 en contribuciones hasta ahora en este ciclo a candidatos demócratas al Congreso y a la presidencia, muestran datos de CRP, incluidos alrededor de $36,000 a Biden.

En Lilly, donde el secretario de Salud y Servicios Humanos, Alex Azar, dirigió una vez la división estadounidense, el 54% del dinero se destinó a los demócratas y el 46% a los republicanos. Los empleados de Lilly han donado  $45,000 a Biden y $13,000 a Trump, según CRP.

Biden no acepta donaciones de PAC corporativos; todos sus dólares de Regeneron, Lilly y Gilead fueron de empleados de la farmacéutica.

Gran parte del cambio general de los laboratorios este año hacia los demócratas se produce en la carrera presidencial. Los datos de Pharma Cash to Congress de KHN que monitorea a los miembros en funciones todavía muestran una preferencia hacia los republicanos del Congreso, $6 millones hasta ahora en comparación con $4,7 millones otorgados a los demócratas.

“Joe Biden tiene a las grandes farmacéuticas, así como a las grandes tecnológicas y a los grandes bancos, en su bolsillo porque ha trabajado para ellos durante casi 50 años, en lugar de para el pueblo estadounidense”, dijo Samantha Zager, vocera de la campaña de Trump.

En la campaña electoral, Biden se ha centrado principalmente en mejorar el seguro médico. Pero también propone dejar que Medicare negocie los precios de los medicamentos, vincular los aumentos de precios a la inflación y permitir que los pacientes compren medicamentos importados.

Biden “reducirá aún más los costos de atención médica mientras expande la cobertura, pone fin a prácticas de facturación sorpresa, primas más bajas y se enfrentará a los abusos de poder de las farmacéuticas”, dijo Rosemary Boeglin, vocera de la campaña.

Antes que Trump asumiera el cargo, dijo que las compañías farmacéuticas se estaban “saliendo con la suya” por los precios que cobran. A pesar de las afirmaciones y promesas del presidente, ha hecho poco para reducir los precios de los medicamentos recetados, según expertos y verificadores de datos.

Una orden ejecutiva de Trump este mes requeriría que Medicare no pague más por los medicamentos que otras naciones desarrolladas, pero comienza con un programa de prueba y su implementación podría demorar meses o años.

Las farmacéuticas estuvieron entre los mayores beneficiarios del recorte de impuestos de 2017 de Trump, ahorrando miles de millones al poder traer a casa efectivo extranjero libre de impuestos y miles de millones más con tasas más bajas.

Elizabeth Lucas, editora de datos de KHN, colaboró con este informe.

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President Donald Trump’s COVID-19 diagnosis — and that of two dozen or more other officials in the White House and Capitol Hill — has scrambled an already confusing autumn. The president’s illness has thrown into doubt the remaining two presidential debates, and positive tests for several Republican senators may threaten the effort to push through a new Supreme Court justice before Election Day.

Meanwhile, it looks increasingly unlikely Congress will approve another round of economic relief before the election, even though that would be good for the president’s political fortunes and could help Democrats, too. And the Food and Drug Administration and the Centers for Disease Control and Prevention continue to fight for scientific credibility.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Kimberly Leonard of Business Insider and Erin Mershon of Stat News.

Among the takeaways from this week’s podcast:

• Trump’s physician, Dr. Sean Conley, has been heavily criticized for his lack of transparency about the president’s health while battling the coronavirus. Conley repeatedly said federal rules under the HIPAA law limited his ability to answer reporters’ questions. That’s because HIPAA (the Health Insurance Portability and Accountability Act of 1996) requires a patient’s consent to release medical information.
• Nonetheless, Trump’s COVID diagnosis renews questions about whether the public has a right to know the details of a president’s health status, especially this year when both candidates are older than 70. Trump’s opponent, former Vice President Joe Biden, has released only limited information, too.
• Trump’s decision to unilaterally call off negotiations on a coronavirus relief package baffled and concerned Republican lawmakers and strategists because it undermines their narrative that the Democrats have refused to budge during talks.
• Although the president has said he would support smaller stimulus bills that would help specific industries or consumers, it’s not clear what Congress would be willing to push out before the election. So, many Republican lawmakers are turning their attention to the upcoming hearings on the Supreme Court nomination of Amy Coney Barrett to rally support.
• The widespread cases of COVID-19 tied to the White House highlight the president’s messages about masks, social isolation and other protective measures and have the potential to alienate voters, especially those who have lost loved ones or know people who have been afflicted with the disease.
• Trump’s comments after coming home from the hospital urging the public to not be afraid of the virus or let it “dominate your life” have tapped into frustration by many people who have suffered from the economic consequences of the pandemic and are eager to put the issue behind them.
• In the vice presidential debate Wednesday, Democratic Sen. Kamala Harris was criticized by Vice President Mike Pence for undermining public confidence in a vaccine when she said she wouldn’t take it if it were being pushed by Trump and not endorsed by public health officials. It’s a tricky issue for Democrats who believe Trump is using the vaccine trials to generate political support and his promise of approval by Election Day is politicizing the process. Yet, they know the public is eager for a successful vaccine.

This week, Rovner also interviews Amy Howe, co-founder of SCOTUSblog and host of the “SCOTUStalk” podcast. Howe explains what the Supreme Court might do with the latest case challenging the constitutionality of the Affordable Care Act.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Atlantic’s “Trump’s Doctor Comes From a Uniquely American Brand of Medicine,” by Eleanor Cummins

Alice Miranda Ollstein: The New York Times’ “How Much Would Trump’s Coronavirus Treatment Cost Most Americans?” by Sarah Kliff

Kimberly Leonard: Business Insider’s “Meet the 30 Leaders Under 40 Who Are Transforming the Future of Hhealthcare in 2020,” by Lydia Ramsey Pflanzer

Erin Mershon: Kaiser Health News’ “Not Pandemic-Proof: Insulin Copay Caps Fall Short, Fueling Underground Exchanges,” by Markian Hawryluk

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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.

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Health insurance costs for Americans who get their coverage through work continued a relentless march upward with average family premiums rising 4% to $21,342 this year, according to a study published Thursday.

The annual survey by KFF found workers on average are paying nearly $5,600 this year toward family coverage, up from about $4,000 in 2010 and $1,600 in 2000. (KHN is an editorially independent program of KFF.)

While health insurance costs rose a modest amount in 2020, as has been the trend in recent years, they soared 55% in the past decade — more than twice the pace of inflation and wages.

About 157 million Americans rely on employer-sponsored coverage — far more than any other type of coverage, including Medicare, Medicaid and individually purchased insurance on the Affordable Care Act exchanges. More than half of employers provide insurance to at least some workers.

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“Conducted partly before the pandemic, our survey shows the burden of health costs on workers remains high, though not getting dramatically worse,” Drew Altman, KFF’s CEO, said in a statement. “Things may look different moving forward as employers grapple with the economic and health upheaval sparked by the pandemic.”

The survey was conducted from January to July as the coronavirus pandemic took hold and upended the nation’s economy. Many of the details of the employers’ plans that the researchers examined were set before the virus hit.

Since 2012, the cost of family coverage has increased 3% to 5% annually. It’s been more than 15 years since these costs were rising at double-digit rates.

Employers help shield workers from much of the cost of their health insurance premiums, though employees often feel the impact via higher deductibles, copayments and lower wages.

On average, workers pay 17% of the premium for single coverage and 27% for family coverage, the survey found. Workers at smaller companies pay 35% of the premium for family coverage, compared with 24% for larger companies, the survey found.

The average annual deductible for single coverage is now $1,644, up 25% in the past five years and 79% in the past decade.

Workers with coverage are exposed to higher costs when using the hospital since 65% have coinsurance, which means they are responsible for a fixed share of the charge, and 13% contribute a copayment, or fixed fee per visit or service. The average coinsurance for hospital admission is 20% and average copayment is $311 per hospital admission.

Workers are protected for catastrophic costs through limits set on their out-of-pocket spending in provider networks, although those amounts vary by employer: 11% face a maximum of less than $2,000, while 18% are in a plan with a maximum of $6,000 or more.

The study also noted that large employers have made it easier for workers to access care by adopting coverage for telemedicine in recent years. Nearly 9 in 10 companies that have 200 or more workers and offer insurance covered these medical appointments done via telephone or computer this year, up from fewer than 3 in 10 in 2015, according to the research. During the pandemic, telemedicine usage has increased markedly as people sought care from the safety of their home.

The KFF study is based on a telephone survey of 1,765 randomly selected nonfederal public and private employers with three or more workers from January to July.

The Trump administration’s pandemic response: decisive action that saved lives, or the greatest failure of any presidential administration? During Wednesday’s vice presidential debate, Vice President Mike Pence and the Democratic challenger, Sen. Kamala Harris of California, offered drastically different takes — from behind  plexiglass screens — on how the president has handled the COVID-19 crisis.

Pence touted problematic claims, such as that President Donald Trump’s ban on travel from China helped the nation respond to the coronavirus (PolitiFact rated a similar claim “False”) and that the country would have a vaccine in less than a year (the director of the Centers for Disease Control and Prevention said a vaccine, yet to be approved, will not be widely available until next year).

Harris said the Trump administration misled the public about how serious the virus is, pointing to briefings Trump and Pence received in January. Trump told journalist Bob Woodward in a recorded interview that he purposely downplayed it.

Our partners at PolitiFact broke down a whole gamut of claims — on fracking, the economic recovery and the Supreme Court. The highlights regarding health care and coronavirus policies follow:

Kamala Harris: “The president said [the coronavirus] was a hoax.”Rating: False

This often-repeated statement falsely attributed to Trump has its roots in a Feb. 28 rally in North Carolina. But it’s a mischaracterization of what he actually said, which was an attack on Democrats’ response to the virus.

Trump cast the Democrats’ criticism of his work as foisting a hoax on the public. “They tried the impeachment hoax,” he said. “That was not a perfect conversation. They tried anything. They tried it over and over. They’d been doing it since you got in. It’s all turning. They lost. It’s all turning. Think of it. Think of it. And this is their new hoax.”

Mike Pence: The Rose Garden event with Judge Amy Coney Barrett “was an outdoor event, which all of our scientists regularly and routinely advised.”Wrong

The event included an indoor component, during which Trump, Barrett and others posed for photos without masks. Public health officials do say outdoor activities are less risky — provided masks are worn — than indoor events, where it might be harder to keep people apart and there’s less ventilation. But attendees of the Sept. 26 White House event for the nomination of Barrett to the Supreme Court did not practice social distancing, and many did not wear masks throughout the event.

Pence: Trump “suspended all travel from China. … Joe Biden opposed that decision. He called it xenophobic and hysterical.”Misleading

There were exemptions in Trump’s travel restrictions on China. On Jan. 21, the CDC confirmed the first U.S. case of the new coronavirus: a patient in Washington state who had traveled from Wuhan, China. On Jan. 31, the Trump administration announced a ban on travelers from China, but it exempted several categories of people, including U.S. citizens and lawful permanent residents. It took effect Feb. 2.

According to The New York Times, about 40,000 people traveled from China to the United States in the two months after Trump announced travel restrictions, and 60% of people on direct flights from China were not U.S. citizens.

As for the “xenophobic and hysterical” comment, Biden has not directly said the travel restrictions were xenophobic. Around the time the Trump administration announced the restrictions, Biden said Trump had a “record of hysteria, xenophobia and fearmongering.” Biden also used the word “xenophobic” in reply to a Trump tweet about limiting entry to travelers from China in which the president described the coronavirus as the “Chinese virus.”

Harris: Obama “created within the White House an office that basically was responsible for monitoring pandemics. They got rid of it. There was a team of disease experts that President Obama and Vice President Biden dispatched to China to monitor what is now predictable and what might happen. They pulled them out.” Largely accurate

Harris described two pieces of Washington’s operation to protect against new viral threats. There was a division within the White House National Security Council. And there was a CDC office in China.

In May 2018, the top White House official in charge of the U.S. response to pandemics left the administration. Then-national security adviser John Bolton reorganized the White House global health team. Homeland security adviser Tom Bossert, who recommended strong defenses against disease and biological warfare, had left in April 2018. Neither Bossert nor the official overseeing the U.S. pandemic response was replaced. Nor were their teams, some of whose responsibilities were farmed out to other corners of the administration.

In China, the CDC program specifically charged with spotting new infectious diseases went from four American staff members in 2017 to none by 2019.

Pence: Biden’s “own chief of staff, Ron Klain, would say last year that it was pure luck, that they did everything possible wrong [with H1N1]. And we learned from that.”Needs context

Klain, Biden’s former chief of staff, spoke about H1N1 during a biosecurity conference in May 2019: “A bunch of really talented, really great people working on it, and we did every possible thing wrong. And it’s, you know, 60 million Americans got H1N1 in that period of time. And it’s just purely a fortuity that this isn’t one of the great mass casualty events in American history. It had nothing to do with us doing anything right. It just had to do with luck.”

Klain has since told Politico and FactCheck.org that his comments were taken out of context, and that they were specifically in reference to the Obama administration’s difficulties meeting the public demand for an H1N1 vaccine. He was not talking about Biden directly.

Pence: The Obama administration “left the strategic national stockpile empty.”Rating: Mostly False

The Obama administration did not leave an “empty” national stockpile. Just months before COVID cases popped up in the U.S., the former director of the stockpile described it as an $8 billion enterprise with extensive holdings of many needed items. But N95 masks, for example, had been depleted after the H1N1 outbreak in 2009.

Pence: On the nation’s COVID response, “the reality is, when you look at the Biden plan, it reads an awful lot like what President Trump and I and our task force have been doing every step of the way.”Misleading

At first glance, the Biden plan does track closely with some of the talking points advanced by the Trump administration: the need to develop and distribute a vaccine, provide COVID tests free, reduce costs for COVID treatments, and produce necessary protective equipment and ventilators. But Biden’s plan proposes many other priorities that the Trump administration has not pursued. Biden also has, throughout the campaign, followed recommendations about mask-wearing and social distancing that the administration has defied — a pattern that’s being blamed for Trump’s own infection with COVID-19 and the outbreak at the White House.

Pence: The Obama administration “left an empty and hollow plan.”Misleading

The Obama administration left a “playbook” that detailed steps to take in the event of an infectious disease outbreak. The 69-page document from 2016 was a National Security Council guidebook created to assist leaders “in coordinating a complex U.S. government response to a high-consequence emerging disease threat anywhere in the world.”

Harris: “Today they still don’t have a plan” to deal with the pandemic.Needs context

Biden said the same thing during the first presidential debate. The Trump administration does have a plan to distribute vaccines once they are produced. But experts say the administration has failed to produce a national testing plan or a national strategy to address the COVID pandemic. The administration maintains its emphasis has been on helping the economy reopen. However, it has fallen short in executing a coordinated response between the federal government and states to combat the coronavirus. More than 210,000 Americans have died of COVID-19, more deaths than in any other country.

Pence (to Harris): “The fact that you continue to undermine public confidence in a vaccine, if a vaccine emerges during the Trump administration, I think is unconscionable.”Needs context

Harris said during the debate that she would not take Trump’s word that a vaccine is effective, insisting she would instead trust the opinion of an expert, such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases: “I will be the first in line to take it, absolutely.” Harris recently suggested Trump would push a vaccine before it was ready to help his electoral chances. But Harris is voicing concerns shared by many Americans. Last month, a Pew poll found Americans are divided on whether to get a COVID vaccine, with 78% saying they are worried it will be approved too quickly.

Harris: “The president hasn’t been transparent in terms of health records.” Accurate

After Trump announced his COVID diagnosis and was admitted to Walter Reed National Military Medical Center for treatment, his physician, Dr. Sean Conley, briefed reporters on the president’s health. Conley provided selective information and declined to answer questions, such as when the president first tested positive for the disease or the condition of his lungs. Conley said he couldn’t share this information, citing HIPAA — the Health Insurance Portability and Accountability Act of 1996. Experts told us HIPAA does prohibit Conley from sharing any health information the president hasn’t authorized him to share. However, if Trump wanted his doctor to be transparent, he could waive HIPAA protections. Beyond the recent questions about his COVID infection, Trump has shared less general health information than past presidents. But no law requires presidents to disclose information about their health.

Pence: Biden and Harris support abortion “all the way up to the moment of birth.”Misleading

Biden and Harris have not said they support abortion up to the moment of birth. They say they support Roe v. Wade, the landmark Supreme Court case that legalized abortion while giving states the ability to regulate it after a certain point. Biden and Harris say they want to codify Roe v. Wade into law and are against state laws that they say violate the rulings in the case. Supporting Roe is not the same as supporting abortion up to the moment of birth, experts say.

“Because Roe allows states to prohibit abortion once a fetus is viable, agreement with the case does not indicate support for abortions ‘up to the moment of birth,’” said Darren Hutchinson, a professor at the University of Florida’s Levin College of Law.

KHN reporters Emmarie Huetteman and Victoria Knight and PolitiFact staff writers Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman and Miriam Valverde contributed to this report.

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.

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