Pandemia obstaculiza al preciado bloque de votantes en centros de adultos mayores

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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.

COVID-19: las farmacéuticas elogiadas por Trump mandan dinero a Biden

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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.

KHN’s ‘What the Health?’: Trump vs. COVID

Can’t see the audio player? Click here to listen on SoundCloud.

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

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.


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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Reducing Drinking Among US Veterans with Unhealthy Alcohol Use Might Improve Chronic Pain Symptoms and Reduce Other Substance Use

US veterans with unhealthy alcohol use who reduce their drinking may gain some improvement in chronic pain symptoms and use of other substances, according to a study in Alcoholism: Clinical and Experimental Research. Hazardous drinking is common in the US, and frequently co-occurs with chronic pain, depression and anxiety, and with tobacco, cannabis or cocaine use. Many people use alcohol and other substances to mask or self-manage pain and psychiatric symptoms, although there is little evidence to support such use. If, conversely, a reduction in drinking (or use of treatment for alcohol misuse) were to benefit co-occurring conditions or substance use, this could support an integrated approach to screening or treatment. The new analysis assessed the impact of drinking reduction on improvement of chronic pain, psychiatric symptoms, and other substance use among US veterans with unhealthy alcohol use – a population with high rates of these co-occurring conditions.

Job-Based Health Insurance Costs Are Up 4% This Year, 55% in Past Decade

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.

In Debate, Pence and Harris Offer Conflicting Views of Nation’s Reality

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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Young Doctor Succumbs to COVID, One of the South’s Many Health Workers Lost

It took Carrie Wanamaker several days to connect the face she saw on GoFundMe with the young woman she had met a few years before.

According to the fundraising site, Adeline Fagan, a 28-year-old resident OB-GYN, had developed a debilitating case of COVID-19 and was on a ventilator in Houston.

Scrolling through her phone, Wanamaker found the picture she took of Fagan in 2018, showing the fourth-year medical student at her side in the delivery room, beaming at Wanamaker’s pink, crying, minutes-old daughter. Fagan supported Wanamaker’s leg through the birth because the epidural paralyzed her below the waist, and they joked and laughed since Wanamaker felt loopy from the anesthesia.

“I didn’t expect my delivery to go that way,” said Wanamaker, a pediatric dentist in upstate New York. “You always hear about it being the woman screaming and cursing at her husband, but it wasn’t like that at all. We just had a really great time. She made it a really special experience for me.”

Fagan’s funeral took place Saturday.

The physician tested positive for the coronavirus in early July and died Sept. 19, after spending over two months in hospital. She had worked in a Houston emergency department, and a family member says she reused personal protective equipment day after day due to shortages.

Fagan is one of over 250 medical staff who died in Southern and Western hot spot states as the virus surged there over the summer, according to reporting by the Guardian and KHN as part of Lost on the Frontline, a project to track every U.S. health care worker death. In Texas, nine medical deaths in April soared to 33 in July, after Gov. Greg Abbott hastily pushed to reopen the state for business and then reversed course.

Among the deceased health workers who have so far been profiled by the Lost on the Frontline team, about a dozen nationwide, including Fagan, were under 30. The median age of death from COVID for medical staff is 57, compared with 78 in the general population. Around one-third of the deaths involved concerns over inadequate PPE. Protective equipment shortages are devastating for health care workers, who are at least three times more likely to become infected with the COVID virus than the general population.

“It kicked me in the gut,” said Wanamaker. “This is not what was supposed to happen. She was supposed to go out there and live her dreams and finally be able to enjoy her life after all these years of studying.”

Fagan worked at a hospital called HCA Houston Healthcare West, and had moved to Texas in 2019 after completing medical school in Buffalo, New York, a few hours from her hometown of LaFayette.

She was the second of four sisters, all pursuing or considering careers in the medical field. A younger sibling, Maureen, 23, said Fagan dealt with patients in uncomfortable or embarrassing situations with “grace,” as she had observed when she accompanied her on two medical mission trips to Haiti. “Addie was very much, ‘Do you understand? Do you have other questions? I will go over this with you a million times if need be.’”

Maureen also mentioned Fagan’s comical side — she was voted by her colleagues as the ‘most likely to be found skipping and singing down the hall to a delivery’ and prone to rolling out hammy Scottish and English accents.

Fagan “loved delivering babies, loved being part of the happy moment when a baby comes into the world, loved working with mothers,” said Dr. Dori Marshall, associate dean at the University at Buffalo medical school. But she found living by herself in Houston lonely, and in February Maureen moved down to keep her company; she could just as easily prepare for her own medical school entrance exam in Texas.

It is unclear how Fagan contracted the coronavirus, but to Maureen it seemed linked to her July rotation in the ER. HCA West is part of HCA Healthcare — the country’s largest hospital chain — and in recent months a national nurses union has complained of its “willful violation” of workplace safety protocols, including pushing infected staff to continue clocking in.

Amid national shortages, Maureen said her sister faced a particular challenge with PPE. “Adeline had an N95 mask and had her name written on it,” she said. “Adeline wore the same N95 for weeks and weeks, if not months and months.”

The CDC recommends that an N95 mask should be reused at most five times, unless a manufacturer advises otherwise. HCA West said it would not comment specifically on Maureen’s allegations, but the facility’s chief medical officer, Dr. Emily Sedgwick, said the hospital’s policies did not involve individuals constantly reusing the same mask.

“Our protocol, based on CDC guidance, includes colleagues turning in their N95 masks at the conclusion of each shift, and receiving another mask at the beginning of their next shift.” A spokesperson for HCA West, Selena Mejia, also said that hospital staff were “heartbroken” by Fagan’s death.

On July 8, Fagan arrived home with body aches, a headache and a fever, and a COVID test came back positive. For a week the sisters quarantined, and Fagan, who had asthma, used her nebulizer. But her breathing difficulties persisted, and one afternoon Maureen noticed that her sister’s lips were blue, and insisted they go to the hospital.

For two weeks, the hospital attempted to supplement Fagan’s failing lungs with oxygen. She grew so weak she wasn’t able to hold her phone up or even keep her head upright. She was transferred to another hospital, where she agreed to be put on a ventilator.

Less than a day later, she was hooked up to an ECMO device for a highly invasive treatment of last resort, in which blood is removed from the body via surgically implanted intravenous tubes, artificially oxygenated and then returned.

She lingered in this state through August, an experience documented on a blog by her software engineer father, Brant, who arrived in Houston with her mother, Mary Jane, a retired special education teacher, even though they were not allowed to visit Fagan.

The medical team tried to wean her off the machines and the nine sedatives she was at one point receiving, but as she emerged from unconsciousness she became anxious and was put back under to stop her from pulling out the tubes snaking into her body. She was able to respond to instructions to wiggle her toes. A nurse told Brant she might be suffering from “ICU psychosis,” a delirium caused by a prolonged stay in intensive care.

The family tried to speak with her daily. “The nurse told us that they have seen Adeline’s eyes tear up after we have been talking to her on the phone,” Brant wrote. “So it must be having some impact.”

On Sept. 15, her parents were at last permitted to visit. “I do not think we were prepared for what we saw, in person, when we entered her room,” he wrote. “Occasionally, Adeline would try to respond, shake her head or mouth a word or two. But her stare was glassy and you were not sure if she was in there.”

It was too much for him. “Being the softy that cannot stand it when one of my girls is hurting, [I] commenced to get lightheaded and pass out.”

Finally, on Sept. 17, it seemed Fagan was turning a corner. Still partly sedated, she was nevertheless able to sit up without support. She mouthed the words to a song, being unable to sing because a tracheostomy prevented air from passing over her vocal cords.

The next day, the ECMO tubes were removed. The day after that, Brant made his last post.

His daughter had suffered a massive brain hemorrhage, possibly because her vascular system had been weakened by the virus. Patients on ECMO also take high doses of blood thinners to prevent clots.

A neurosurgeon said that even on the remote chance Fagan survived surgery, she would be profoundly brain-damaged.

“We spent the remaining minutes hugging, comforting and talking to Adeline,” Brant wrote.

“And then the world stopped.”


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Moved by Plight of Young Heart Patient, Stranger Pays His Hospital Bill

Even with insurance, Matthew Fentress faced a medical bill of more than $10,000 after a heart operation. A cook at a senior living community in Kentucky, he figured he could never pay what he owed — until a stranger who lives 2,000 miles away stepped in to help.

“The system still failed me,” said Fentress, 31. “It was humanity that stepped up.”

Karen Fritz, a retired college professor in Las Vegas, saw part of his story on “CBS This Morning,” which partners with KHN and NPR on the crowdsourced Bill of the Month investigation. Fritz found the story online, and then she called the hospital to donate $5,000 toward Fentress’ bill.

“I’ve been a young person in college with medical bills. I just really felt convicted to help him out, to help him get beyond his financial struggles. I had no hesitation; I felt led by the Holy Spirit to do that,” said Fritz, 64, who taught business and marketing at various schools. “When you help other people, it gives you joy.”

Fentress was just 25 when doctors diagnosed him with viral cardiomyopathy, a heart disease that developed after a bout of the flu. In his six years of grappling with that chronic condition, which could lead to heart failure, he had already been sued by his hospital after missing a payment and declared bankruptcy.

Financial fears reignited this year when his cardiologist suggested he undergo an ablation procedure to restore a normal heart rhythm. He said hospital officials at Baptist Health Louisville assured him he wouldn’t be on the hook for more than $7,000, a huge stretch on his $30,000 annual salary.

Though the procedure went well, the bill filled him with dread. His portion totaled more than $10,000 for the ablation and related visits in 2019 and 2020. After an adjustment, a spokesperson for his insurer, United Healthcare, said he owed nearly $7,900. That was the same as the annual out-of-pocket maximum for in-network care under his plan, which also included a $1,500 annual deductible. Like millions of other Americans, Fentress is considered underinsured.

Fentress said he learned about Fritz’s donation when he got a call from a hospital representative. He submitted a recent pay stub to the hospital, and its financial aid program covered the rest.

Hospital officials said Fentress at one point had been under the incorrect impression that he’d have to pay big monthly payments and couldn’t apply for financial assistance because he’d gotten it before.

“Baptist Health consistently has encouraged Mr. Fentress to apply for financial assistance to provide the information we need to determine a qualifying amount,” Charles Colvin, Baptist Health’s vice president for revenue strategy, said in a statement. “We are pleased to have received the additional information needed to provide that financial assistance.”

Fentress said he’s incredibly grateful to Fritz. He plans to stay in touch with her, and he’s sending her a T-shirt he designed with a picture of a heart and the words “Be nice.”

“This is the first time ever since I was 25 that I haven’t had medical debt. It’s a wonderful feeling. It gives me a lot of peace of mind,” Fentress said. “But I feel guilty that a lot of other people are still suffering.”

Do you have an interesting medical bill you want to share with us? Tell us about it!


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Does the Federal Health Information Privacy Law Protect President Trump?

Within one day, President Donald Trump announced his COVID diagnosis and was admitted to Walter Reed National Military Medical Center for treatment. The flurry of events was stunning, confusing and triggered many questions. What was his prognosis? When was he last tested for COVID-19? What is his viral load?

The answers were elusive.

Picture the scene on Oct. 5. White House physician Dr. Sean Conley, flanked by other members of Trump’s medical team, met with reporters outside the hospital. But Conley would not disclose the results of the president’s lung scans and other vital information, invoking a federal law he said allows him to selectively provide intel on the president’s health.

“There are HIPAA rules and regulations that restrict me in sharing certain things for his safety and his own health,” he told the reporters.

The law he’s referring to, HIPAA, is the Health Insurance Portability and Accountability Act of 1996, which includes privacy protections designed to shield personal health information from disclosure without a patient’s consent.

Because this is likely to remain an issue, we decided to take a look. In what cases does HIPAA restrict the sharing of information — and is the president covered by it?

Experts agreed that he is, but several noted there are exceptions to its protections — stirring debate over the airwaves and on Twitter regarding what information about the president’s health should be released.

Explaining the Protections

HIPAA and the rules for its implementation apply to medical providers — such as doctors, dentists, pharmacists, hospitals — and most health plans that either provide or pay for medical care.

In some cases, the law permits the sharing of medical information without specific consent, such as when needed for treatment purposes or billing. Examples include doctors or hospitals sharing information with other physicians or facilities involved in the patient’s care, or information shared about tests, drugs or other medical care so bills can be sent to patients.

Other than that, without specific patient consent, the law is clear.

“The default rule under HIPAA is that health care providers may not disclose a patient’s health information. Period,” said Joy Pritts, a consultant in Washington, D.C., and a former privacy official in the Obama administration.

The experts we consulted all agreed that Trump’s doctors are bound by HIPAA. Since he is their patient, they cannot share his medical information without his consent.

Patients can allow some information to be released while demanding that other bits be withheld.

That may be why the public has been given only select details about Trump’s COVID-19 status, such as when Conley discussed the president’s blood pressure reading but not the results of his lung scans.

Trump “can pick and choose what he wants to disclose,” Pritts said.

So it is up to Trump to give his doctors the green light to report to the public on his condition.

“HIPAA does not prevent the president of the United States from authorizing the disclosure of all publicly relevant information,” said Lawrence Gostin, a professor of global health law at Georgetown University. “He can share it if he wanted to and he can tell his doctors to share it.”

Elizabeth Gray, a teaching assistant professor of health policy and management at George Washington University, said that because Conley shared some medically private information with the American public, there must have been a conversation between the president and his doctors about what was OK to include in their press briefings.

“He would have had to have given his authorization,” said Gray. In other words, Trump OK’d the details his doctors mentioned, but when follow-up questions were asked, she said, HIPAA was “a shield” because “the president hadn’t authorized the release of anything else.”

Still, beyond HIPAA, other factors could lead to less-than-complete disclosure of the president’s health.

For starters, Trump is the commander in chief, and his personal physician is a member of the military.

“If your commander in chief says, ‘I’m giving you a command — forget about HIPAA,’” said Thomas Miller, a resident fellow with the American Enterprise Institute.

Pritts and others also said the president’s physician may not be covered by HIPAA if his care is provided by the White House medical unit, which does not bill for its services or involve health insurance.

But, “whether covered by HIPAA or not, a physician has an ethical obligation to maintain patient confidentiality,” Pritts said.

And Leaks?

It’s also important to note that HIPAA applies only to health care professionals and related entities working within that sphere.

So, when Sean Spicer, former White House press secretary, tweeted on Oct. 5 that a journalist had violated HIPAA (he misspelled it as “HIPPA”) by reporting that a member of the White House press shop had COVID-19, he was wrong, said the experts.

“Journalists are not bound by HIPAA,” said Gostin.

Gray likened HIPAA in that way to a door.

“Behind that door is health care information. Hypothetically, only doctors have access to that information, and HIPAA prevents health care providers from unlocking that door,” she said. “But, once the info gets out of that door, then HIPAA no longer applies.”

And the information is likely to come out — sooner or later, said Miller. “Leaking will take care of most reporting and disclosure” about the president’s health, he said.

The Exceptions

Within HIPAA are a couple of exceptions identifying when health information can be disclosed without the authorization of the patient.

For example, the law does allow for disclosure if it “is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.”

Might that apply here, given that Trump took a ride around Walter Reed in a government SUV with Secret Service agents, or returned to a White House filled with other employees?

Jonathan Turley, a professor of public interest law at George Washington University Law School, said he doesn’t think the public health exemption would apply in this case.

“If a patient is contagious and noncompliant, doctors can make disclosure in the interest of public health,” Turley wrote in an email. “However, the team of doctors stated that they felt that it was appropriate to send President Trump back to the White House to continue to recover.”

Moreover, Turley noted that nothing was withheld that would have qualified for this exception. “The world knows that the president is COVID-positive and still likely contagious,” he wrote. “It is unclear what further information would do in order to put the world on notice.”

Some experts, however, expressed a different view. They argued that the details of when the president last tested positive would provide insight into who may have been exposed and how long he should be considered infectious and asked to isolate. Even so, the law’s public health exemption is usually interpreted to mean such information would be shared only with state and local health officials.

There are two HIPAA exceptions that apply specifically to the president, said Gray.

“They could make that disclosure to people who need to know, to the Secret Service or the vice president, but it is essentially only to protect [the president],” said Gray. “There is also an armed forces exception, but disclosures are in regards to carrying out a military mission, which doesn’t apply here.”

What about national security?

Miller, at AEI, said concerns about national security could be among the reasons for more disclosure, such as questioning a president’s ability to carry out duties. But HIPAA wasn’t designed to address this point.

Some argue that because the president is not just an average citizen, he should waive his right to medical privacy.

“The president is not just an individual; the president is the chief executive,” said Charles Stevenson, an adjunct lecturer on American foreign policy at Johns Hopkins University. “The president loses a lot of privacy because our political system, our governmental system demands it. The president always has to be available to the military and that means the state of his health is a matter of national security.”

Historical precedent

Trump is one in a long line of presidents who have not been completely transparent in sharing their medical information.

“There’s a pretty strong tradition of these things being obscured,” said John Barry, an adjunct faculty member at the Tulane University School of Public Health and Tropical Medicine. And no federal law requires a president to provide this information.

One of the most notable examples is President Woodrow Wilson, said Barry.

Wilson likely caught the so-called Spanish influenza in 1919, which was kept secret. Later that year, he had a severe stroke that disabled him, the gravity of which was also hidden from the public.

President John F. Kennedy used painkillers and other medications while in office, which wasn’t made public until years after his death.

And when President Ronald Reagan was shot in 1981, he was much closer to death than his White House spokesperson described to the public. There were also questions about Reagan’s mental acuity while in his final years in office. He was diagnosed with Alzheimer’s disease five years after his final term.

Why would White Houses want to obscure health information of presidents?

“Every White House wants the public to think the president is healthy, strong and capable of leading the country,” said Barry. “That’s consistent across parties and presidencies.”


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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Refuge in the Storm? ACA’s Role as Safety Net Is Tested by COVID Recession

The Affordable Care Act, facing its first test during a deep recession, is providing a refuge for some — but by no means all — people who have lost health coverage as the economy has been battered by the coronavirus pandemic.

New studies, from both federal and private research groups, generally indicate that when the country marked precipitous job losses from March to May — with more than 25 million people forced out of work — the loss of health insurance was less dramatic.

That’s partly because large numbers of mostly low-income workers who lost employment during the crisis were in jobs that already did not provide health insurance. It helped that many employers chose to leave furloughed and temporarily laid-off workers on the company insurance plan.

And others who lost health benefits along with their job immediately sought alternatives, such as coverage through a spouse’s or parent’s job, Medicaid or plans offered on the state-based ACA marketplaces.

From June to September, however, things weren’t as rosy. Even as the unemployment rate declined from 14.7% in April to 8.4% in August, many temporary job losses became permanent, some people who found a new job didn’t get one that came with health insurance, and others just couldn’t afford coverage.

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The upshot, studies indicate, is that even with the new options and expanded safety net created by the ACA, by the end of summer a record number of people were poised to become newly uninsured.

What’s more, those losses could deepen in the months ahead, and into 2021, if the economy doesn’t improve and Congress offers no further assistance, health policy experts and insurers say.

“It’s a very fluid situation,” said Sara Collins, vice president for health care coverage and access at the Commonwealth Fund, a New York-based health research group. “The ACA provides an important cushion, but we don’t know how much of one yet, since this is first real test of the law as a safety net in a serious recession.”

Collins also noted that accurately tracking health insurance coverage and shifts is difficult in the best of times; amid an economic meltdown, it becomes even more precarious.

Coverage Was Already on the Decline

Some 20 million people gained coverage between 2010 and 2016 under the ACA’s expansion of Medicaid and its insurance marketplaces for people without employer-based coverage. A gradually booming economy after the 2008-2009 recession also helped. The percentage of the population without health insurance declined from about 15% in 2010 to 8.8% in 2016.

But then, even as the economy continued to grow after 2016, coverage began to decline when the Trump administration and some Republican-led states took steps that undermined the law’s main aim: to expand coverage.

In 2018, 1.9 million people joined the ranks of the uninsured, and the Census Bureau reported earlier this month that an additional 1 million Americans lost coverage in 2019.

The accelerating decline is helping fuel anxiety over the fate of the ACA in the wake of the death of Supreme Court Justice Ruth Bader Ginsburg. The high court is scheduled to hear a case in November brought by Republican state officials, and supported by the Trump administration, that seeks to nullify the entire law.

In July, researchers at the Urban Institute, a Washington, D.C., think tank, forecast that around 10 million workers and their dependents would lose employer coverage in 2020. But they estimated that two-thirds of them will have found new coverage by year’s end — leaving about 3.3 million uninsured.

A more recent Urban Institute report, released Sept. 18, and using 2020 data from the Census Bureau, calculated that of the roughly 3 million people under age 65 who had lost job-based insurance between May and July, 1.4 million found coverage elsewhere — most through Medicaid — and 1.9 million became newly uninsured. Notably, 2.2 million of those who lost their coverage were between 18 and 39 years old; 1.6 million were Hispanic.

Another recent study, using different methods, reported higher numbers for the same period. The analysis released by the Economic Policy Institute last month determined that between April and July 6.2 million people lost employer coverage. The authors didn’t calculate how many found alternative coverage via Medicaid or the ACA, however.

Other findings support the notion that the health insurance loss trend shifted by mid summer. KFF, for example, published an analysis Sept. 11 showing that most companies that offered coverage to begin with chose to continue insuring furloughed and temporarily laid-off workers between March and the end of June. But as the virus continued to batter the economy, employers moved to permanently shed those jobs. (KHN is an editorially independent program of KFF.)

“The issue now is that the temporary layoffs have greatly decreased and permanent job losses, including jobs that came with health coverage, are increasing,” said Cynthia Cox, a KFF vice president and director for the Program on the ACA.

Many low-income workers who lose their jobs and don’t have coverage through a spouse or parent turn to Medicaid, the federal-state health program for low-income people. The Centers for Medicare & Medicaid Services reported last week that enrollment in Medicaid and the Children’s Health Insurance Program grew by 4 million between February and June, a nearly 6% increase since the beginning of the coronavirus crisis.

The Impact of the Marketplaces

Gains and losses of coverage in the ACA marketplace are not yet clear, experts say. The Trump administration issued a report in June indicating that 487,000 people had, between January and June, enrolled in an ACA plan via the federal website, healthcare.gov. But that report failed to say how many people dropped an ACA plan in that period — for example, because they could no longer afford the premiums.

A study by Avalere, a health research and consulting firm in Washington, D.C., has estimated that enrollment in the ACA marketplaces since March could have swelled by around 1 million. That includes new enrollees in the 13 ACA marketplaces that states, plus the District of Columbia, operate. Many of those states held a “special enrollment period” when the pandemic hit. Healthcare.gov, run by the Trump administration, did not offer a special enrollment period.

About 11 million were enrolled in an ACA plan in February. Open enrollment for coverage that would start on Jan. 1, 2021, begins Nov. 1.

Jessica Banthin, a senior health policy researcher at the Urban Institute and until 2019 deputy director for health at the Congressional Budget Office, said it’s anyone’s guess how many people who lost their job-based coverage this year will choose this option. She said numerous factors will influence people’s health insurance decisions this fall, and into 2021.

Chief among them is gauging whether they might soon get a new job, or get back an old job, that offers insurance. That may hold some people back from enrolling in an ACA plan this fall, Banthin said. Plus, buying insurance may be too expensive, especially for families more concerned with paying for housing, food and child care while going without a paycheck.

“Health insurance may not be their immediate concern,” Banthin said. “Many people’s lives have been disrupted as never before. There’s a lot of trauma out there.”

Collins of the Commonwealth Fund said that, even before the pandemic, a growing proportion of families were vulnerable to loss of coverage and care.

In a survey of more than 4,000 adults early this year, Collins and colleagues found a “persistent vulnerability among working-age adults in their ability to afford coverage and health care that could worsen if the economic downturn continues.”

In large part, that’s because 1 in 5 respondents who had coverage were “underinsured.” Underinsurance reflects the extent to which coverage leaves people at risk of high out-of-pocket costs — a situation exacerbated by widespread job loss.

“Now is absolutely not be the time for the ACA to be further undermined, let alone killed outright,” said Stan Dorn, director of the National Center for Coverage Innovation at Families USA.