El , los Centros para el Control y Prevención de Enfermedades (CDC) advirtieron que las pequeñas partículas en el aire, no solo las gotas más grandes producto de un estornudo o la tos, podrían infectar a otros. Citó en ese momento una “evidencia” creciente.

Para el 21 de septiembre, , con una nota al pie que decía que se había publicado por error y que los CDC estaban en proceso de actualizar sus recomendaciones.

La medida puso a los CDC en medio de un debate sobre cómo el coronavirus infecta a las personas. Esas pautas podrían marcar la diferencia entre tener restaurantes, bares y otros lugares donde la gente se está reuniendo a la mitad de su capacidad, o reabrir por completo.

Y generó más preguntas sobre la intromisión de la política en la agencia de salud pública y sobre si los funcionarios de la Casa Blanca están dictando qué decir a las autoridades de salud.

Entonces, ¿qué dice realmente la ciencia sobre la transmisión aérea?

Aunque es una investigación en curso, muchas de las piezas apuntan hacia el potencial de transmisión aérea.

El desafío de probar la transmisión aérea

La del sitio web de los CDC decía: “Existe una creciente evidencia de que las gotas y las partículas pueden permanecer suspendidas en el aire y ser inhaladas por otros, y viajar distancias superiores a los 6 pies (por ejemplo, durante el ensayo de un coro, en restaurantes o en clases de gimnasia.”

¿Por qué es esto tan importante? Significa que es posible que sea necesario modificar las pautas para un distanciamiento físico adecuado.

Seis pies es el punto de referencia de seguridad que ha ayudado a dar forma a la reapertura de escuelas y negocios en todo el país. El número se basa en el hallazgo de larga data de que las gotas más grandes de la tos son tan pesadas que la mayoría de ellas caen al suelo antes de llegar a los 6 pies.

Pero las gotas mucho más pequeñas pueden permanecer en el aire por más tiempo. El debate es si portan suficiente virus para infectar a otra persona. Si la respuesta es sí, las implicaciones para la vida cotidiana podrían ser sustanciales.

Donald Milton, profesor de la Escuela de Medicina de la Universidad de Maryland, ha visto muchas pruebas de que la transmisión aérea es un factor importante, pero ha enfatizado que es difícil encontrar una respuesta definitiva.

Nadie está en desacuerdo con que estar cerca de alguien con la enfermedad sea la principal amenaza. Pero Milton dijo que lo que sucede durante ese tiempo es difícil de desentrañar.

“Podría ser que alguien tosa y te infectes al recibir un golpe directo de gotas en el ojo o la boca”, dijo Milton. “O podría ser a través de una partícula en el aire que inhalas. O podrías haber tocado algo y luego tocado tu nariz o tu boca. Es algo extremadamente difícil de dilucidar”.

Dicho esto, muchos incidentes y estudios apuntan hacia la idea de que las partículas en el aire juegan un papel más importante de lo que se pensaba.

La investigación

Un grupo internacional de investigadores de China, Australia y los Estados Unidos revisó recientemente la . Concluyeron que era muy posible.

Un estudio publicado en informó que un minuto de hablar en voz alta podría producir “1,000 núcleos de gotitas que contienen virus que podrían permanecer en el aire durante más de ocho minutos”.

¿La conclusión de los autores? “Es probable que otros los inhalen y, por lo tanto, causen nuevas infecciones”.

El transporte público es un campo de pruebas clave.

, los científicos observaron a 126 pasajeros en dos autobuses que realizaban un viaje que duró aproximadamente una hora y media. Un autobús estaba libre de virus, el otro tenía un pasajero infectado. Las personas que viajaban en el autobús con el virus tuvieron 41,5 veces más probabilidades de infectarse.

Otros investigadores han analizado un : la práctica de dos horas y media de duración del coro del Skagit Valley Chorale en Mount Vernon, Washington. De las 61 personas que asistieron, hubo 53 casos confirmados y potenciales, y dos muertes.

Un estudio de la tomó muestras del aire en las habitaciones del hospital de dos pacientes con COVID. Encontraron partículas aéreas que tenían suficiente carga viral para infectar a alguien a más de 15 pies de distancia de los pacientes.

En julio, una carta abierta que pedía a las agencias de salud nacionales e internacionales que “reconozcan el potencial de propagación a través del aire” de COVID-19.

Escribieron que estudios confiables “han demostrado más allá de cualquier duda razonable que los virus se liberan durante la exhalación, el habla y la tos en microgotas lo suficientemente pequeñas como para permanecer en el aire y representar un riesgo de exposición”.

Aún así, un informe de julio de la (OMS) descubrió que si bien la transmisión aérea era posible, se necesitaba una investigación más sólida para confirmar que presenta un riesgo notable.

Milton dijo que, si los líderes de salud pública se tomaran más en serio la transmisión aérea, esto tendría algunas consecuencias. La mayor parte de la actividad comercial podría continuar, pero los restaurantes y bares, debido a que las máscaras no sirven para comer y beber, enfrentarían un obstáculo mayor.

Más allá de eso, se vuelve crítica una mayor atención a la ventilación en espacios más cerrados, al igual que el suministro de máscaras N95. .

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On , the Centers for Disease Control and Prevention warned that tiny airborne particles, not just the bigger water droplets from a sneeze or cough, could infect others. It cited growing “evidence.”

By , with a note saying it had been posted in error and the CDC was in the process of updating its recommendations.

The move put the CDC in the middle of a debate over how the coronavirus infects people. Its guidelines could make the difference between restaurants, bars and other places where people gather fully reopening sooner or much later.

And it raised more questions about politics at the public health agency and whether White House officials are dictating policy to health authorities.

So what does the science on airborne transmission actually say?

The emerging picture is a work-in-progress, but many of the pieces do point toward the potential for airborne transmission.

The Challenge of Proving Airborne Transmission

The CDC’s  said, “There is growing evidence that droplets and airborne particles can remain suspended in the air and be breathed in by others, and travel distances beyond 6 feet (for example, during choir practice, in restaurants, or in fitness classes).”

Why is this a big deal? It means the guidelines for proper physical distancing might need to be increased.

Six feet is the benchmark for safety that has helped shape the reopening of schools and businesses nationwide. The number is based on the long-held finding that larger water drops from a cough are so heavy that most of them fall to the ground before the 6-foot mark.

But much smaller droplets can hang in the air longer. The debate is whether they carry enough of the virus to infect another person. If the answer is yes, the implications for everyday life could be substantial.

University of Maryland Donald Milton School of Public Health professor Donald Milton sees plenty of evidence that airborne transmission is a major factor, but he emphasized that a definitive answer is hard to come by.

No one disagrees that being near someone with the disease is the main threat. But Milton said what happens during that time is tough to untangle.

“It could be they cough and you get infected by getting a direct hit on your eye or mouth,” Milton said. “Or could it be through an airborne particle that you inhale. Or you might have touched something and then touched your nose or your mouth. It’s fiendishly difficult to sort that out.”

That said, many incidents and studies point toward the idea that airborne particles play a bigger role than has been thought.

The Research

An international group of researchers from China, Australia and the United States recently . They concluded it was highly plausible.

A study published in the  reported that one minute of loud talking could produce “1,000 virus-containing droplet nuclei that could remain airborne for more than eight minutes.”

The authors’ conclusion? “These are likely to be inhaled by others and hence trigger new infections.”

Public transit is a key testing ground.

, scientists looked at 126 passengers on two buses making a trip that lasted about an hour and a half. One bus was virus-free, the other had one infected rider. The people on the bus with the virus were 41.5 times more likely to be infected.

Many other researchers have noted the  at the 2½-hour-long choir practice of the Skagit Valley Chorale in Mount Vernon, Washington. Of the 61 people who attended, there were 53 confirmed and potential cases and two deaths.

´¡Ìý sampled the air in the hospital rooms of two COVID patients. They found aerosol particles carrying enough viral load to infect someone more than 15 feet away from the patients.

In July, 239 researchers  that called on national and international health agencies to “recognize the potential for airborne spread” of COVID-19.

Credible studies, they wrote, “have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure.”

Still, a July  report found while airborne transmission was possible, more robust research was needed to confirm that it presents an appreciable risk.

If public health leaders take airborne transmission more seriously, Milton said, there are a few implications. Most business activity could continue, but restaurants and bars — because masks don’t fit with eating and drinking — would face a higher hurdle.

Beyond that, more attention to ventilation in more closed spaces becomes important, as does the supply of N95 masks. Those masks continue to be in short .

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With the executive order, Trump said, “This is affirmed, signed and done, so we can put that to rest.”

Health law and health policy experts say Trump has put nothing to rest.

Here’s why.

°Õ³ó±ðÌý is brief.

“It has been and will continue to be the policy of the United States to give Americans seeking healthcare more choice, lower costs, and better care and to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.”

Joe Antos with the American Enterprise Institute, a market-oriented think tank, said the order “has no technical content.”

“All it really is, is a statement that he wants one or more of his departments to come up with a plan. And he doesn’t give any guidance or the vaguest outline of what that plan should be.”

It takes more than a bill title to actually deliver guaranteed coverage. A Republican measure in the Senate is a good example. It’s called the Protect Act, but it has  that would allow insurance companies to drop coverage of certain expensive diseases from all their policies.

So far, Republican proposals  what the Affordable Care Act already provides. And University of Pennsylvania law professor Allison Hoffman said Trump’s executive order doesn’t change that.

“The language itself guarantees nothing near the protections in the Affordable Care Act, and such sweeping protections are only possible by congressional action, not regulation,” Hoffman said.

Trump and other Republicans on the campaign trail have faced repeated questioning about what will happen if the U.S. Supreme Court invalidates the Affordable Care Act. The White House is strongly behind a legal case to declare it unconstitutional. Oral arguments before the court are scheduled for .

Indiana University health law professor David Gamage said the executive order is no stopgap should the White House win that argument.

“Were the court to hold the Affordable Care Act unconstitutional, the executive order would still do nothing, because it has no enforcement power,” Gamage said.

Larry Levitt, head of health policy at KFF, a widely used source of neutral health care data,  “a pinky promise to protect people with preexisting conditions.”

Trump’s critics have said the order runs counter to the administration’s goal of undoing the Affordable Care Act. But as and others point out, there are other ways to guarantee coverage to everyone.

Lanhee Chen at Stanford University’s Hoover Institution said high-risk pools remain a popular idea in conservative circles.

“Most conservative analysts, for example, have supported a system of well-funded high-risk pools at the state level to provide protections for the impacted population,” Chen said.

High-risk pools have been around for decades. With them, the government, rather than a private insurance company, pays for a person’s care. But as with everything in health care, you don’t get something for nothing. State high-risk pools in the past lacked enough money to cover the large number of people with needs.

Hoffman said some high-risk pools charged very high premiums, making them unaffordable to many people.

Coverage for preexisting conditions is a persistent issue because so many Americans have them or fear having them in the future.

KFF estimates that  have a preexisting condition that would have led to a denial of coverage in the individual insurance market before the Affordable Care Act took effect.

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“President Trump marshaled the full resources of the federal government and directed us to forge a seamless partnership with governors across America in both parties,” Pence said during his speech Wednesday night at the Republican National Convention.

Clearly, the federal government has provided supplies and funding to states led by both parties in response to the pandemic, and Pence himself has held regular with governors in both parties. But Pence was speaking about the actions of Trump, not his own.

Pence’s comments ignored Trump’s multiple feuds, frequently with Democratic governors, about state-federal responsibilities and the pandemic response.

A Trump campaign spokesperson sent us a list of dozens of teleconferences and meetings that Trump or Pence had with ,Ìýincluding Democrats such as  and Michigan’s . In March, Trump sent a  to governors thanking them for “stepping up to help America confront this unprecedented global pandemic.” The campaign pointed to actions by administration officials to brief governors about making available supplies, such as ,Ìý, and .

Trump Argued With Governors Over COVID-19 Supplies, Tests

Early in the pandemic, Trump traded barbs with governors, especially over where the responsibility lay in .

After declaring a national emergency over the health crisis on March 13, Trump directed governors to order their own ventilators, respirators and supplies, saying the federal government is “not a shipping clerk.” Governors in both parties shot back that Trump’s stance, and the lack of coordination from Washington, left states bidding against one another and the federal government for access to critical equipment.

said it was akin to competing on eBay with all the other states plus the Federal Emergency Management Agency.

Whitmer and Maryland Gov. Larry Hogan, a Republican and then chair of the National Governors Association, were among those pleading for better coordination from FEMA to ensure that supplies were distributed based on need.

“The lack of any centralized coordination is creating a counterproductive competition between states and the federal government to secure limited supplies, driving up prices and exacerbating existing shortages,” they wrote in a joint March 30  in The Washington Post.

´¡Ìý, Trump said during a White House briefing that governors should be “appreciative” toward him and the federal government.

Speaking of Pence, Trump said: “He calls all the governors. I tell him — I mean, I’m a different type of person — I say, ‘Mike, don’t call the governor of Washington. You’re wasting your time with him. Don’t call the woman in Michigan.’” On , Trump said Whitmer was “way in over her head, she doesn’t have a clue.”

In April, Trump said that testing “is a local thing” and that states should turn to commercial labs for help. After he was ,ÌýTrump said the federal government would step up efforts to get testing supplies.

Governors also called on Trump early on to enact the , a law that gives the president authority to expedite the supply of materials for national defense, in order to ramp up production of personal protective equipment and COVID-19 testing supplies. While the president did eventually invoke the act to produce ventilators and medical equipment, he  to do so and did it sparingly. Ìý²¹²Ô»åÌý called for him to broaden its use.

Trump’s justification for slow-rolling the act was that he didn’t want the government to intervene in the private sector.

“You know, we’re a country not based on nationalizing our business,” Trump said at a coronavirus task force  on March 22. “Call a person over in Venezuela, ask them how did nationalization of their businesses work out? Not too well.”

In April, Trump said that Georgia Gov. Brian Kemp, a Republican, had reopened Georgia  In May, he criticized Pennsylvania Gov. Tom Wolf, a Democrat, for keeping parts of his state closed that Trump said were 

°Õ°ù³Ü³¾±èÌý in mid-April that it was up to him — not the governors — to decide when to reopen states on lockdown.

Some Governors Bypassed the Federal Government to Work Together

Frustrated with the responses from the Trump administration, some governors teamed up with one another to get needed supplies.

, a coalition of governors from seven Northeastern states, including New York, Connecticut, New Jersey, Rhode Island, Pennsylvania and Delaware, joined together to buy personal protective equipment and ventilators and create a unified reopening strategy.

, some governors were calling on the feds for help and not getting what they needed. There were shortages of testing supplies, as well as personal protective gear. Washington state asked for 4.2 million N95 respirators. It received a bit under 500,000. It asked for about 300,000 gowns. It got about 160,000.

On Aug. 18, a bipartisan group of governors — five Democrats and five Republicans —  they would be partnering with the Rockefeller Foundation to create a national testing strategy in the absence of federal action. The 10 states are Louisiana, Maryland, Massachusetts, Michigan, Ohio, North Carolina, Utah, Arkansas, Rhode Island and Virginia. Their goal is to buy and deploy 5 million COVID-19 antigen tests.

Feuds Between Trump Administration and States Continue

°Õ³ó±ðÌý sought to pressure states to reopen schools for in-person instruction. In July, to cut off funding if schools didn’t reopen.

This summer, the Trump administration reduced the federal share of National Guard assistance to the states to help with pandemic response, despite pleas from governors in both parties. An Aug. 3  said that the federal government would no longer continue to pay for 100% of the tab for most states and that it would be reduced to 75% as of Aug. 21.

And when the CDC unveiled new testing guidelines that downplayed the need to test people who don’t show symptoms — Ìý— Ìý²¹²Ô»åÌý said that they wouldn’t follow it. Asymptomatic people are thought to be significant spreaders of the virus.  at times praised certain responses by the Trump administration to help their states respond to the pandemic.

Our Ruling

Pence said, “President Trump marshaled the full resources of our federal government from the outset. He directed us to forge a seamless partnership with governors across America in both political parties.”

Trump and top administration officials have communicated with governors of both parties for months in meetings, phone calls and written communication. But Pence’s comment ignores that Trump has feuded with governors over state-federal responsibilities, supplies and policies for shutting down or reopening. Trump also has suggested a lesser role for the federal government and said that the handling of COVID-19 should be left to the states.

We rate this claim Mostly False.

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When Fox News host Chris Wallace noted that Trump has yet to put forward a replacement plan, Trump told him to stay tuned.

“We’re signing a health care plan within two weeks, a full and complete health care plan that the Supreme Court decision on DACA gave me the right to do,” on “Fox News Sunday.”

“The Supreme Court gave the president of the United States powers that nobody thought the president had.”

Trump said he would “do things on immigration, on health care, on other things that we’ve never done before.”

We wanted to know if the Supreme Court really did that. So we ran the president’s words by a number of people who study constitutional and administrative law. We heard several reasons why the Supreme Court might not have said what Trump thinks it said.

The Likely Source

We asked the White House press office for the basis of Trump’s assertion and never heard back. Several law professors pointed to a  by University of California-Berkeley law professor John Yoo, best known as authoring a that led to waterboarding enemy combatants during the George W. Bush administration.

In the article, Yoo argues that when the Supreme Court ruled against the administration’s rollback of Deferred Action for Childhood Arrivals, or DACA, the court made it more difficult for new presidents to unwind the policies of their predecessors.

How might this give Trump new power?

In theory, Trump could enact a policy, even one judged illegal by the courts, and the person who follows him into office would need to jump through a number of hoops to undo it.

Yoo wasn’t sure if Trump could use the argument to make sweeping changes in health care, saying it “depends on what the administration policy actually says.”

But as Yoo sees it, should Trump establish a new program, the ruling “requires his successor to follow a burdensome process, which could take a year or more, to repeal it.”

Many legal experts disagree with Yoo’s interpretation. Before we go there, we need to recap the court’s DACA decision.

Court Sends DHS Back to the Drawing Table

President Barack Obama created DACA on the grounds that every administration has to . Obama argued that it was more important to deport violent criminals, drug dealers and thieves than people who had come into the country illegally when they were little. So long as they had committed no serious offenses and met other criteria, they could apply to avoid deportation.

Under Trump, the Department of Homeland Security moved to end DACA. Supporters of the program sued, saying that under the Administrative Procedure Act, that action was arbitrary. In , a 5-4 majority on the Supreme Court agreed.

The ruling describes how Homeland Security Secretary Kirstjen Nielsen got in a procedural bind when she inherited the decision of her predecessor (Acting Secretary Elaine Duke) to end the program. She erred, Chief Justice John Roberts wrote, because instead of making the case for ending DACA as her own decision, she came up with new reasons to justify the earlier move.

“Because Nielsen chose not to take new action, she was limited to elaborating on the agency’s original reasons,” Roberts wrote. “But her reasoning bears little relationship to that of her predecessor and consists primarily of impermissible ‘post hoc rationalization.'”

The court didn’t say Homeland Security couldn’t change the policy. It said the Administrative Procedure Act requires an agency to consider the key options it faces and explain why it chose the one it picked. With DACA, it said the change needed to show a fuller vetting of its choices.

No New Power Created

So while Trump technically lost that case, he is using the ruling (and Yoo’s theory) to voice confidence that he can do things no one thought possible.

Legal scholars give several reasons that might be off the mark. Broadly, they say the court’s ruling changed nothing.

“It’s a straightforward application of long-standing administrative law doctrine that dates back at least to President Ronald Reagan,” said Cary Coglianese, director of the Penn Program on Regulation and a professor of law at the University of Pennsylvania. “Agencies have to explain why they are doing something. They have to look at the plausible alternatives and give a reason for the one they selected.”

Justice Brett Kavanaugh also did not see a new take on an old law. In his , he called the ruling on the Administrative Procedure Act “narrow.”

In a similar vein, the court left intact the specific power behind DACA of selective enforcement of the law.

“That’s an ordinary part of executive branch practice, and nothing in the Supreme Court’s DACA decision should be read to authorize anything beyond that simple practice,” said Yale University law professor Cristina Rodríguez.

The path to undoing this sort of executive action may not be as long as Yoo described. The court spelled out how Nielsen could have ended DACA without much delay, said Eric Freedman, professor of constitutional law at Hofstra University Law School.

“If she had considered other possible solutions, what she did would have been fine,” Freedman said. “She would have complied with the Administrative Procedure Act and no one would have enjoined her.”

There is also something unusual about DACA itself that makes it less of a model for other steps Trump might take.

The program was in place for quite a while before Trump tried to end it. As a result, about 700,000 people ultimately counted on it. The court said that reliance on the program should have factored into the decision to end it.

A new policy from Trump wouldn’t have time to accumulate that critical mass.

“Anything Trump does now will be enjoined tomorrow,” said Josh Blackman at the South Texas College of Law. “So there will be no reliance, and the next administration could do what it wanted.”

Blackman said the court’s ruling did create some murkiness around challenging the legality of an unwanted policy. But he said an agency could justify a change strictly for reasons of policy, not law.

Lastly, the DACA decision was about a policy not to enforce the law in certain circumstances. Robert Chesney at the University of Texas Law School said that focus also limits the scope of the ruling.

“If Trump wants to create new rules, the example does not fit in the first place,” Chesney said.

A “full and complete health care plan” and major immigration changes would likely require new government actions. Without new laws from Congress, that would be out of reach.

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Appearing on CBS News’ “Face the Nation,” Barr said the U.S. Park Police and Secret Service used “standard crowd control” methods during the June 1 action. Host Margaret Brennan reminded him that the Park Police had said chemical irritants were used.

“No, there were not chemical irritants,” . “Pepper spray is not a chemical irritant. It’s not chemical.”

Brennan interjected: “Pepper spray, you’re saying, is what was used.”

“Pepper balls. Pepper balls,” Barr clarified.

Barr’s statement about chemical irritants is wrong. The Park Police saying its units fired pepper balls, a product that contains a chemical irritant. Pepper balls are a generic term for small plastic balls that burst upon impact. They fall into the category of less-lethal impact munitions. Think of the popular mock battle game called paintball using balls filled with something other than paint.

The Park Police told PolitiFact that its officers deployed products from the PepperBall company.

The weakest variety of pepper ball contains a 0.5% concentration of the chemical irritant pelargonic acid vanillylamide, or PAVA, a . (The company offers a version that is 10 times more potent, but it is unclear if Park Police used that one.)

“PAVA primarily affects the eyes causing closure and severe pain,” according to a report by , an independent scientific body that advises the government.

The National Institutes of Health webpage on the active ingredient in PAVA, powder carries these four warning pictograms:

After the incident near the church, there was regarding which devices federal officers used to send the crowd running. While there was debate over the description of the chemicals used, the Park Police confirmed that chemical agents had been deployed.

PAVA is the synthetic version of the natural chemical found in chili peppers. For those interested in chemistry, it is formed by “the formal condensation of the amino group of 4-hydroxy-3-methoxybenzylamine with the carboxy group of nonanoic acid,” according to the .

A on less-lethal weapons said pepper balls contain “highly irritating pepper powder.”

The PepperBall company’s website says its product is good for “area saturation,” meaning anyone close to the point of impact is affected by the chemical.

As the area outside the church was cleared, multiple and reported noxious fumes that caused a burning sensation in protesters’ eyes and throats. As federal officers fired on the crowd near the church, protesters cried out that tear gas was being used.

We reached out to the Justice Department and did not hear back.

Our Ruling

Barr said federal officers used no chemical irritants to clear people away from a District of Columbia church Trump planned to visit. He said pepper balls are not chemical irritants.

The Park Police used impact munitions made by the PepperBall company. Those munitions contain PAVA, a synthetic chemical that causes extreme eye pain.

The Justice Department says pepper balls contain “highly irritating pepper powder.”

We rate Barr’s claim Pants on Fire.

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“Look, the World Health Organization offered the testing kits that they have available and to give it to us now. We refused them. We did not want to buy them. We did not want to get them from them. We wanted to make sure we had our own,” Biden said.

A similar claim about WHO test kits has also been circulating on .

The Biden campaign referred us to a that said the WHO shipped coronavirus tests to nearly 60 countries at the end of February, but the U.S. was not among them. That is technically correct, but it suggests that the United States would have been on the list under any circumstances.

The countries WHO helped are ones that lack the virology lab horsepower that exists across the United States. The outreach work by the Pan American Health Organization is a case in point.

The group is WHO’s arm in the Americas. It conducted trainings and sent materials to conduct tests to 29 nations. The list included Paraguay, Bolivia, Argentina, Chile, Belize, Costa Rica, El Salvador, Honduras, Nicaragua and many others.

The on “countries with the weakest health systems.”

“No discussions occurred between WHO and CDC about WHO providing COVID-19 tests to the United States,” said WHO spokesperson Margaret Harris. “This is consistent with experience since the United States does not ordinarily rely on WHO for reagents or diagnostic tests because of sufficient domestic capacity.”

According to interviews with several infectious-disease experts, Biden’s statement leaves out context about how countries decided on which test they’d use to identify the presence of the coronavirus.

WHO lists — including that of China, the United States, Japan, Hong Kong, Thailand, France and Germany — each one targeting different parts of the COVID-19 genetic profile.

Christopher Mores, a global health professor at George Washington University, said that when faced with an outbreak, the WHO will usually adopt the best test that a research group brings forward.

The German one became the approach WHO circulated as its preferred model.

Aid groups, such as the Pan American Health Organization, took that model and built their training and supplies around it. If the model was like the recipe in a cookbook, the supplies were the ingredients in a home meal kit from Blue Apron.

Any country could use whatever recipe it preferred, and even if the United States had picked the WHO’s protocol, it wouldn’t need the WHO to sell it the materials to follow it. Germany released its , but the U.S. decided to have the Centers for Disease Control and Prevention develop its own. That protocol was published Jan. 28.

The CDC’s test was different and more complicated than the German test. It worked in the CDC lab, but , results were inconsistent. The CDC had to resend packages with new chemical reagents.

started developing their own tests and were ready to use them, but had to wait for emergency approval from the Food and Drug Administration. All of this added up to a delay in testing capabilities, which resulted in fewer Americans being tested and an overall slower U.S. response compared with other countries.

When asked to respond to Biden’s claim, the Trump campaign pointed to multiple news stories that said it’s not uncommon for the and to develop their own tests during outbreaks, and that the CDC did so during the Ebola and Zika outbreaks. The campaign also said the CDC’s test had a compared with other diagnostic tests like those for MERS and Zika, which took months to develop. And the issue with the CDC’s protocol was not the test itself, but rather a , the campaign added.

That’s Not How It Works

While it might seem odd that the Trump administration shunned the WHO’s coronavirus test protocol, it’s normal for countries with advanced research capabilities to want to develop a measure they trust.

“I don’t know if WHO agreed to sell the kits to us, but it should never have been something we needed to do given our technological expertise and the fact we would have ‘taken kits from low- and middle-income countries’ that otherwise could not make or afford them,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, in an email.

It’s also unlikely, Mores said, that the WHO offered to sell kits to the U.S., because that’s not normally what the organization does.

“In my experience, this is never something that I would have to purchase,” he said.

Typically, Mores said, American labs have all of the basic ingredients and equipment to run the test — all that would be needed is the viral sequences and an exact testing protocol. The only catch at the moment is that supplies of those basic ingredients are stretched thin due to high demand.

Our Ruling

Biden said, “The World Health Organization offered the testing kits that they have available and to give it to us now. We refused them. We did not want to buy them.”

Biden has a point that the U.S. did not attempt to use the WHO test. But the U.S. would never have needed complete kits from WHO. Even if it had adopted the WHO testing approach, it already had access to all the necessary materials.

WHO said there was never any talk of WHO sending testing kits to the United States.

Biden’s words leave out other important context and information.

The U.S. chose to use its own test, rather than the one circulated by WHO. Other nations, such as China, Japan and France, also developed their own tests. Multiple public health experts said that is not unusual.

Biden’s emphasis on WHO offering kits is simply wrong. We rate this claim Mostly False.

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“If you like your employer-based plan, you can keep it,” Biden . “If you have private insurance, you can keep it.”

It was a time warp moment that whipped us back to 2013.

“If you like your health care plan, you can keep it,” was President Barack Obama’s go-to pitch point as he stumped for the Affordable Care Act. By our count, Obama said some version of that line 37 times without any caveats or conditions.

For millions of people buying coverage on their own — about 8% of the market — it proved wrong.

The claim earned Obama .

“Everyone knew that [Obamacare] was meant to make certain types of coverage go away,” said former Republican congressional staffer Rodney Whitlock. “He kept saying it, even when the whole goal was to push people out of bad plans, junk insurance, and into plans that met a minimum coverage standard.”

Today, with the law already in place, the removal of existing plans isn’t baked into Biden’s proposal. Whitlock and other analysts say that technically, Biden can fairly say that he’s not out to cancel anyone’s insurance.

His main idea is to set up a government-run insurance program where people would pay premiums to get covered. The public plan would go head-to-head with private carriers and, if consumers preferred it, they could buy in.

Biden would make premiums more affordable with larger subsidies than the current law. On top of that, for states that have expanded Medicaid to any adult just a bit above the federal poverty line, they would have the option to put those people into the public plan, so long as the state continued to pay Washington what it does today.

Beware The Pitfalls In Health Care

History has shown that health care promises are tough to keep. The industry has many players, each angling for advantage. People who have spent years watching how it works say Biden’s reassuring words could crumble, as employers, employees and states adjust to the new ground rules.

Biden’s proposal wouldn’t necessarily force insurers to cancel plans, said Melinda Buntin, health policy chair at Vanderbilt University School of Medicine. But don’t expect the companies that buy insurance to sit still.

“Employers — especially small businesses with lower-income workers — might choose to drop coverage if their employees would qualify for the public plan with more generous subsidies,” Buntin said.

What employers choose to do highlights a widespread feature of insurance in America. Employers decide what plans to offer their workers and, in many cases, the option is to take it or leave it. The worker’s personal preference can be irrelevant. Or, anyone who takes a new job likely moves into a new insurance plan. That would be just as true under Biden’s plan as it is today.

How any of this plays out hinges on the details of Biden’s public option, and those remain unclear. New York University’s Sherry Glied said a very generous plan could entice many workers to ditch their employer-based insurance, leaving companies with too few people to attract affordable bids from insurance companies. Glied, though, is generally optimistic that the rules would still make employer plans a cheaper deal for employees.

“The plan retains most of the benefits of employer coverage, so people would probably stick with it, and the presence of a public option paying Medicare-like rates would likely lower payment rates all around,” she said.

One clear difference between Obama’s and Biden’s use of the line is politics.

In 2009, the fear was that the government would take over the entire insurance market. Obama deployed the line “to reassure already insured Americans,” University of North Carolina-Chapel Hill health policy professor Jonathan Oberlander said.

Biden’s focus today is on his Democratic rivals.

“It is aimed partly as a critique of ‘Medicare for All’ and those Democratic presidential candidates who have endorsed Medicare for All,” Oberlander said.

That would include Bernie Sanders, Elizabeth Warren and Kamala Harris. Medicare for All would essentially ban all private insurance.

Penn Law professor Allison Hoffman credits Biden with trying to help those who slip through the cracks, because they can’t get on Medicaid or would need deeper subsidies to buy private insurance. That incremental approach might define the plan’s limits, she said.

“It might be a very effective gap filler that would not force anyone off their current coverage, but also might not motivate very many to switch to the public option,” Hoffman said.

Hoffman also noted that, while Biden spoke specifically about people keeping their private insurance, the possible impact on people covered by Medicaid expansion under Obamacare are quite different. He gives states the option to shift that group from expanded Medicaid into the public option plan.

Where that happened, those people would see their current plans disappear.

Thomas Miller at the market-oriented American Enterprise Institute takes a more negative view of Biden’s reassuring words about existing coverage. Miller cautioned that there are many ways Biden’s plan could go awry, particularly if the government throws more weight behind the public option, at the expense of private ones.

“How long you can keep your present plan is a matter of how long it can, under its current terms, remain affordable, or how long before it threatens to outcompete the public option,” Miller said. “You can have your plan until it’s not allowed to be around anymore.”

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Health care dominated early, with Sens. Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums.

But the candidates broke ranks on the details and not all of their claims stayed strictly within the lines.

Only two candidates — New York City Mayor Bill de Blasio and Warren — raised their hands in favor of banishing private insurance to install a government-sponsored Medicare for All approach.

Klobuchar, a single-payer skeptic, expressed concern about “kicking half of America off their health insurance in four years.” (That’s correct: In 2017, a majority of Americans had private coverage, with 49% getting that insurance through work, according to the .)

Former Texas Rep. Beto O’Rourke, who also supports maintaining a private insurance system, outlined his own universal health care plan, based on a  bill in Congress.

The single-payer talk set off other discussions about the role of health insurance and the cost of care. We fact-checked some of the biggest claims.

Warren: “The insurance companies last year alone sucked $23 billion in profits out of the health care system. $23 billion. And that doesn’t count the money that was paid to executives, the money that was spent lobbying Washington.”

We contacted Warren’s campaign, who directed us to a  from the National Association of Insurance Commissioners, a nonpartisan group of industry regulators. It supports her assessment.

The report says that in 2018, health insurers posted $23.4 billion in net earnings, or profits, compared with $16.1 billion a year prior.

This came up in the context of Warren’s support for eliminating private insurance under a Medicare for All system. However, the financing and price tag of such a system is unclear.

Booker: “The overhead for insurers that they charge is 15%, while Medicare’s overhead is only at 2%.”

This is a flawed comparison. Booker said administrative overhead eats up much more for private carriers than it does for Medicare, the government insurance program for seniors and the disabled. But Medicare piggybacks off the Social Security Administration, which covers costs of enrollment, payments and keeping track of patients.

Also, Medicare relies on private providers for some of its programs, and overhead charges there are higher. Medicare’s overhead is less than that of private carriers, but exact figures are elusive.

The insurance companies’ trade group, America’s Health Insurance Plans (AHIP), reported in 2018 that  went to non-health care services. That includes taxes of 4.7% and profits of 2.3%. The  that in 2018, total expenses were $740.6 billion, with administrative expenses of $9.9 billion. That comes to 1.3%, less than Booker said.

Warren: “I spent a big chunk of my life studying why families go broke, and one of the No. 1 reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance.”

Is the No. 1 reason people go broke the cost of health care? We’ve rated similar statements  — partially accurate but lacking important context.

A 2005 study Warren co-authored and a 2009 paper both found that health care expenses were a leading cause of personal bankruptcy. But these claims have come under dispute, in particular from academics who suggest that people may overstate the role medical bills play in their financial problems. Other research suggests a far narrower impact, though that, in turn, has been criticized for focusing only on adult hospitalizations.

That said, research from the  found that medical bills are a leading cause of personal debt — in 2014, the CFPB found that nearly 20% of credit reports included a medical debt tradeline.

But Rep. Tulsi Gabbard (Hawaii) drew on examples of universal health coverage in other countries to explain why she still supported some private insurance options.

Gabbard: “If you look at other countries in the world who have universal health care, every one of them has some form of a role of private insurance.”

This is correct. Virtually every country with universal health care includes a role for private insurance. Some allow it to cover services not addressed by the national plan. Others allow it as a means to get care faster. Others heavily regulate it as a principal source of coverage.

For instance, Canada, the model for the principal Medicare for All bill, allows private insurance to address prescription drug coverage, private rooms in hospitals and vision and dental care. (It is not allowed to compete with the government plan.) In England, about 10% of people — mostly wealthier people — elect for private coverage, which can yield faster access to care. Countries such as the Netherlands and Switzerland heavily regulate private coverage.

Beyond Medicare for All, candidates touched on strategies to bring down drug prices as well as other issues.

Klobuchar: “2,500 drug prices have gone up in double digits since [Donald Trump] took office.”

This is accurate, according to from Pharmacy Benefits Consultants, an industry group, which listed a number of pharmaceutical products experiencing price increases as high as 1,468%.

And the numbers are  than Klobuchar suggested.

An analysis by the Associated Press found that, between January and July 2018, more than 4,400 branded prescription drugs experienced price increases. Meanwhile, data compiled by Rx Savings Solutions found that the list price of more than 3,000 drugs went up this year.

O’Rourke: “In Texas, the single largest provider of mental health care is the county jail system.”

This is correct.

Texas jails are the largest mental health care systems in the state, according to a report from the . The , which includes a 108-bed unit, identifies itself as the largest mental health care facility in Texas.

This is not a Texas-specific issue. According to a , it is more common to see Americans getting mental health care in jails and prisons than hospitals or other dedicated treatment facilities.

Election Day is 495 days away.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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President Donald Trump has floated a plan to cut drug prices. Democratic and Republican ideas abound in Congress, where lawmakers have put more than 40 bills on the table. In 2018,Ìý targeting pricing and costs.  a move backed by the state’s Republican governor to allow imports from Canada. So far, Vermont is the only state to take that step.

Why do prescription drugs draw so much attention? Because millions of Americans rely on them, and 

America spends about on these drugs, roughly as much as the combined revenues of the top three .

That spending flows mainly in two ways: retail drugs sold at pharmacies, and drugs provided by doctors and other clinicians at hospitals, outpatient clinics and long-term care centers. Retail drugs account for about 10% of all health care spending. The doctor-administered drugs add about another 6% to 7%.

Tracking the money challenges the savviest of analysts. Between the drugmakers and the patients lie an array of middlemen, who end up masking the true prices through discounts to one another and rebates to patients.

Here are a few benchmarks to help you navigate the realm of prescription drugs.

Out-Of-Pocket Costs

With all the focus on affordability, it’s worth noting that about a third of all retail prescriptions come at no cost to the patient. Another half have an out-of-pocket cost of under $10. In recent years, the average out-of-pocket cost has fallen from about $10 to a bit over $8.

There are several reasons, including company rebates, better drug cost protections through the Affordable Care Act, and greater use of generic drugs, which are cheaper than brand-name drugs protected by patent.

But just because the pressure has eased on average doesn’t mean the financial burden isn’t intense for the relative few. A small number of people and prescriptions accounted for a huge share of the estimated total out-of-pocket costs of $57.8 billion in 2017.

The Federal Bill Grows

Even if most individuals are cushioned from rising drug prices, taxpayers, through the federal government, are not. Spending skyrocketed after the Medicare Part D prescription drug benefit took effect in 2006 and has continued to rise rapidly since.

U.S. Drug Prices Are Higher

One reason states such as Florida are interested in importing drugs from Canada is many drugs are cheaper there. The Commonwealth Fund, a New York-based health policy group, compared a basket of common drugs (of the retail sort) in the United States and several other countries. Using the American cost as a benchmark of 100, it calculated the cost in Canada, the United Kingdom, France, Germany, Switzerland and Australia.

Germany was the closest match to the American price tag, but Canada, the U.K. and Australia were all about half the cost.

Other studies reached the same general result. The U.S. Health and Human Services Department looked at the  (physician-administered drugs) and found that for 20 prices were higher in the United States. A Canadian-American research team looked at spending on primary care drugs in America and 10 other nations, including all of the ones in the Commonwealth study. It found U.S. .

Broadly, the United States spends more on drugs because prices for many drugs are higher, and patients, usually on the advice of a doctor, take newer, high-cost drugs.

Follow The Money

One of the reasons the prescription drug market poses a challenge to lawmakers is because it has many moving parts. On the payer side, there are patients, the government and employers. On the receiving end are drugmakers, wholesalers, health care plans, pharmacies and pharmacy benefit managers, which are firms that negotiate prices on behalf of payers.

The money moves around a lot, but policy analyst Allan Coukell at the Pew Charitable Trusts modeled the flow among all the players to estimate how much money ended up with each one. For 2016, the drugmakers were the top gainers, with $204 billion (on the retail side), but the pharmacies also did well with about a quarter of the total.

Lobbying

Ever since the passage of the Medicare Part D prescription drug benefit, pharmaceutical companies have invested heavily in lobbying. There was a spike in 2009 as Congress debated the Affordable Care Act, but after a short dip, spending rose again and now stands at $281 million, about where it was nearly a decade ago.

No industry group spends more on lobbying — by a long shot. The insurance industry came in a distant second at $158 million on lobbying last year.

The drug industry can’t ignore the big proposals in Washington that could change the landscape, said Georgetown University researcher Jack Hoadley.

Both Democrats and Republicans, including the White House, have bills to peg American prices to prices in Japan and Europe.

There are bills to let the government negotiate directly with drug companies to reduce prices in the Medicare program. Among the public, that approach enjoys broad bipartisan support, with  in favor.

“The fact that the administration, congressional Republicans and Democrats are all talking about drug prices is putting all stakeholders on edge,” Hoadley said.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).