Democrats Are Running Hard on Health Care in Georgia’s Senate Runoffs. Republicans? Not So Much.


This story is from a reporting partnership that includes WABE, NPR and KHN. It can be republished for free.

Vice President Mike Pence was the clear celebrity draw at a Nov. 20 campaign event for Georgia’s two incumbent U.S. senators, Kelly Loeffler and David Perdue. Both Republicans are fighting to keep their seats against two Democratic challengers in the runoff election set for Jan. 5.

People were so eager to see Pence at the rally in Canton, Georgia, that parking spots were scarce and a long line of cars snaked through the parking lot of a community college. Some drivers jumped the curb and parked in the grass.

Hundreds of people, many unmasked, were given temperature checks before boarding large coach buses for a short ride to the rally site. The venue was a large, open space outside the conference center, but few attendees maintained physical distance

The runoff in Georgia was triggered when no candidate in either Senate race won more than 50% of the vote in the general election on Nov. 3.

In the midst of the coronavirus pandemic and with the fate of the Affordable Care Act in question, Republicans hope the two incumbents will win reelection, thus preserving their party’s 50-48 control of the Senate.

But if the two challengers, Raphael Warnock and Jon Ossoff, win their runoffs, Democrats will gain narrow control of the Senate, with Vice President-elect Kamala Harris serving as the designated tie-breaker.

Yana De Moraes came to the rally from another Atlanta suburb, Buford. She is uninsured and, after a recent hospital stay, said the high cost of medical care was weighing on her mind.

“We would like our health care costs lowered, so it could be more affordable,” she said, with a rueful laugh. “So you don’t get another heart attack while you’re getting a bill!”

De Moraes added she’d also like to see better price controls on prescription drugs to stop pharmaceutical companies from “robbing American people.”

Others on their way to the rally said they were looking for any kind of change, ideally one that minimizes government involvement in health care.

Barry Brown made the 40-mile drive from his home in Atlanta for the rally. He’s retired but too young to qualify for Medicare, so he has ACA insurance, which he affords with the help of a federal subsidy.

“It sort of works. It’s better than nothing,” Brown said. “I would like to see an improved health care situation. I don’t know what that will be, so maybe they’ll mention that today. I’m hoping so.”

But at the rally, Loeffler only briefly mentioned her health care plan, which focuses on reducing drug prices and giving people access to insurance options that cost less but offer fewer benefits.

When it was his turn to speak, Perdue didn’t talk much about health care either, though he did take a shot at Obamacare, which he’s voted multiple times to overturn.

“Remember a little thing called the Affordable Care Act? You think that was done bipartisan?” Perdue asked the crowd. “No! It was done with a supermajority! Can you imagine what they’re gonna do if they get control of the Senate?”

As the two Republicans have campaigned throughout the state, they have consistently stoked fears about what Democrats will do, and health care policy has not led their messaging.

Their Democratic challengers, however, have been all over health care in their own speeches.

Warnock opened his runoff campaign to unseat Loeffler with a modestly attended Nov. 12 event devoted to health care. That’s also been a focus for Ossoff in his bid to win Perdue’s seat.

“This is why these Senate runoffs are so vital,” Ossoff explained at a small, physically distanced event in the shadow of the Georgia Capitol building in Atlanta on Nov. 10.

Ossoff and Warnock support adding a public insurance option to the Affordable Care Act. They also have emphasized the role Democrats will play in resurrecting key parts of the law if the U.S. Supreme Court decides to overturn it. The justices are set to make a ruling next year.

“If the Supreme Court strikes down the Affordable Care Act, it will be up to Congress to decide how to legislate such that preexisting conditions remain covered,” Ossoff said.

Voters like Janel Green, a Democrat, connect with that message. She’s from the nearby suburb of Decatur and is fighting breast cancer — for the second time. Green wondered whether her private health insurance might try to deny her coverage if the protections in the ACA disappear.

“I have to worry about whether or not next year in open enrollment that I won’t be discriminated against, that I won’t have limits that would then potentially end my life,” she said.

More than one-quarter of Georgians have preexisting conditions that could make it hard to get coverage if the ACA is struck down, according to an analysis by KFF. (KHN is an editorially independent program of KFF.)

That possibility also drove Atlanta resident Herschel Jones to support the runoff. On a recent weekday morning, he dropped by an Ossoff campaign office to pick up a yard sign.

Jones, who has diabetes, is insured through the Veterans Health Administration. He said everyone deserves access to health care.

“It’s a main issue, because the Affordable Care Act benefits all those individuals who might have preexisting conditions,” Jones said.

One likely reason Ossoff and Warnock are running so much harder on health care than Perdue and Loeffler is because that strategy paid off for Democrats in the general election, said Ken Thorpe, a health policy professor at Emory University.

President-elect Joe Biden can thank independent voters for his win in Georgia, Thorpe said, and they were drawn to him because of his promise to uphold Obamacare.

“The threat of potentially losing health insurance in the midst of this pandemic turned out to be probably the major defining issue in the election,” Thorpe said.

Polling in the days leading up to the Nov. 3 election showed Democrats were motivated on the issues of health care and the coronavirus pandemic.

For Democrats to win Georgia’s Senate seats, Thorpe said, they’ll need to stay focused on those issues. That emphasis could help them attract additional moderate voters, as well as entice those in the party base to cast ballots a second time.

“The health care issue is the probably main motivating factor that’s gonna get Democrats and independents to the polls,” he said.

Still, no Democrat has ever won a statewide runoff race in Georgia. That means that even with a strong health care message, it’ll be tough for Ossoff and Warnock to break that trend and unseat the Republicans, Thorpe said.

This story is from a reporting partnership that includes WABENPR and KHN.

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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Biden Wins, but His Health Agenda Dims With GOP Likely to Hold Senate

Former Vice President Joe Biden secured the 270 electoral votes needed to capture the White House on Saturday, major news organizations projected,  after election officials in a handful of swing states spent days in round-the-clock counting of millions of mail-in ballots and early votes.

The Democrat’s victory came after the latest tallies showed him taking an insurmountable lead in Pennsylvania, a state both Biden and President Donald Trump had long identified as vital to their election efforts.  Trump has signaled he will fight the election results in several states, filing a number of lawsuits and seeking recounts.

“America, I’m honored that you have chosen me to lead our great country,” Biden tweeted shortly after the news organizations called the race. “The work ahead of us will be hard, but I promise you this: I will be a President for all Americans — whether you voted for me or not.”

The Democratic celebration was tempered because it appeared the party would have a hard time taking back the Senate majority it lost in 2014. If that bears out, it will likely keep Biden and Democratic lawmakers from enacting many of the plans they campaigned on, including major changes in health care.

Party control of the Senate may not be determined until January — thanks to what preliminary returns suggest will be runoffs for both Senate seats in Georgia. No candidate for either seat reached the required 50% threshold.

Without a Democratic majority in the Senate, Biden will likely face strong Republican opposition to many of his top health agenda items — including lowering the eligibility age for Medicare to 60, expanding financial assistance for health insurance under the Affordable Care Act, and creating a “public option” government health plan.

However, his administration would be a bulwark to defend the ACA against Republican attacks, although the Supreme Court case challenging the health law — which will be heard next week — presents a major wild card for its future.

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Health care was a key element of Biden’s campaign, especially improving the federal response to the coronavirus pandemic. He championed the use of face masks and blasted the Trump administration for shifting to states much of the responsibility for fighting the virus and helping hospitals. He was regularly mocked by the president for wearing a mask, working and campaigning from home, and not having an in-person Democratic convention.

Even before the latest vote tallies were released late Saturday morning, Biden had begun moving toward setting up his administration. On Thursday his transition team unveiled a website, BuildBackBetter.com, although it was only one page. And the former vice president held a meeting Thursday with health and economic advisers on the pandemic.

In a brief television statement Friday night, Biden reiterated his commitment to fight the pandemic, which he said “is getting more worrisome across the country.”

“We want everyone to know on day one we are going to put our plan to control this virus into action. We can’t save any of the lives that have been lost, but we can save a lot of lives in the months ahead,” Biden said.

The electoral outcome is not the one Democrats were hoping for — or, to some extent, expecting, based on preelection polling. Andy Slavitt, who ran the Centers for Medicare & Medicaid Services during the Obama administration, noted that frustration in a tweet Wednesday. “A large disappointment is that many hoped for a significant repudiation of Trump & his indifference to human life, human suffering, his corruption, and goal of getting rid of the ACA. No matter the final total it will be hard to make that claim,” Slavitt said.

Still up in the air is how willing a Republican-led Senate will be to provide further relief to individuals, businesses and states hit hard by the pandemic, and whether they will participate in previously bipartisan efforts to curtail “surprise” out-of-network medical bills and get a handle on prescription drug prices.

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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KHN’s ‘What The Health?’: Change Is in the Air

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Assuming former Vice President Joe Biden becomes President-elect Joe Biden and Republicans retain control of the Senate, the health agenda could be very different from what Democrats campaigned on. A GOP Senate is unlikely to want to pursue many of Biden’s agenda items, including expanding eligibility for Medicare, boosting financial assistance for people who buy insurance under the Affordable Care Act, and creating a federal “public option” insurance plan.

Meanwhile, no matter who is elected, the ACA is on the line next week as the more conservative Supreme Court hears oral arguments in a case that could potentially result in its total overturn. A decision in that case is not expected until sometime next year.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Kimberly Leonard of Business Insider and Mary Ellen McIntire of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Republicans and Democrats on Capitol Hill might find common ground on some smaller — but important — issues, such as restricting surprise medical bills, which consumers get after they receive care from doctors outside their insurance network. But changes in the GOP committee chairs could dim current efforts to reduce prescription drug prices.
  • One issue that might have bipartisan support next year is enhancement of the public health system. The coronavirus pandemic has shown that parts of the system have deteriorated in recent years.
  • Democrats’ dreams of major gains in both the House and Senate failed to materialize Tuesday. That suggests that their arguments that Democrats would protect the ACA did not carry as much weight this year as they did in 2018, when the party saw success in midterm elections.
  • Although the campaign is over, there’s no clear indication that the debate on how to attack COVID-19 will become less politicized. The fear of another economic shutdown and the consequences of that for millions of Americans is driving strong — and very divided — public sentiment on the issue.
  • The Trump administration appeared to be seeking to enhance the president’s campaign in Georgia when it announced Sunday that it would allow the state to starkly revamp its offerings of ACA marketplace plans in a couple of years.

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

Julie Rovner: The New York Times’ “A New Item on Your Medical Bill: The ‘Covid’ Fee,” by Sarah Kliff and Jessica Silver-Greenberg

Joanne Kenen: PBS NewsHour’s “Amid COVID-19 Pandemic, Wisconsin Voters Choose Biden Over Trump,” by Laura Santhanam

Kimberly Leonard: The Wall Street Journal’s “States Hire Consultants for Covid-19 Help, With Mixed – and Expensive – Results,” by Jean Eaglesham and Kirsten Grind

Mary Ellen McIntire: The AP’s “Counties With Worst Virus Surges Overwhelmingly Voted Trump,” by Carla K. Johnson, Hanna Fingerhut and Pia Deshpande

To hear all our podcasts, click here.

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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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Coming Abortion Fight Could Threaten Birth Control, Too

Abortion opponents were among those most excited by the addition of Justice Amy Coney Barrett to the Supreme Court. And they had good reason to be.

As a law professor and circuit court judge, Barrett made it clear she is no fan of abortion rights. She is considered likely to vote not only to uphold restrictions on the procedure, but also, possibly, even to overturn the existing national right to abortion under the Supreme Court’s landmark rulings in Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey.

Her first opportunity to weigh in could come soon. A Mississippi ban on abortions after 15 weeks — impermissible under existing court precedents — is awaiting review by the justices, who could decide as early as this week to take up the case.

That’s the headline. But many overlook other things that could flow from a new abortion jurisprudence — such as erasing the right to birth control that the court recognized in a 1965 case, Griswold v. Connecticut. During her confirmation hearings, Barrett specifically refused to say whether she felt Griswold was correctly decided.

That was a flashing red warning light for Nancy Northup, president of the Center for Reproductive Rights, a legal advocacy group that argues cases on abortion and contraception. Roe, said Northup, is part of a century of jurisprudence based on the idea that the Constitution protects the liberty of individuals. “It began with cases about how one educates one’s children, and includes same-sex marriage, contraception and abortion,” she said. “You can’t just take Roe out and not unravel the whole fabric.”

Yet from what Barrett has said and written about the Constitution, continued Northup, “it’s clear she doesn’t believe it protects the right to personal liberty.”

Abortion rights advocates worry that the court could go beyond overturning Roe and Casey. If those precedents are overturned, abortion decisions would return to the states. But the court could go a step further and recognize “fetal personhood,” the idea that a fetus is a person with full constitutional rights from the moment of fertilization. That would create a constitutional bar to abortion, among other things, meaning even the most liberal states could not allow the procedure.

Personhood amendments were on the ballot in several states about a decade ago. They were rejected by voters even in conservative states like Mississippi after opponents argued that recognizing life at fertilization would outlaw not just abortion, without exceptions, but also things like in vitro fertilization and many forms of contraception, including some birth control pills, “morning after” pills, and intrauterine devices (IUDs) that some think could cause very early abortions by preventing a fertilized egg from implanting in the uterus. (More recent scientific evidence suggests nearly all those methods actually prevent ovulation, not  implantation.)

But an abortion law passed in Georgia in 2019 not only includes a ban on abortion at the point a heartbeat can be detected — often before a woman is aware she is pregnant — but also has a fetal personhood provision. Georgia is appealing a federal district court ruling that struck down the law as a violation of Roe.

Proponents of these personhood provisions are cautiously optimistic. “It looks like there will be a court more friendly to a challenge to Roe,” said Les Riley, interim president of the Personhood Alliance, the group pushing the concept. “But to some extent we’ve been down this road before.”

Previous courts since the early 1990s that were thought poised to overturn Roe did not.

And even if the court were to uphold a law like the Mississippi ban it is considering now, he said, “all that’s saying is they agree that states can regulate or ban abortion at 15 weeks. What we want to do is have the factual reality that life begins at conception recognized in law.”

Mary Ziegler, a law professor at Florida State University who has written two books on the abortion battle, said the court wouldn’t have to recognize fetal personhood to threaten many forms of contraception.

States could effectively ban contraception by arguing that some contraceptives act as abortifacients, she said. The court has already opened the door to this argument. In the 2014 Hobby Lobby case, it allowed some companies to decline to offer birth control coverage otherwise required by the Affordable Care Act to their employees. The owners of the companies that brought the suit said they believe some contraceptives are a form of abortion, and the court said the requirement violated their religious freedom. The court used a similar reasoning in a 2020 case exempting the Roman Catholic order Little Sisters of the Poor from even having to sign a paper that would officially exempt them from the ACA contraceptive mandate.

Medical groups and the federal government don’t consider any form of contraception approved by the Food and Drug Administration an abortion equivalent, because the standard medical definition of the start of pregnancy is when a fertilized egg implants in the uterus, not when sperm and egg first unite. Yet the court has not always followed science on the issue.

Still, Ziegler said, “personhood has always been the endgame” for abortion foes, not simply overturning Roe, which would let each state decide whether to outlaw abortion. “Allowing states to leave abortion legal has never been the endgame,” she said.

Interestingly, however, Riley of the Personhood Alliance said that while he hopes his side will win eventually, he is not necessarily hoping that win will come from the Supreme Court.

“We think the strategy has been misguided for years,” he said. “Right now, five justices can overturn anything. That’s not the system of government our founders had in mind.”

Rather, he said, his organization is working more at the state and local level “to lay the groundwork of people’s hearts being changed.”

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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Feds Approve Fractious Georgia Plan to Change ACA Marketplace

With the Trump administration announcing two days before Election Day that Georgia’s healthcare.gov website will no longer provide options for residents shopping for plans starting in 2022, consumers will need to rely on private brokers, insurance companies, agents and commercial websites.

Republican Georgia Gov. Brian Kemp, who pushed the plan, argued that this would give private entities an opening to aggressively advertise and compete for consumers and increase the number of plans sold for 2023.

The plan, which generated overwhelming opposition and almost no support during the public comment period, has been greeted warily as a test of how radically states can alter the rules of the Affordable Care Act under the Trump administration. Skeptics say Georgia’s plan would resurrect the chaotic and murky marketplace that existed before the ACA was passed, in which individual brokers would push the policies that paid the biggest commissions, even if they didn’t have the best price or offered coverage with major loopholes.

“The payoff doesn’t strike me as being there,” said Joseph Antos, a health care expert at the American Enterprise Institute, a right-leaning think tank in Washington, D.C. “I’m sure people in Georgia, just like everyone else, have had the federal website URL [healthcare.gov] pumped into their heads. The people who would be newly interested in exchange coverage are clearly not going to know where to go.”

The timing of the announcement is notable, coming on the eve of a national election in which President Donald Trump and Republicans have been on the defensive about their efforts to unravel the Affordable Care Act. Georgia has also been targeted in recent weeks by the campaign of Democratic presidential nominee Joe Biden, who visited the state last week.

It also comes just as the 2021 open enrollment period has gotten underway. The federal exemption, known as a 1332 waiver, is expected to face legal challenges, because the ACA permits states to try out different methods only if they lead to at least the same number of people getting insurance.

The number of Georgians purchasing health insurance through the federal marketplaces has declined during the Trump administration.

The Kemp administration predicts the change will increase enrollment by 6.8% for plans starting in 2023. If successful, that would partially reverse the coverage losses that have occurred under Trump. Enrollment dropped from 587,845 in 2016 to 458,437 in 2019, although it climbed a bit to 463,910 this year. Georgia’s overall drop of 21% was twice the national average decline, according to KFF data. (KHN is an editorially independent program of KFF.)

Laura Colbert, executive director at Georgians for a Healthy Future, a nonprofit advocacy group, said the enrollment decline in Georgia plans was due to increases in premiums and cuts in outreach efforts. Since Trump took office, enrollment has decreased in 39 states.

In her approval letter, Seema Verma, administrator of the federal Centers for Medicare & Medicaid Services, said the enrollment outreach set up by the Obama administration, known as the Navigator program, “has simply had limited impact on reducing the overall uninsured rate in Georgia, suggesting there may be a more effective way to reach and engage consumers. In fact, one of the key criticisms of HealthCare.gov and the implementation of the Navigator program is that it has squeezed local agents and brokers out of the market with government-funded competition.”

But there has been almost no public support for the plan, even among people within Georgia’s insurance and brokerage industries. Seventy-two of 75 organizations submitting formal comments opposed the change, and 1,746 of 1,751 individual letters favored the unified format of healthcare.gov, where all plans are listed and can be compared on price and other factors.

“Even though I was educated at an elite university, it is still difficult to be certain I am choosing the best option for my situation,” one commentator wrote. “I am certain that the proposal to force me off the exchange and into the hands of for-profit insurers or brokers will benefit them and not me.”

Christen Linke Young, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy, said Georgia’s proposal says “over and over there will be new options and new competition, but brokers already exist. The waiver doesn’t enable new options; it just takes away healthcare.gov.”

Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities, said that for people too poor to afford private plans, healthcare.gov has been an effective way to redirect consumers to state Medicaid programs. Private brokers, she said, have no such incentive to help them access public coverage. “These are thousands of people who could be lost along the way,” Straw said.

Brokers get paid more to sell short-term plans that do not have to offer as many benefits as ACA-complaint plans: on average $8.42 per member each month for the short-term plans versus $6.88 for the ACA plans, according to Georgia’s calculations. Georgia officials said that was too small a difference to “drastically” change broker behavior.

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As Georgia Reopened, Officials Knew of Severe Shortage of PPE for Health Workers

As the coronavirus crisis deepened in April, Georgia officials circulated documents showing that to get through the next month, the state would need millions more masks, gowns and other supplies than it had on hand.

The projections, obtained by KHN and other organizations in response to public records requests, provide one of the clearest pictures of the severe PPE deficits states confronted while thousands fell ill from rising COVID-19 cases, putting health workers at risk.

Georgia on April 19 had 932,620 N95 respirator masks — one of the best protections for health workers against infection — and expected to burn through nearly 7 million within a month. It urgently needed to buy 1.4 million more, according to documents obtained by the Brown Institute for Media Innovation and shared with KHN. For gowns, officials expected to go through 16.1 million in 30 days, a staggering amount compared with the 21,810 the state had at the time.

“Making progress with PPE needs. Biggest challenge now is gowns and we are working it,” Georgia Emergency Management and Homeland Security Agency Director Homer Bryson wrote on April 19 to two of Gov. Brian Kemp’s senior-most aides.

Even so, one day later, the first-term Republican governor announced he would begin to reopen the state’s economy, including gyms, restaurants, hair salons, theaters and a host of other businesses.

“We have relied on data, science and the advice of health care professionals to guide our approach and decision-making,” he said at a news conference, “putting the health and well-being of our citizens first and doing our best to protect lives and livelihoods.”

“Our state agencies and the governor felt confident in the state’s ability to meet daily PPE requests from our local emergency preparedness partners and medical facilities when Georgia began implementing its measured reopening plan,” Cody Hall, the governor’s spokesperson, said in response to questions. “We have continued to meet those needs since April.” He noted the state is now building a PPE stockpile.

A Matter of Life or Death

After Georgia eased its lockdown, COVID cases spiked. Requests for PPE from health workers in the Atlanta area escalated through April and May, according to numbers provided by the nonprofit Atlanta Beats COVID-19, which makes face shields for health workers and other residents.

According to public data on the Georgia Department of Public Health’s website, at least 80 Georgia health care workers have died from COVID-19, including after the state reopened its economy.

One was John “Derrick” Couch, a nurse practitioner who worked in Fort Oglethorpe, Georgia. Shortly after graduating with his master’s degree in nursing on May 10, the worker at Med First Immediate Care Medical Center grew sick with COVID-19. His wife, Karol, cared for him at home for a time before he was hospitalized. He died after 36 days on a ventilator, according to a GoFundMe page set up to help his family cover his health care expenses.

“Karol wants everyone to know that Covid-19 doesn’t care or discriminate. She says John would want all of his colleagues and friends in healthcare and community to demand proper equipment and protection,” it said. Med First Immediate Care did not respond to a request for comment.

Between March 16 and Aug. 9, 48 COVID-19-related complaints regarding inadequate PPE in Georgia health care facilities were closed by the Occupational Safety and Health Administration, the federal agency responsible for workplace safety. The PPE complaints accounted for the majority — roughly 6 in 10 — of Georgia’s COVID-19 complaints submitted to OSHA during the four-month period.

In April and May, “we received thousands of requests for N95 masks, but we couldn’t get our hands on the right materials to even make an N95 mask,” said Caroline Dunn, Atlanta Beats COVID-19’s communications coordinator.

Nationally, health workers continue to express alarm about protective equipment supplies as COVID-19 hot spots reemerge across the country. A National Nurses United survey in July found 87% of nurses working in hospitals reported reusing at least one piece of single-use PPE. Only a quarter of nurses surveyed felt their employers were providing a safe workplace.

“There’s really been this normalization and this acceptance that some people are going to be expendable. And that’s completely unacceptable,” said Dabney Evans, director of the Center for Humanitarian Emergencies at Emory University in Atlanta.

Another document projecting PPE supplies, dated April 10 and developed by Georgia health and emergency management officials, relied on a calculator from the U.S. Centers for Disease Control and Prevention to estimate how quickly Georgia would burn through supplies across hospitals, nursing homes, dialysis clinics, jails and prisons. The state had 527,424 N95 respirators but needed a total of nearly 1.1 million to get through the ensuing seven days. The projected need grew to 4.8 million masks when estimating supplies for the following 31 days.

It had 196,500 gloves on hand but would need more than 12.1 million to get through a week, and 54 million for 31 days. The state had about 122,000 face shields but required more than 458,000 for the coming seven days. For a month, the projected need ballooned to over 2 million.

The April 10 estimates — a day when Georgia’s new COVID-19 case count rose by about 1,000 people — were sent to the U.S. Department of Health and Human Services and Federal Emergency Management Agency as part of a broad effort to assess what states needed across health care settings to operate for at least seven days and up to a month. Federal officials asked state public health and emergency management officials to submit PPE projections daily, according to emails among state personnel, HHS and FEMA.

PPE estimates would be used “to determine projections for our region and the next hot spots within each state,” Jeanne Eckes, an HHS official working with FEMA on the federal government’s COVID-19 response, wrote in an April 3 email to officials in multiple states throughout the South, according to correspondence obtained by KHN.

Calculations Matter

Georgia officials contend the state’s estimated PPE deficits were larger early in the pandemic because projections accounted for all COVID-positive cases. Once the state had more information on how many of these positives were asymptomatic cases and how many led to hospitalizations, it could better gauge what was needed, they argued. Multiple changes were made to its burn-rate calculations, including a May 8 adjustment that replaced the total case count with hospital-based COVID cases, which reduced the projected demand for PPE.

However, multiple experts disputed the idea that knowing the number of asymptomatic patients would be relevant for PPE projections. In facilities like nursing homes and jails — both of which were accounted for in the Georgia estimates — asymptomatic individuals could spread the virus if not quarantined immediately.

“Because there’s not on-the-spot, point-of-care testing available for the most part, you have to use PPE throughout the hospital all the time,” said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security. “In this day and age, you just have to presume that everyone has COVID.”

When the state’s case count began surging in March, many COVID-19 patients treated at Tift Regional Medical Center in Tifton, Georgia, needed ICU-level care and were from nearby Dougherty County, a Georgia hot spot where hospitals were quickly overwhelmed.

“There were times to which we were down to only having a few days of PPE left,” said Dr. Kaine Brown, a physician and medical director at Tift, adding that the hospital was partly saved by donations of N95 and cloth masks. Gowns were the biggest problem. PPE supplies have since improved — as of early July, the hospital had stockpiled more than eight months’ worth of surgical masks and enough N95s and gowns to last six months and about three months, respectively.

Georgia’s stay-at-home order for most residents expired April 30; it remains in place for individuals at higher risk of severe illness.

“We were very apprehensive about [easing restrictions],” Brown said. “Those of us who had been working on the front lines knew how infectious this was.”

Since May, Georgia has reopened a broad swath of businesses. In early July, more than 1,000 health care workers signed a letter to Kemp urging him to institute a statewide mandate requiring face coverings, to close bars and nightclubs, and prohibit indoor gatherings of more than 25 people. Georgia currently bans gatherings of more than 50 people if social distancing cannot be observed.

State officials say PPE supplies have “greatly improved” since the start of the public health emergency. As of Aug. 14, the state had distributed 3.9 million N95s, 13.1 million surgical masks, 36.6 million gloves, 4.6 million gowns and 1.6 million face shields, among other items, according to the Georgia Department of Public Health. Early on, Georgia also relied on donations to bolster PPE supplies when many items were unattainable through normal supply channels, which have since become more reliable.

However, even with the increased stocks, workers still reuse protective equipment and many fret over the uncertainty about how long they can do so safely. Another community-based organization, the Atlanta chapter of Sewing Masks for Area Hospitals, said that from April to June the organization gave out over 59,000 cloth masks to 152 health care facilities in the Atlanta area, including large hospitals, such as Children’s Healthcare of Atlanta and Emory St. Joseph’s Hospital. Kayla Hittig, a co-founder of the sewing group, said that health care workers were using the cloth masks to cover their N95 or surgical masks to make them last longer.

“That’s the thing we hear the most — how often do we have to use these and how protective are they, for how long?” said Richard Lamphier, president of the Georgia Nurses Association.

Lamphier wasn’t critical of the state officials’ efforts to ensure health workers are protected.

“I think they’ve done the best they could with the situation they had,” he said.

It wasn’t enough to protect John Couch, whose family is reeling from his death.

“He was my whole life,” Karol Couch said. “My life is shattered.”

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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California GOP Consultant Rues ‘Big Mistake’ That Led to Family’s COVID Infections

SACRAMENTO — The tweet Richard Costigan posted July 23 was bluntly honest: “We tried our best to limit exposure to #COVID19 but we slipped up somewhere.”

Costigan tweeted while waiting anxiously in the parking lot of a hospital outside Sacramento. The veteran Republican political consultant had just dropped his wife, Gloria, off at the emergency room. He wasn’t allowed to go in with her.

🙏 needed 🚨! My wife is in the #ER as she can’t catch her breath. She has been having severe coughing fits that won’t stop. We tried our best to limit exposure to #COVID19 but we slipped up somewhere. I am coughing as well. This🦠 is nasty. I am waiting in parking lot.

— Richard Costigan (@richardcostigan) July 24, 2020

His thoughts traveled back to the small family gathering they had attended in Georgia nearly two weeks before with their 23-year-old daughter, Emma, and 17-year-old son, Andrew. They had planned it so carefully. Nobody wanted to get Gloria’s 88-year-old mother sick.

But here they were, Costigan’s wife battling for breath in the ER, and Costigan sitting in his car coughing.

The family’s journey since then has been one of sleeplessness, pain and worry about the future. And it’s one that Costigan, who worked as deputy chief of staff for Republican Gov. Arnold Schwarzenegger, is taking to social media and his 4,400 Twitter followers.

And our night continues to get worse – now I can’t stop coughing. I am going to need to leave Andrew in the room. #COVIDー19 is insidious – it’s like it knows you are stressed and scared and then decides what can it do to pile on. When we got here – I was fine.

— Richard Costigan (@richardcostigan) July 26, 2020

Looking back, Costigan, 54, doesn’t think he and Gloria, 53, contracted the virus on their separate flights to Georgia, where the family owns a home. The flights were nearly empty and the passengers and crew wore masks, he said.

In Georgia, the family continued its regimen of social distancing and wore masks whenever they left the house — protocols they had followed for months at home in California. And when they gathered with their relatives on that sunny Saturday in July, they were careful to space the chairs 6 feet apart in the backyard.

But they didn’t wear masks, he said, and family members went in and out of the house to grab drinks and use the restroom. “We thought we’d done everything right, and we screwed up,” Costigan said in a July 29 phone interview. “We made a big mistake.”

Now seven of the 10 family members who attended that backyard gathering are sick. Emma and Andrew don’t have any symptoms but haven’t been tested. Exactly who introduced COVID-19 to the group is unclear. No one showed signs of sickness at the time. The first person to become sick was Gloria’s sister, then her niece — then her mom.

Gloria Costigan became sick after they returned to Sacramento, spent a night in the hospital, needed an oxygen machine at home and developed COVID-related pneumonia. By Saturday, however, she no longer needed supplemental oxygen.

Folks please #MaskUp #practicesocialdistancing #StayHome – you cannot get complacent. This 🦠 just needs one small opening and 💥- as of right now half of our family has it. It is scary. Every time I cough now I worry. I can’t see my wife in the hospital.

— Richard Costigan (@richardcostigan) July 24, 2020

Costigan’s reputation as a straight shooter, respected and liked by both Democrats and Republicans, could help change minds about the virus, said Barbara O’Connor, emeritus director of the Institute for the Study of Politics and Media at California State University-Sacramento.

“I think that Richard is being very honest about what’s going on,” said O’Connor, who has known Costigan for decades. “It’s not political. It’s really human.”

Lawmakers who have responded on Twitter with messages of support include state Controller Betty Yee, and state Sens. Richard Bloom and Steve Glazer, all Democrats. Sen. Richard Pan (D-Sacramento), a physician who chairs the Senate Health Committee, has texted well wishes to Costigan.

For his followers, Costigan’s chronicles of the virus remain grim.

“I can’t go very far without needing to lay down,” he wrote in a July 25 tweet. “Been sleeping constantly last two days and the joint pain is intense.”

In another tweet two days later, the symptoms were the same:

#Coughing continues, joints ache. All I want to do is lay on the floor and sleep. I have a complete lack of energy. Every time I try to take a deep breath, I start coughing. I just don’t want to move. My wife’s O2 levels are still low even with machine.

— Richard Costigan (@richardcostigan) July 27, 2020

Gloria’s 88-year-old mom is at home with a cough, he said.

Costigan talked to California Healthline about his family’s disease odyssey and what he hopes people will take away from his COVID-19 Twitter chronicles. The interview has been edited for length and clarity.

Q: You have tweeted in such detail about the horrible symptoms you experienced. How do you feel now?

My ribs just hurt with the coughing and the fatigue, and my joints hurt. I have the sweats and vivid dreams. I sleep on the floor because it’s more comfortable than the bed.

This thing just hits like a ton of bricks. It’s also the nervousness of it. How long is it going to last? Who are we going to expose to it? I just don’t know what the end game is.

Q: What is it like at your house now?

I wear a mask inside, Gloria wears a mask inside, and Andrew wears a mask. Gloria is sleeping in Emma’s old bedroom, I’m in our bedroom, and Andrew stays upstairs. When I’m hacking, you can see the spit come out. I’m worried about getting pneumonia. That’s something I’m worried about giving to my kid. It’s not just COVID.

Our daughter can only stand on our front porch. She delivers food to us. She puts it by the door, rings the bell and stands 6 feet back.

Q: You suspect you got COVID from the family gathering in Georgia. How do you trace it to that event?

When we looked at everybody that was at the gathering, we were trying to figure it out. It started with my sister-in-law getting sick. Out of 10 of us, seven of us are sick.

We never thought of our family being the one to harm us. Sometimes, you can’t control your anger. You want to be mad at someone. Gloria and I just decided we’re not going to blame anyone. We just don’t know who had it.

Q: How has this experience been so far for you and your family?

It’s been a bizarre week. I went to Kaiser Thursday night. You drop your significant other off. You can’t go in. Off they go to the tented area and I wait in the parking lot. She is admitted. Her oxygen levels are low. She gets a CT, she gets a shot in her stomach for possible blood clots. She gets out Friday and they send oxygen tanks to your house. … She’s in her early 50s and doesn’t have any health issues [otherwise].

Saturday, my son is doubling over in pain. I end up in the ER with my son, and I start coughing. I’m getting the side eye from everyone. Thankfully, he had a kidney stone.

Q: What kind of precautions have you and your family taken these past few months?

We hadn’t been anywhere for months. It was: Stay home. Work from home. No school.

Going to the store was extremely stressful. You go to the store, mask up, glove up, you bleach your shoes when you come home, spray down your car, wash your hands, use a towel to dry your hands, the towel goes straight into the washing machine.

Our son got frustrated with us because we wouldn’t let him see his friends. He saw photos of friends of his partying at Folsom Lake. We were the hardcore parents.

Q: In posts on social media, you are asking people to wear a mask. Why do you think it’s become a political issue?

I’ve been taking flak from friends of mine because I’ve been posting “wear a mask.” Wearing a mask — somehow it has become a freedom issue. It’s not a grand conspiracy. Wearing a mask is a simple thing to do to prevent someone else from getting sick. I do not understand how this has turned into a political issue. The government has a role to play. This is a health care crisis.

It’s been a tough 48 hours – two trips the ER. First my wife, Gloria who is now home, and now Andrew who just was taken for a CT scan. Folks – this 🦠 is bad. Please Please Please take precautions. #mask #maskup #practicesocialdistancing — Our medical professionals are amazing! pic.twitter.com/nW0GZHwpji

— Richard Costigan (@richardcostigan) July 26, 2020

Q: How do you move forward in this pandemic?

We’re locking down. Nobody is coming into our circle. I don’t want it again. To see my wife this way is hard.

I want folks to realize this thing is non-discriminatory. It doesn’t matter who you are.


This KHN story first published on California Healthline, a service of the California Health Care 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.