Category Archives: Crisis Management
Cartoon – What are the Odds?
Cartoon – A Fine-Tuned Plan
Cartoon – Coronavirus Planning
Administration’s Handling of Coronavirus Threatens a Long Unemployment Crisis
On Friday, the Bureau of Labor Statistics will release employment numbers for April that are expected to show a tragic and historic increase in unemployment. Consensus estimates anticipate more than 20 million jobs lost and an unemployment rate of 16 percent—a figure that may well be an underestimate given that millions of people may not be looking for jobs, effectively exiting the labor force and reducing the labor force participation rate. Moreover, state-level unemployment claims data show that this economic pain is being felt across the country, with sharp rises in joblessness in every state. And Thursday’s jobless claims release suggests that job losses have continued at high levels since the April unemployment survey was taken.
While the immediate cause of this spike in joblessness is, of course, the necessary stay-at-home orders and social distancing measures taken to respond to the crisis, the rise in unemployment—and how long it lasts—cannot be separated from choices made by the Trump administration. In understanding the state of the economy, as well as what comes next, the following three elements of this crisis must be understood:
- The economic crisis we are facing—and the economic pain we expect in the months ahead—is the result of a failed public health response. The Trump administration ignored early warnings, misled the public, and made the coronavirus crisis worse. The fact that the administration bungled the testing regime early on in the crisis meant that the United States could never contain the virus, as other countries such as South Korea, New Zealand, and Taiwan have done. As a consequence of that failure, the United States has had to engage in social distancing that has meant economic shock in order to avoid significantly greater levels of infections and deaths. The depth and scope of the economic pain being felt is a consequence of the administration’s delayed response and complete failure take leadership during this crisis.
- The administration’s inability to put in place appropriate public health measures going forward—combined with its insistence that efforts to contain the virus should be lifted in the absence of those measures—is likely to not only prolong the public health crisis but also extend the economic pain. Rather than provide workers, businesses, and families the confidence that they can return to activity safely, the administration is taking steps that try to ignore the risk of infection, such as absolving employers of responsibility for worker safety through a liability shield or forcing workers to return to work even when they have concerns about their health. In this environment, we are likely to see decreased demand for some time to come because people will have little confidence in individual state reopening strategies disconnected from science—as we are already seeing across the country.
- By rejecting efforts that would support families, workers, and communities during this crisis, the administration and its allies in Congress are putting us on a path for continued double-digit unemployment even after the pandemic finally ends. Indeed, the Congressional Budget Office (CBO) projects that the unemployment rate—absent additional action—will be near 10 percent at the end of 2021, several months after they project social distancing as a result of the health crisis abates. By opposing efforts to provide sufficient aid to states and localities; relief to families and unemployed workers; and assistance to those struggling the most, President Donald Trump, Majority Leader Mitch McConnell (R-KY), and their allies are insisting on making this extended period of double-digit unemployment a reality.
There is an alternative path, however: Taking the necessary steps to address the public health crisis and ensure that people can go back to work safely and doing what is needed to address the immediate economic pain and avoid prolonged unemployment. As Congress and the administration consider an additional stimulus package, they should put in place necessary public health protections while providing robust aid to families, workers, and communities for as long as the crisis lasts. This will allow us to avoid double-digit unemployment from being a devastating reality for American families for the next year and a half or more.
Public health failures has driven unemployment up
The rise in unemployment over the past two months is a direct consequence of the public health crisis—one that could have taken a far less severe toll under an administration that had been better prepared for it and that had approached it more wisely. The Trump administration has failed to develop an evidence-based plan to end the coronavirus crisis. Instead, its mismanagement has resulted in widespread fear and uncertainty as to when it might be appropriate to reopen parts of the economy. President Trump did not take the pandemic seriously when cases first emerged in the United States; his administration failed to use the month of April—when the nation was largely shut down—to ramp up the testing, contact tracing, and other pieces necessary for the public health response. And now, Trump is pushing states to reopen too soon. Before people feel comfortable enough to once again venture out of their homes and reengage in work and other economic activities, we need to ensure the country has developed the necessary health infrastructure to allow us to gradually reopen our economy without sparking a second wave of infections.
The economic crisis cannot end until public health crisis is solved
The Trump administration and its allies are arguing that the way to solve the economic crisis is to open up the country, ending stay-at-home orders and engaging in aggressive efforts to force business to return to normal. But in the absence of public health measures that actually allow activity to return safely, the administration’s strategy appears to be one of “ignore and press on,” with potentially devastating results for workers and communities. This strategy includes:
- Pushing communities to lift stay-at-home orders and other public health measures before sufficient testing, tracing, isolation and ongoing surveillance is in place
- Forcing workers back on the job, even without sufficient personal protective equipment or workplace safety protections—whether by removing unemployment insurance for those who are recalled to unsafe situations or through executive actions such as those taken for the meatpacking industry
- Proposing to absolve employers of the responsibility to keep workers and communities safe through blanket immunity from liability—a measure that would do nothing to keep workers safe or build confidence in economic reopening
These steps reflect an acceptance of elevated risks of transmission, and ultimately, death. And despite the president’s rhetoric, it will make it less likely that the economy can return faster.
First, it is clear that the public isn’t going to feel safe to return to normal economic activity absent additional public health measures. A recent Washington Post-University of Maryland poll found that “67 percent say they would be uncomfortable shopping at a retail clothing store, and 78 percent would be uncomfortable eating at a sit-down restaurant.” These results were similar both in states that had loosened restrictions and those that had not and is consistent with other data. As long as people are anxious that returning to normal activities could put them at risk of contracting the virus, the economy will be unable to recover.
Second, a strategy that fails to put in place the necessary protections against spreading the virus will increase transmission among the public, and especially workers, in ways that may force additional shutdowns and prolong the period of public health crisis. In sum, prolonged public health crisis equals a prolonged state of economic distress—extending the number of months with a job market like April’s. The best approach—an approach adopted by other countries who are faring better both with their health outcomes and their economic impacts—is a national plan to fight the virus that is based on testing, tracing, and isolation.
After the pandemic ends, double-digit unemployment will persist under the current course
The CARES act provided large, necessary relief to most Americans, including assistance for workers, families, and small businesses. But this assistance will run out before the economic emergency is behind us, forcing the economy into unnecessarily prolonged hardship.
Indeed, the measures in the CARES Act both leave important gaps and will expire long before the economy is expected to return to normal. States and localities are facing extreme budget shortfalls. If action is not taken before state budget deadlines on July 1, states are likely to begin implementing layoffs of teachers and first responders and service cuts in the coming months that will cause additional job loss. Expanded unemployment insurance benefits expire at the end of July, removing an important lifeline for those out of work. While the direct payments in the CARES Act provided important assistance to families, the $1,200 per person payment will not be enough to sustain households through a prolonged crisis. The initial Paycheck Protection Program (PPP) support for small businesses has run out, and a second round of funding may soon run out too. And in important areas such as housing, food assistance, child care, and health coverage, among others, the CARES Act failed to do enough to address the hardship being felt today, let alone over a prolonged crisis—even as it provided generous aid to corporations.
As a result, under baseline projections—those that assume no further action on the part of the government—double-digit unemployment is expected to be a feature of the economy for at least the next year and a half. As noted above, the CBO estimates that the unemployment rate will remain near 10 percent at the end of 2021—many months after they predict that social distancing due to the pandemic itself ends.
Yet the Trump administration and congressional Republicans have indicated that they are prepared to accept this reality, or at best, offer solutions that do nothing to shift it. White House economic adviser Kevin Hassett said that another round of coronavirus relief legislation might not be necessary, and chief economic adviser Larry Kudlow said on Sunday that nothing has been decided yet and that “there’s kind of a pause period right now” and that “we will wait and see.” Senator McConnell has dismissed state and local aid as a “blue state bailout,” despite pain being felt in all states.
To the extent the administration or its allies have signaled a desire to act, they have focused on measures that would be woefully insufficient to address the economic challenges we face. Aside from the liability shield, Trump has signaled a push for poorly targeted corporate tax cuts or a payroll tax cut that would fail to benefit those who are out of work. An illustrative example of Trump’s approach is his call for removing limits on corporate deductions for meals and entertainment—effectively allowing companies to deduct expenses for sports tickets, golf trips, or visits to casinos—which would provide a benefit to corporations and their wealthiest executives but do little to help put money in the hands of those who need it.
A better path: a response that meets the public health and economic challenge
As it considers another package to address this crisis, Congress has the opportunity to take a path that rejects double-digit unemployment as a lasting feature of this crisis. The approach Congress should take would allow economic activity to restart safely and ensure that, as the economy restarts, we are actually getting people back to work rather than accepting a recession that keeps millions unemployed.
First, that requires a sufficient public health response. The purpose of stay-at-home orders in the first place was to suppress transmission to low levels and buy time to put in place extensive testing and contact tracing programs, but we have yet to meet those goals. Nationally, we still need to increase our testing capacity and reach at least 500,000 tests a day; scale up contact tracing—both manually and by apps that meet privacy standards—in order to isolate people who test positive as well as their contacts; and have in place a far more robust disease surveillance system.
And second, it requires an economic response that offers relief that both addresses immediate pain that families, small businesses, and communities are facing and is sufficient to build back to a stronger economy.
In particular, the package must be:
- At a scale necessary to address the crisis. We need to pursue a fiscal response that is proportional to both the public health and economic threat posed by COVID-19. The economic consequences of this crisis are staggering. Children are going hungry; households are piling massive debts; millions of homeowners are delaying their mortgage payments; small businesses in hard hit states received fewer loans than others; minority small business owners are struggling to stay open; and state and local governments are preparing for significant layoffs of teachers and first responders in the absence of federal aid. Action needs to be sufficiently large to both address the immediate hardship that families are facing and get the economy back to work. This big push for aid has to be coordinated at the national, state, and local levels. An important lesson form the Great Recession was that austerity at the level of states and localities was a key factor in delaying economic recovery for years, since states were in austerity mode from 2008 until 2012, contributing to lower GDP growth. And, in contrast to concerns raised by some congressional Republicans—concerns that were absent during the passage of nearly $2 trillion in tax cuts in 2017—we have the fiscal capacity to respond robustly, especially with interest rates near zero. Indeed, evidence suggests that increased fiscal stimulus may increase fiscal sustainability.
- Sustained for the duration of the crisis. Relief must be sustained, automatic, and available with certainty for as long as it is needed. We should learn from the Great Recession, when stimulus was insufficient and removed too soon. During that crisis, unemployment insurance expired for many workers long before the crisis had passed; fiscal aid ended long before state and fiscal budget cuts ceased being a drag on the recovery. Key measures to support the economy, such as unemployment insurance, state and local aid, and direct relief to families, should automatically extend for the duration of the economic crisis—ensuring that we are providing sufficient relief and necessary stimulus as long as is needed to support a robust recovery.
- Targeted to all the areas where Americans are feeling economic hardship. There is no silver bullet that will bring the economy back. We need a multilayered attack that addresses the root cause of the problem—the spread of the virus—and ameliorates its symptoms in the form of hardship for families, workers, small businesses, and communities. Building off the CARES Act, additional aid needs to make sure it is reaching those who have been excluded. That requires ensuring that aid is more completely available—for example, ensuring that immigrant families can access needed relief or closing loopholes that prevent workers from having access to paid leave. It also means providing much needed assistance in areas such as food assistance, child care, housing, and for people with disabilities—areas that would both address concentrated harm and support the economy going forward. Finally, the package should be designed so that—rather than exacerbating structural problems in our economy that benefited corporations over workers—it puts us on a path for a stronger economy once the crisis ends.
The administration and its allies appear content to accept a prolonged period of public health and economic harm that is a result of the mismanagement of the COVID-19 crisis to date—essentially condemning the nation to a greater toll from the virus itself and a much longer period of economic distress. It must be clear that the harsh reality of the April jobs report—and the much broader pain that has been felt over recent weeks—was the result of both failed policy decisions and mismanagement. By the same token, we have the choice going forward as to whether we accept further pain or take steps that would both keep people healthy and get Americans back to work.
I’m a nurse in a Covid-19 unit. My hospital’s leaders frighten me more than the virus.
I’m a nurse in a Covid-19 unit. My hospital’s leaders frighten me more than the virus
I’ve been a nurse for almost 10 years, working mainly on a hospital’s cardiac floor.
One day I was assigned to a makeshift intensive care unit that had previously been an observation unit for highly stable patients waiting for test results. Many of the patients in this new Covid-19 unit were intubated, with ventilators breathing for them.
When I started the shift, a trained intensive care unit nurse was crying in the supply closet. She was overwhelmed and anxious, hadn’t worked on her familiar unit in weeks, and had been told that her next shift would be an overnight one — and she had no choice in the matter.
Many of us don’t have a choice. We are assigned to work in unfamiliar units, with patients who are outside our expertise, without any training. We’re lost.
Most shifts start with nurses crying. Most shifts end that way too.
“It’s out of our hands,” we hear from hospital administrators.
Nurses who typically work in outpatient clinics are being sent to inpatient floors and assigned to care for patients who are acutely ill. Many haven’t worked at the bedside in decades. The number of patients who have fallen in this unit has risen exponentially in the past two weeks due to lack of training of outpatient nurses.
I wonder if the patients know their nurses are overwhelmed, and that many of them are scared they’ll make a deadly mistake.
“Everyone is out of their comfort zone, just hang in there,” we’re told.
Doctors have been instructed not to enter patients’ rooms unless they must as a way to minimize their exposure to the virus that causes Covid-19 while nurses go from one room to the next, medicating, bathing, turning, and comforting their patients without changing their uncomfortable personal protective equipment, since supplies are limited. This work can take hours. It is not uncommon for nurses to go all day without drinking water or eating because that would mean removing our protective gear.
During one of my shifts, a doctor at my hospital posted several TikToks he made while sitting at the nurses’ station of a busy Covid-19 unit as nurses whispered words of encouragement to patients clinging to life supported by ventilators. Over our words and the hum of the ventilators, I wondered if our patients heard music coming from this doctor’s TikToks.
“We hear your concerns, but there’s nothing we can do,” doesn’t reassure or encourage us.
One day as I worked in the makeshift ICU, one of the hospital’s leaders went floor to floor making an important delivery. She approached our nursing station in her crisp professional attire and fresh disposition, and proudly delivered a supply of makeup-removing wipes. She told us to use the wipes to clean our faces before putting on our N95 masks so we could reuse the masks later, then moved on to the next nurses’ station without asking how our staff was doing or if we needed anything. I wonder if she had noticed the nurse crying in the supply closet.
“That’s above us, we don’t make those decisions,” is passing the buck at its worst.
Excuses from hospital administrators seem to have punctuated every shift for the past six weeks. The praise and applause from hospital leadership only go so far.
I can read in my co-workers’ faces and hear from the stories they tell that the biggest danger we face is not Covid-19. It’s the hospital’s administration.
Leadership is failing us, even as we stand firm in not failing our patients. We care for your loved ones, Covid-19 or not, monitor their vital signs, give them medications, rub lotion on their backs, help them to the bathroom, and brush their hair. We FaceTime their families from our personal phones so they can see their loved ones fighting to live. This is important care that nurses are proud to provide.
The narrative is simple. Nursing, and nurses, are not valued. It’s a shame, and maybe even a deadly shame, that hospital leaders don’t care about nurses like we care for our patients.
1.4 million healthcare jobs lost in April
Healthcare lost 1.4 million jobs in April amid the COVID-19 pandemic, primarily in ambulatory healthcare services, according to the latest jobs report from the U.S. Bureau of Labor Statistics.
The April count compares to 43,000 healthcare jobs lost in March.
Within ambulatory healthcare services, April job losses included offices of dentists (503,300), offices of physicians (243,300), and offices of other healthcare practitioners (205,100).
Hospitals lost 134,900 jobs last month, compared to the 200 positions they added to the U.S. economy in March.
The April jobs report marks the second consecutive month that healthcare employment did not grow. In the 12 months prior to March — the month the World Health Organization declared the COVID-19 spread a pandemic — industry employment had grown by 374,000, according to the bureau.
Bloomberg reported the number of healthcare workers has doubled to 16 million in the last three decades, and until March, the industry has lost jobs in only four months during that period.
Overall, the U.S. lost 20.5 million jobs in April, and the unemployment rate reached 14.7 percent, the highest since the Great Depression, according to the bureau.
The unemployment rate does not reflect Americans still working who have had their hours or pay reduced, The New York Times noted.
14 health systems receiving biggest CARES Act payments
Hospitals across the U.S. received their first payments in April from the $175 billion in relief aid Congress allocated to cover expenses or lost revenues tied to the COVID-19 pandemic.
The first $50 billion in funding from the Coronavirus Aid, Relief and Economic Security Act was delivered to hospitals last month. HHS distributed $30 billion based on Medicare fee-for-service reimbursements and another $20 billion based on hospitals’ share of net patient revenue.
HHS released new data May 7, sharing where the $50 billion in funding went. The department provided a list of hospitals that received payments and agreed to the terms and conditions for receiving the relief aid as of May 4. As part of those terms, hospitals agreed not to balance bill COVID-19 patients and to submit documents showing the funds were used for expenses or lost revenue attributable to COVID-19.
Here are the 10 health systems that received the most funding:
1. Dignity Health (San Francisco): $180.3 million
2. Cleveland Clinic: $103.3 million
3. Stanford Health Care (Palo Alto, Calif.): $102.4 million
4. Memorial Hermann Health System (Houston): $92.4 million
5. NYU Langone Hospitals (New York City): $92.1 million
6. The County of Los Angeles: $80.9 million (Los Angeles County operates four hospitals)
7. Hackensack (N.J.) Meridian Health: $76.8 million
8. Florida Cancer Specialists & Research Institute (Fort Myers): $67.3 million
9. Memorial Hospital for Cancer and Allied Diseases (New York City): $64 million
10. Massachusetts General Hospital (Boston): $58.1 million
Separately, major publicly traded hospital operators disclosed how much funding they received from the CARES Act. Each company received at least $195 million.
1. HCA Healthcare (Nashville, Tenn.): $700 million
2. Tenet Healthcare (Dallas): $345 million
3. Community Health Systems (Brentwood, Tenn.): $245 million
4. Universal Health Services (King of Prussia, Pa.): $195 million
Coronavirus’ double whammy on vulnerable populations
Minorities and low-income people are more likely to become seriously ill if infected with the coronavirus, according to a new Kaiser Family Foundation analysis.
Why it matters: These populations are also less likely to be able to social distance, or have been hit hardest economically by doing so. The coronavirus may be a national problem, but its impact is most devastating to the people who were already worse off.
The big picture: Even before the virus hit, minorities suffered from worse health outcomes, in part because they’re more likely to be low-income — which is also correlated with higher rates of chronic conditions.
- People with underlying health conditions — like heart disease, chronic obstructive pulmonary disease (COPD), uncontrolled asthma, diabetes or obesity — are more vulnerable to severe illness from the novel coronavirus.
- Health care and socioeconomic disparities also exacerbate Native Americans’ and black Americans’ risk.
- And “even though the shares of Hispanic and Native Hawaiian or Pacific Islander nonelderly adults at higher risk for serious illness if infected are similar to that of White adults, these groups face disparities in other health, social, and economic factors that may contribute to barriers to health care associated with coronavirus,” KFF adds.
Between the lines: People with low-income jobs deemed essential — like grocery store workers, home health aides or delivery drivers — are also at higher risk of contracting the virus.
- Those in other low-income jobs, like in retail or restaurants, are more likely to be out of work right now or working fewer hours.
- As the fight between businesses and workers heats up in states reopening sooner than public health experts advise, low-income workers have less of an option to quit if they feel unsafe.
States face economic death spiral from Coronavirus
https://www.axios.com/coronavirus-states-economy-295ac091-9dc2-4852-be67-d070ec268d8c.html
YEAR-OVER-YEAR CHANGE IN STATE TAX REVENUES
April 2020 vs. April 2019, select states
Early numbers show how significantly the coronavirus is devastating states’ revenue streams — and could force choices between raising taxes or gutting services and laying off public employees.
Why it matters: Even as some states move toward reopening, the economic ramifications of having shut down will haunt them far into the future.
- When states can reopen, and how quickly industries are able to bounce back, could either worsen or improve projections.
What to watch: Sens. Bob Menendez (D-N.J.) and Bill Cassidy (R-La.) plan to introduce bipartisan legislation as soon as next week that would create a $500 billion fund designed to help struggling state and municipality budgets in the wake of COVID-19.
- “If there was another way to do this, I’d rather do it the other way,” Cassidy tells Axios. “But what I don’t want to happen is all this money spent for families and for employers to go to waste because cities cannot provide essential services.”
- Menendez tells Axios: “This is the time to step up to the plate.”
By the numbers: The Urban Institute has been compiling lost revenue data as states make it publicly available. So far, there are figures for about one in four states that compare this April’s state income and sales tax revenue collections against those from April 2019.
- The data shows collections dropping between 20% and more than 50%, depending on the state, senior researcher Lucy Dadayan tells Axios — and those figures could get worse as new data comes in.
- South Dakota is an outlier in the states the Urban Institute has tracked so far, in that revenues actually appear up for April. That may be largely because it is one of very few states that did not issue a stay at home order. But experts expect to see revenue declines next month.
- Although it has not yet released April sales tax numbers to enable a year-over-year comparison, California’s staggering tax revenue loss due to COVID-19 has led to an expected $54.3 billion budget shortfall through FY 2021 — including a $13.4 billion shortfall this fiscal year, the governor announced Thursday. That’s with a $21 billion surplus last year.
- New York also has yet to release April tax revenue data, but its latest budget projection has the state short as much as $13.3 billion in FY 2021, according to Dadayan’s analysis of most recent state budget projections. Illinois is looking at a more than $4.6 billion shortfall for next fiscal year.
- Arizona is projecting to be short more than half a billion dollars for this fiscal year.
- The projected shortfalls for FY 2020, which ends at the end of June for most states, is arguably a bigger problem because there isn’t much time left to make changes, per Axios’ Dan Primack.
The big picture: Democratic-leaning cities have seen the highest case and death rates. But red and blue states alike are facing serious budget shortfalls.
- That’s why some Republican senators are getting behind efforts to provide federal dollars to help states balance budgets.
- Even after accounting for state emergency savings accounts — which in many states were at an all-time high — 33 states will likely need to fill budget gaps of 5% or more, according to a recent analysis by Moody’s Analytics.
- 21 states would need to fill gaps of 10% or more.
- “Anybody is going to be overwhelmed by this — even states who were well prepared,” Dan White, director of government consulting and fiscal policy research at Moody’s Analytics, tells Axios.
Between the lines: Much of the burden will likely be pushed on struggling local governments’ plates, White said.
- Cities have also lost smaller revenue sources such as hotel occupancy fees, inspection fees and construction fees.
- Some could be forced to lay off public workers needed to combat the virus and keep the public safe — such as firefighters, paramedics, public hospital workers.
- It’s either that or raise taxes in the midst of high unemployment and financial insecurity. “That’s the death spiral,” said Menendez, who has been talking with mayors across his state.
- New York City Mayor Bill de Blasio has already said he may have to start furloughing municipal employees if the city doesn’t receive federal funds to help fill budget gaps.
Some state and local governments will wait to make tough budget decisions in the hopes that they get needed funds from Congress, which is in heated negotiations around the fourth stimulus package.
Republican lawmakers have been hesitant to provide this much federal help to states, but they’ve been warming to the idea.
- Menendez says he expects several Republican senators besides Cassidy to sign on to their proposal.
HENRY KOTULA 