npr--2020-04-27--Ex-Officials Call For $46 Billion For Tracing, Isolating In Next Coronavirus Package

Ex-Officials Call For $ 46 Billion For Tracing , Isolating In Next Coronavirus Package Two leading former federal health officials , who served in recent Republican and Democratic administrations , are spearheading a call for a $ 46 billion public health investment in a next coronavirus aid package in order to safely reopen the economy .
Andy Slavitt , former director of Medicare and Medicaid in the Obama administration , and Scott Gottlieb , a former Food and Drug Administration chief for President Trump , say that Congress needs to devote funding to help states track down people who have @ @ @ @ @ @ @ to offer resources to infected and exposed individuals who wish to self-isolate .
`` The existing public health system is currently capable of providing only a fraction of the contact tracing and voluntary self-isolation capacity required to meet the COVID-19 challenge , '' Slavitt and Gottlieb , along with a prominent group of public health officials and others , write in a letter to House and Senate leaders .
The letter was first obtained by NPR and will be released on Monday .
The officials warn that `` current testing capacity and accuracy @ @ @ @ @ @ @ that the last aid package , signed into law Friday , contained $ 25 billion for testing .
`` We believe the next step is to complement that investment with the additional support required to allow states to track and isolate infected populations , which will be a vital part of safely reopening the economy , '' they write .
The Trump administration is actively trying to reopen the economy .
To do so safely , the authors say Congress needs to spend $ 46.5 billion on three public health needs : • @ @ @ @ @ @ @ contact tracing workforce .
The officials estimate the workforce needs to increase by 180,000 until a vaccine is on the market .
• $ 4.5 billion to use vacant hotels so that infected and exposed people without a place to self-isolate have somewhere they can go so they do n't spread the virus .
• $ 30 billion to offer 18 months of income support — a per-person stipend of $ 50 a day , like jury duty — for those voluntarily self-isolating .
The authors propose Congress appropriate this funding in the @ @ @ @ @ @ @ block grants to states and territories twice annually .
The public health officials who also signed the letter include Mark McClellan , who served as both FDA commissioner and head of the Centers for Medicare & Medicaid Services under President George W. Bush ; and Vivek Murthy , former surgeon general in the Obama administration and now adviser to former Vice President Joe Biden , the presumptive Democratic presidential nominee .
But it 's significant that Slavitt and Gottlieb , who have separately advised the White House , are now joining forces on @ @ @ @ @ @ @ reopen the economy .
`` There is no silver bullet in the fight against coronavirus , '' Slavitt told NPR .
`` But if we want to get back to a more normal existence , we need to give states the tools they need to contain the virus . ''
The proposal comes as governors have struggled with competing interests of reopening their economies while keeping their communities safe .
A handful of states have taken steps to relax their social distance guidelines , including Alaska , Georgia and Tennessee .
Others , @ @ @ @ @ @ @ extended their restrictions into May .
Michigan Gov .
Gretchen Whitmer , who has come under fire from protesters , defended her stay-at-home orders Sunday , while raising Gottlieb and Slavitt 's main points .
`` What we know is that we have to have robust testing , '' she said on ABC 's This Week .
`` We have to have community tracing .
We 've got to have a plan for isolation for people that do get tested positive for COVID-19 in the future . ''
The White House has released @ @ @ @ @ @ @ when states might reopen .
It involves the states having appropriate data regarding case levels , the capacity to treat all patients , testing of health care workers and the ability to trace contacts of those infected .
On Sunday , Gottlieb raised concerns that some states were opening their economies too soon and increasing the risk of infection .
`` Georgia 's certainly not out of the woods , '' Gottlieb said on CBS 's Face The Nation .
`` They 're only testing about 1 % of the total population .
@ @ @ @ @ @ @ House would sign off on the new measure , but sources familiar with the plans say the White House has been briefed on the proposals .
Ultimately , the White House would have to sign off any package .
In the end , as Slavitt and Gottlieb argue , control of the outbreak will be the strongest factor in stimulating the U.S. economy .
`` Testing , complemented with a full contract tracing strategy , will allow states to prevent small campfires from becoming big forest fires , '' Slavitt said .

Ex-Officials Call For $46 Billion For Tracing, Isolating In Next Coronavirus Package
Enlarge this image toggle caption Alex Edelman/AFP via Getty Images Alex Edelman/AFP via Getty Images
Two leading former federal health officials who served in recent Republican and Democratic administrations are spearheading a call for a $46 billion public health investment in a future coronavirus aid package in order to safely reopen the economy.
Andy Slavitt, former director of Medicare and Medicaid in the Obama administration, and Scott Gottlieb, a former Food and Drug Administration chief for President Trump, say that Congress needs to devote funding to help states track down people who have been exposed to the coronavirus, and to offer resources to infected and exposed individuals who wish to self-isolate.
"The existing public health system is currently capable of providing only a fraction of the contact tracing and voluntary self-isolation capacity required to meet the COVID-19 challenge," Slavitt and Gottlieb, along with a prominent group of public health officials and others, write in a letter to House and Senate leaders.
Politics Listen: Scott Gottlieb And Andy Slavitt On 'Morning Edition' About Congressional Letter Call For Public Health Investment In Next Congressional COVID-19 Aid Package Listen · 11:19 11:19
The letter was first obtained by NPR and will be released on Monday.
The officials warn that "current testing capacity and accuracy must be improved," but note that the last aid package, signed into law Friday, contained $25 billion for testing.
"We believe the next step is to complement that investment with the additional support required to allow states to track and isolate infected populations, which will be a vital part of safely reopening the economy," they write.
The Trump administration is actively trying to reopen the economy. To do so safely, the authors say Congress needs to spend $46.5 billion on three public health needs:
$12 billion to help expand the contact tracing workforce. The officials estimate the workforce needs to increase by 180,000 until a vaccine is on the market.
$4.5 billion to use vacant hotels so that infected and exposed people without a place to self-isolate have somewhere they can go so they don't spread the virus.
$30 billion to offer 18 months of income support — a per-person stipend of $50 a day, like jury duty — for those voluntarily self-isolating.
The authors propose Congress appropriate this funding in the next relief package to be distributed via block grants to states and territories twice annually.
The public health officials who also signed the letter include Mark McClellan, who served as both FDA commissioner and head of the Centers for Medicare & Medicaid Services under President George W. Bush; and Vivek Murthy, former surgeon general in the Obama administration and now adviser to former Vice President Joe Biden, the presumptive Democratic presidential nominee.
But it's significant that Slavitt and Gottlieb, who have separately advised the White House, are now joining forces on what public health criteria is needed to reopen the economy.
"There is no silver bullet in the fight against coronavirus," Slavitt told NPR. "But if we want to get back to a more normal existence, we need to give states the tools they need to contain the virus."
The reopening debate hits states
The proposal comes as governors have struggled with competing interests of reopening their economies while keeping their communities safe.
A handful of states have taken steps to relax their social distancing guidelines, including Alaska, Georgia and Tennessee.
Others, like North Carolina and Michigan, have extended their restrictions into May.
Michigan Gov. Gretchen Whitmer, who has come under scrutiny from protesters, defended her stay-at-home orders Sunday while raising Gottlieb and Slavitt's main points.
"What we know is that we have to have robust testing," she said on ABC's This Week. "We have to have community tracing. We've got to have a plan for isolation for people that do get tested positive for COVID-19 in the future."
The White House has released a three-phase plan that provides guidelines for when states might reopen.
It involves the states having appropriate data regarding case levels, the capacity to treat all patients, testing of health care workers and the ability to trace contacts of those infected.
On Sunday, Gottlieb raised concerns that some states were opening their economies too soon and increasing the risk of infection.
"Georgia's certainly not out of the woods," Gottlieb said on CBS's Face The Nation. "They're only testing about 1% of the total population."
It's unclear whether the White House would sign off on the new measure, but sources familiar with the plans say the White House has been briefed on the proposals. Ultimately, the White House would have to sign off any package.
In the end, as Slavitt and Gottlieb argue, control of the outbreak will be the strongest factor in stimulating the U.S. economy.
"Testing, complemented with a full contact tracing strategy, will allow states to prevent small campfires from becoming big forest fires," Slavitt said.


npr--2020-04-27--Americans Are Generally Skeptical Of Government, But Want It To Intervene In A Crisis

Americans Are Generally Skeptical Of Government , But Want It To Intervene In A Crisis Americans are generally skeptical of too much government intervention .
Over the last three decades , the number of people saying they want the government to do less usually outnumbers those saying they want it to do more , according to Gallup .
The times when that has n't been true or when that gap has shrunk have roughly coincided with times of national crisis .
However , over the last several years , those saying government should do more to solve the country 's @ @ @ @ @ @ @ on par with those saying government is doing too much .
Do n't see the graphic above ?
Click here .
And that was before the coronavirus pandemic .
This is one of those times when government counts .
This is when government is called upon to fill the gaps that individuals and private industry ca n't .
Hurricanes , tornadoes , floods , economic and health crises — these are the times people especially depend on their government , and need it to function properly .
They also need to trust the @ @ @ @ @ @ @ 's no confusion .
President Trump has struggled on this front .
In an effort , he says , to tamp down potential hysteria and fear , Trump initially downplayed the coronavirus .
His messages have been mixed .
And he 's floated unproven treatments and experimental ideas .
Why ?
`` You have to understand , I 'm a cheerleader for this country , '' Trump said earlier this month .
`` I do n't want to create havoc and shock and everything else . ''
But the result has been that @ @ @ @ @ @ @ says about the coronavirus , according to the latest NBC News/Wall Street Journal poll .
The good news is Americans do trust what their local officials and government health experts are saying about the virus .
Do n't see the graphic above ?
Click here .
The briefings in ( really ) brief : Trump and members of his coronavirus task force did not hold press briefings Saturday or Sunday this past weekend .
That follows Friday 's short briefing .
In fact on Saturday , Trump tweeted that they 're not worth @ @ @ @ @ @ @ to be seen whether the briefings return to their normal form Monday , though one is on the schedule as per usual for 5 p.m .
ET .
`` It 's more than stupid ; it 's dangerous . ''
— On NPR 's All Things Considered Sunday , House Speaker Nancy Pelosi criticized Trump 's effort to withhold funding from the World Health Organization and other steps his administration is reportedly taking to sideline the global health agency .
— When Is It Safe To Ease Social Distancing ?
Here 's What @ @ @ @ @ @ @ Researchers have suggested one standard : 1 new infection per million people in a given state .
They estimate that states with this level of transmission should be able to keep outbreaks from flaring up even after people start mingling again , though the researchers stress that states would still need to limit large gatherings .
— 'No Evidence ' Yet That Recovered COVID-19 Patients Are Immune , WHO Says : `` There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection @ @ @ @ @ @ @ NYC Poison Control Sees Uptick In Calls After Trump 's Disinfectant Comments : New York City 's Department of Health and Mental Hygiene said that in an 18-hour period ending at 3 p.m. Friday , the poison control center recorded 30 cases .
That compares with only 13 cases for the same time frame one year ago .
— Science Becomes A Dividing Issue In Year Of Election And Pandemic : As COVID-19 takes over the political conversation , Americans ' ambivalence about science — and experts in general — is likely to @ @ @ @ @

Americans Are Generally Skeptical Of Government, But Want It To Intervene In A Crisis
Enlarge this image toggle caption Olivier Douliery/AFP via Getty Images Olivier Douliery/AFP via Getty Images
Updated at 11:35 a.m. ET
Americans are generally skeptical of too much government intervention. Over the past three decades, the number of people saying they want the government to do less usually outnumbers those saying they want it to do more, according to Gallup.
The times when that hasn't been true or when that gap has shrunk have roughly coincided with times of national crisis. However, over the past several years, those saying government should do more to solve the country's problems has crept up to almost being on par with those saying government is doing too much.
Loading...
Don't see the graphic above? Click here.
And that was before the coronavirus pandemic.
This is one of those times when government counts. This is when government is called upon to fill the gaps that individuals and private industry can't. Hurricanes, tornadoes, floods, economic and health crises — these are the times people especially depend on their government and need it to function properly.
They also need to trust the information they're hearing, so there's no confusion. President Trump has struggled on this front. In an effort, he says, to tamp down potential hysteria and fear, Trump initially downplayed the coronavirus. His messages have been mixed. And he has floated unproven treatments and experimental ideas. Why?
"You have to understand, I'm a cheerleader for this country," Trump said earlier this month. "I don't want to create havoc and shock and everything else."
But the result has been that most Americans don't trust what he says about the coronavirus, according to the latest NBC News/Wall Street Journal poll. The good news is Americans do trust what their local officials and government health experts are saying about the virus.
Loading...
Don't see the graphic above? Click here.
The briefings in (really) brief
Trump and members of his coronavirus task force did not hold press briefings Saturday or Sunday this past weekend. That follows Friday's short briefing. In fact on Saturday, Trump tweeted that they're not worth the time and effort.
A briefing was planned for Monday evening at 5 p.m. ET, but then was removed from the White House schedule late Monday morning.
White House press secretary Kayleigh McEnany told reporters Monday that Trump and the task force will hold briefings later in the week. But, she said: "They may have a different look."
Quotation of the weekend
"It's more than stupid; it's dangerous."
— On NPR's All Things Considered on Sunday, House Speaker Nancy Pelosi criticized Trump's effort to withhold funding from the World Health Organization and other steps his administration is reportedly taking to sideline the global health agency.
Latest confirmed U.S. case and death totals
Loading...
Other key coronavirus stories from NPR
— Ex-Officials Call For $46 Billion For Tracing, Isolating In Next Coronavirus Package: Two leading former federal health officials, who served in recent Republican and Democratic administrations, are spearheading a call for a $46 billion public health investment in a next coronavirus aid package to safely reopen the economy.
— When Is It Safe To Ease Social Distancing? Here's What One Model Says For Each State: Researchers have suggested one standard: 1 new infection per million people in a given state. They estimate that states with this level of transmission should be able to keep outbreaks from flaring up even after people start mingling again, though the researchers stress that states would still need to limit large gatherings.
— 'No Evidence' Yet That Recovered COVID-19 Patients Are Immune, WHO Says: "There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection," the organization wrote.
— NYC Poison Control Sees Uptick In Calls After Trump's Disinfectant Comments: New York City's Department of Health and Mental Hygiene said that in an 18-hour period ending at 3 p.m. Friday, the poison control center recorded 30 cases. That compares with 13 cases for the same time frame one year ago.
— Science Becomes A Dividing Issue In Year Of Election And Pandemic: As COVID-19 takes over the political conversation, Americans' ambivalence about science — and experts in general — is likely to come to the forefront.
Benjamin Swasey of NPR's Washington Desk contributed to this report.


npr--2020-04-27--Patients Are Being Billed For Some Phone Chats With Doctors That Used To Be Free

Patients Are Being Billed For Some Phone Chats With Doctors That Used To Be Free Karen Taylor had been coughing for weeks when she decided to see a doctor in early April .
The number of COVID-19 cases had just exceeded 5,000 in Texas , where she lives .
Cigna , her health insurer , said it would waive out-of-pocket costs for telehealth patients seeking coronavirus screening through video conferences .
So Taylor , a sales manager , talked with her physician on an Internet video call .
The doctor 's office charged her $ 70 .
She protested .
@ @ @ @ @ @ @ it goes toward your deductible and you 've got to pay the whole $ 70 , ' `` she says .
Policymakers and insurers across the United States say they are eliminating copayments , deductibles and other barriers to telemedicine for patients confined at home who need to consult a doctor for any reason .
`` We are encouraging people to use telemedicine , '' New York Gov .
Andrew Cuomo said last month after ordering insurers to eliminate copays , which are typically collected from the patient at the time of a @ @ @ @ @ @ @ But in a fragmented health system — which encompasses dozens of insurers , 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest .
In some cases , doctors are billing for telephone calls that used to be free .
Patients say doctors and insurers are charging them upfront for video appointments and phone calls — and not just copays but sometimes the entire cost of the visit , even if it 's covered @ @ @ @ @ @ @ promised , insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers .
Executives at telehealth organizations say insurers have been slow to update their software and policies .
`` A lot of the insurers who said that they 're not going to charge copayments for telemedicine ― they have n't implemented that , '' says George Favvas , CEO of Circle Medical , a San Francisco company that delivers family medicine and other primary care via livestream @ @ @ @ @ @ @ us right now . ''
One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only .
Another is that Blue Cross Blue Shield , Aetna , Cigna , UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process .
Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families .
All four insurance giants say improved telehealth benefits @ @ @ @ @ @ @ .
Nor can governors or state insurance regulators force those plans , which are regulated federally , to upgrade telehealth coverage .
Many employer plans are starting to eliminate cost sharing , such as copays and deductibles , now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits , says Brian Marcotte , CEO of the National Business Group on Health , a coalition of very large , mostly self-insured employers .
For many doctors , business and billings have plunged because of the coronavirus shutdown @ @ @ @ @ @ @ may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay , says Sabrina Corlette , a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University .
`` A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine , '' she says .
`` So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment . ''
David DeKeyser , a marketing @ @ @ @ @ @ @ a physician 's advice via video after coming in contact with someone who attended an event where coronavirus was detected .
The office charged the whole visit — $ 280 , not just the copay ― to his debit card without notifying him .
`` It happened to be payday for me , '' DeKeyser says — a week earlier and the charge could have caused a bank overdraft .
An email exchange got the bill reversed , he says .
With wider acceptance , telehealth calls have suddenly become an important and @ @ @ @ @ @ @ Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits .
Some doctors are charging for phone calls that were once considered an incidental and nonbillable part of a previous office visit .
Blue Cross plans in Massachusetts , Wyoming , Alabama and North Carolina are paying for phoned-in patient visits , according to America 's Health Insurance Plans , a lobbying group .
`` A lot of carriers would n't reimburse telephonic encounters '' in the past , Corlette says .
Catherine @ @ @ @ @ @ @ , says what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $ 80 copay .
`` What would have been treated as a phone call , they now bill as telemedicine , '' she says .
`` The physician would not call me without billing me . ''
She protested the charge and said she has not been billed yet .
By many accounts , the number of doctor encounters via video has soared since the Department of Health and Human Services said in @ @ @ @ @ @ @ steps to expand Americans ' access to telehealth services . ''
Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances , HHS says .
The program has also temporarily stopped requiring doctors to charge patients a copay at the time of the visit .
At the same time , the CARES Act , passed by Congress last month to address the COVID-19 emergency , allows private , high-deductible health insurance to make an exception for telehealth in terms of cost sharing @ @ @ @ @ @ @ video doctor visits even if patients have n't met the deductible .
Dozens of private health insurers listed by AHIP say they have eliminated patients ' copays and other cost sharing for telemedicine .
Cigna , however , has waived only some out-of-pocket costs — the costs of telehealth appointments associated with COVID-19 screening .
Cigna did not respond to requests for comment .
Teladoc Health , a large , publicly traded telemedicine company , said its volume has doubled to 20,000 medical visits a day since early March .
Its stock price @ @ @ @ @ @ @ Jan. 1 .
With such a sharp increase , it 's not surprising that insurers and physicians are struggling to keep up , says Circle Medical CEO Favvas .
`` It 's going to be an imperfect process for a while , '' he says .
`` It 's understandable , given that things are moving so quickly . ''
Abbie VanSickle , a California journalist , wanted her baby 's scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic .
Her insurer , UnitedHealthcare , @ @ @ @ @ @ @ pediatrician told her .
Mom and baby had to come in .
`` It seems like such an unnecessary risk to take , '' VanSickle says .
`` If we ca n't do wellness visits , we 're surely not alone . ''
A UnitedHealthcare spokesperson says that there was a misunderstanding and that the baby 's remote visit would be covered without a copay required of VanSickle .
Jacklyn Grace Lacey , a New York City medical anthropologist , had a similar problem .
She had to renew a prescription a few @ @ @ @ @ @ @ a patient 's share of the cost for telehealth appointments .
The doctor 's office told her she needed to come in for a visit or book a telemedicine appointment .
The video visit came with an `` administrative fee '' of $ 50 that she would have had to pay upfront , she says — five times what the copay would have been for an in-person session .
`` I was not going to go into a doctor 's office and potentially expose people just to get a refill on my monthly @ @ @ @ @ @ @ should check with their insurer before any telehealth visit to make sure telemedicine is covered by their health policy , Corlette says .
If your employer plan does n't pay for telemedicine or requires a copay , check with your company 's human resources department .
The company might change that policy if it is self-insured , as most large employers are .
`` If you know of coworkers in the same boat , encourage them to ask HR as well , '' she says .
`` HR may pay more attention if @ @ @ @ @ @ @ '' Kaiser Health News is a nonprofit , editorially independent program of the Kaiser Family Foundation .
KHN is not affiliated with Kaiser Permanente .

Patients Are Being Billed For Some Phone Chats With Doctors That Used To Be Free
Enlarge this image toggle caption sesame/Getty Images sesame/Getty Images
Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. The number of COVID-19 cases had just exceeded 5,000 in Texas, where she lives.
Cigna, her health insurer, said it would waive out-of-pocket costs for telehealth patients seeking coronavirus screening through video conferences. So Taylor, a sales manager, talked with her physician on an Internet video call.
The doctor's office charged her $70. She protested. But "they said, 'No, it goes toward your deductible and you've got to pay the whole $70,' " she says.
Policymakers and insurers across the United States say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need to consult a doctor for any reason.
"We are encouraging people to use telemedicine," New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate copays, which are typically collected from the patient at the time of a doctor visit, for telehealth sessions.
But in a fragmented health system — which encompasses dozens of insurers, 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest. In some cases, doctors are billing for telephone calls that used to be free.
Patients say doctors and insurers are charging them upfront for video appointments and phone calls — and not just copays but sometimes the entire cost of the visit, even if it's covered by insurance.
Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers. Executives at telehealth organizations say insurers have been slow to update their software and policies.
"A lot of the insurers who said that they're not going to charge copayments for telemedicine ― they haven't implemented that," says George Favvas, CEO of Circle Medical, a San Francisco company that delivers family medicine and other primary care via livestream. "That's starting to hit us right now."
One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process.
Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families. All four insurance giants say improved telehealth benefits don't necessarily apply to such coverage. Nor can governors or state insurance regulators force those plans, which are regulated federally, to upgrade telehealth coverage.
Many employer plans are starting to eliminate cost sharing, such as copays and deductibles, now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits, says Brian Marcotte, CEO of the National Business Group on Health, a coalition of very large, mostly self-insured employers.
For many doctors, business and billings have plunged because of the coronavirus shutdown. New rules notwithstanding, many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, says Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.
"A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine," she says. "So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment."
David DeKeyser, a marketing strategist in Brooklyn, N.Y., sought a physician's advice via video after coming in contact with someone who attended an event where coronavirus was detected. The office charged the whole visit — $280, not just the copay ― to his debit card without notifying him.
"It happened to be payday for me," DeKeyser says — a week earlier and the charge could have caused a bank overdraft. An email exchange got the bill reversed, he says.
With wider acceptance, telehealth calls have suddenly become an important and lucrative potential source of physician revenue. Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.
Some doctors are charging for phone calls that were once considered an incidental and nonbillable part of a previous office visit. Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina are paying for phoned-in patient visits, according to America's Health Insurance Plans, a lobbying group.
"A lot of carriers wouldn't reimburse telephonic encounters" in the past, Corlette says.
Catherine Parisian, a professor in North Carolina, says what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $80 copay.
"What would have been treated as a phone call, they now bill as telemedicine," she says. "The physician would not call me without billing me."
She protested the charge and said she has not been billed yet.
By many accounts, the number of doctor encounters via video has soared since the Department of Health and Human Services said in mid-March that it would take "unprecedented steps to expand Americans' access to telehealth services."
Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances, HHS says. The program has also temporarily stopped requiring doctors to charge patients a copay at the time of the visit.
At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows private, high-deductible health insurance to make an exception for telehealth in terms of cost sharing. Such plans can now pay for video doctor visits even if patients haven't met the deductible.
Dozens of private health insurers listed by AHIP say they have eliminated patients' copays and other cost sharing for telemedicine. Cigna, however, has waived only some out-of-pocket costs — the costs of telehealth appointments associated with COVID-19 screening. Cigna did not respond to requests for comment.
Teladoc Health, a large, publicly traded telemedicine company, said its volume has doubled to 20,000 medical visits a day since early March. Its stock price has nearly doubled, too, since Jan. 1.
With such a sharp increase, it's not surprising that insurers and physicians are struggling to keep up, says Circle Medical CEO Favvas.
"It's going to be an imperfect process for a while," he says. "It's understandable, given that things are moving so quickly."
Abbie VanSickle, a California journalist, wanted her baby's scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic. Her insurer, UnitedHealthcare, would not pay for it, the pediatrician told her. Mom and baby had to come in.
"It seems like such an unnecessary risk to take," VanSickle says. "If we can't do wellness visits, we're surely not alone."
A UnitedHealthcare spokesperson says that there was a misunderstanding and that the baby's remote visit would be covered without a copay required of VanSickle.
Jacklyn Grace Lacey, a New York City medical anthropologist, had a similar problem. She had to renew a prescription a few weeks after Cuomo ordered insurers to waive a patient's share of the cost for telehealth appointments.
The doctor's office told her she needed to come in for a visit or book a telemedicine appointment. The video visit came with an "administrative fee" of $50 that she would have had to pay upfront, she says — five times what the copay would have been for an in-person session.
"I was not going to go into a doctor's office and potentially expose people just to get a refill on my monthly medication," she says.
Patients should check with their insurer before any telehealth visit to make sure telemedicine is covered by their health policy, Corlette says. If your employer plan doesn't pay for telemedicine or requires a copay, check with your company's human resources department. The company might change that policy if it is self-insured, as most large employers are.
"If you know of coworkers in the same boat, encourage them to ask HR as well," she says. "HR may pay more attention if the request comes from multiple sources."
Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.


npr--2020-04-27--Voting Rights For Hundreds Of Thousands Of Felons At Stake In Florida Trial

Voting Rights For Hundreds Of Thousands Of Felons At Stake In Florida Trial A contentious federal civil rights trial is slated to begin Monday that will determine whether hundreds of thousands of people with felony convictions will be able to vote this fall in the swing state of Florida .
On one side of the case is Florida , along with a slew of other states supporting it from the sidelines .
On the other , hundreds of thousands of people who have completed their sentences but currently ca n't vote because of one thing they lack : money .
@ @ @ @ @ @ @ year and a half after Florida voters overwhelmingly approved Amendment 4 to the state 's constitution , which automatically restores voting rights to most people with felony convictions after they complete `` all terms of their sentence . ''
Soon after the vote , state lawmakers passed a bill defining `` all terms '' to mean that all fines , fees and restitution connected to a case would have to be paid before someone regained the right to vote .
That law triggered the lawsuit , with the plaintiffs arguing that the requirement @ @ @ @ @ @ @ creates a lifetime sentence for crimes they 've tried to move on from .
`` They know we ca n't pay it .
And that 's what really hurt me the most and made me angry , because they know we ca n't pay it , '' said Betty Riddle , one of the 17 named plaintiffs in the suit .
Florida has already lost several legal battles tied to the law .
U.S. District Judge Robert Hinkle , who will be hearing the case , issued a temporary ruling that was upheld @ @ @ @ @ @ @ is `` genuinely unable '' to pay what is owed should be able to vote .
An estimated 82 % of people with felony convictions have not yet paid the money they owe , according to expert witness testimony submitted in the case by University of Florida professor Daniel Smith .
The data he analyzed incorporated only 48 out of Florida 's 67 counties and did not account for people who were too poor to pay .
Smith said overall it was `` practically impossible '' to quantify how many people might not @ @ @ @ @ @ @ law , because of sloppy , decentralized record-keeping from the state .
The state has repeatedly admitted in court that it has no centralized way of tracking what payments are owed or even which payments have already been made .
Several of the plaintiffs in the case say they have been unable to get answers on how much money they still owe .
`` I do n't know where you go , a one-stop shop , to get something that says you 've paid all your fines and fees , '' Toshia Brown @ @ @ @ @ @ @ at the Florida Department of State 's office , said in a deposition .
`` I do n't know how they would be able to get that information . ''
`` If you ca n't vote unless you pay back what you owe , but the state ca n't tell you how much you owe — then you 'll never get your constitutional rights restored , '' said Lisa Foster of the nonprofit Fines and Fees Justice Center , which has been working to eliminate fines and fees from the criminal justice system @ @ @ @ @ @ @ along party lines , with Democrats in favor of granting voting rights to people who still owe money , while Republicans are opposed .
But the plaintiffs have gotten some support from some libertarians .
`` If you boil what conservatism is down to its most basic principle , it is a government that can not act arbitrary and capricious against its people , '' said Arthur Rizer , an attorney with the libertarian think tank R Street Institute , who has filed a brief backing the plaintiffs .
`` And besides putting @ @ @ @ @ @ @ prison , the most powerful thing a government can do is strip your right to participate in the democratic process . ''
The state 's allies say the arguments being used against the new law are misguided .
`` It 's not some sort of Jim Crow conspiracy '' to deny the disproportionately nonwhite felons their rights , said J. Christian Adams , the president of the conservative Public Interest Legal Foundation .
`` There 's a whole lot of crime victims in Florida — regular people — sometimes people in the communities @ @ @ @ @ @ @ n't ever gon na get the restitution if the plaintiffs have their way , '' said Adams .
Until Amendment 4 passed , Florida had barred people with felony convictions from voting for life since 1868 , a few years after the Civil War .
For years the only way to get rights restored was through the state 's clemency board , made up of the governor , attorney general , chief financial officer and agriculture commissioner .
But the number of people granted clemency varied widely depending on the administration .
A @ @ @ @ @ @ @ state 's clemency process was unconstitutional , highly politicized and disproportionately stacked against African Americans .
States are watching the trial closely .
Thirty states currently require someone with a felony conviction to pay fines , fees and restitution before they regain voting rights .
Attorneys general in Alabama , Arizona , Arkansas , Georgia , Kentucky , Louisiana , Nebraska , South Carolina , Texas and Utah jointly submitted an amicus brief in support of Florida 's case .
The states argue that they have a `` substantial interest '' in seeking @ @ @ @ @ @ @ vote restored and that the case could set legal precedent .
`` If States are limited in their ability to pursue reenfranchisement alongside their other interests , some States may well throw in the towel and prohibit any felon from regaining the right to vote , '' they wrote .
All of the attorneys general on the brief declined interview requests , as did the office of Florida Gov .
Ron DeSantis .
Hinkle has granted class status to the 17 named plaintiffs , meaning that any decision would apply to hundreds of @ @ @ @ @ @ @ not pay the money they owe .
The judge has hinted that if the state does not act , he might have to come up with a court-ordered solution for how to determine if someone is able to pay or not .
Hinkle has accused the state of trying to `` run out the clock '' of the case and has stated that he aims to resolve the issues before the November presidential election .
Because of COVID-19 , the trial will largely take place via video and phone conference .
Unusually for @ @ @ @ @ @ @ nation will be able to listen in .
`` This is the issue I worked hardest and longest on , '' said Howard Simon , the former director of the American Civil Liberties Union of Florida , who retired just after Amendment 4 passed in 2018 .
`` I 'll definitely be calling in . ''

Voting Rights For Hundreds Of Thousands Of Felons At Stake In Florida Trial
Enlarge this image toggle caption Zak Bennett/AFP via Getty Images Zak Bennett/AFP via Getty Images
A contentious federal civil rights trial is slated to begin Monday that will determine whether hundreds of thousands of people with felony convictions will be able to vote this fall in the swing state of Florida.
On one side of the case is Florida, along with a slew of other states supporting it from the sidelines.
On the other, hundreds of thousands of people who have completed their sentences but currently can't vote because of one thing they lack: money.
The much-anticipated class action trial comes a year and a half after Florida voters overwhelmingly approved Amendment 4 to the state's constitution, which automatically restores voting rights to most people with felony convictions after they complete "all terms of their sentence."
Soon after the vote, state lawmakers passed a bill defining "all terms" to mean that all fines, fees and restitution connected to a case would have to be paid before someone regained the right to vote.
That law triggered the lawsuit, with the plaintiffs arguing that the requirement to pay all fines and fees effectively creates a lifetime sentence for crimes they've tried to move on from.
"They know we can't pay it. And that's what really hurt me the most and made me angry, because they know we can't pay it," said Betty Riddle, one of the 17 named plaintiffs in the suit.
Florida has already lost several legal battles tied to the law.
U.S. District Judge Robert Hinkle, who will be hearing the case, issued a temporary ruling that was upheld by an appellate court that anyone who is "genuinely unable" to pay what is owed should be able to vote.
An estimated 82% of people with felony convictions have not yet paid the money they owe, according to expert witness testimony submitted in the case by University of Florida professor Daniel Smith.
The data he analyzed incorporated only 48 out of Florida's 67 counties and did not account for people who were too poor to pay. Smith said overall it was "practically impossible" to quantify how many people might not be able to vote under the new law, because of sloppy, decentralized record-keeping from the state.
The state has repeatedly admitted in court that it has no centralized way of tracking what payments are owed or even which payments have already been made. Several of the plaintiffs in the case say they have been unable to get answers on how much money they still owe.
"I don't know where you go, a one-stop shop, to get something that says you've paid all your fines and fees," Toshia Brown, the chief of voter registration services at the Florida Department of State's office, said in a deposition. "I don't know how they would be able to get that information."
"If you can't vote unless you pay back what you owe, but the state can't tell you how much you owe — then you'll never get your constitutional rights restored," said Lisa Foster of the nonprofit Fines and Fees Justice Center, which has been working to eliminate fines and fees from the criminal justice system.
Politically the case has largely split along party lines, with Democrats in favor of granting voting rights to people who still owe money, while Republicans are opposed. But the plaintiffs have gotten some support from some libertarians.
"If you boil what conservatism is down to its most basic principle, it is a government that cannot act arbitrary and capricious against its people," said Arthur Rizer, an attorney with the libertarian think tank R Street Institute, who has filed a brief backing the plaintiffs. "And besides putting you in jail, putting you in prison, the most powerful thing a government can do is strip your right to participate in the democratic process."
The state's allies say the arguments being used against the new law are misguided.
"It's not some sort of Jim Crow conspiracy" to deny the disproportionately nonwhite felons their rights, said J. Christian Adams, the president of the conservative Public Interest Legal Foundation.
"There's a whole lot of crime victims in Florida — regular people — sometimes people in the communities hardest hit by crime, that aren't ever gonna get the restitution if the plaintiffs have their way," said Adams.
Until Amendment 4 passed, Florida had barred people with felony convictions from voting for life since 1868, a few years after the Civil War. For years the only way to get rights restored was through the state's clemency board, made up of the governor, attorney general, chief financial officer and agriculture commissioner. But the number of people granted clemency varied widely depending on the administration.
A federal judge in 2018 ruled that the state's clemency process was unconstitutional, highly politicized and disproportionately stacked against African Americans.
States are watching the trial closely. Thirty states currently require someone with a felony conviction to pay fines, fees and restitution before they regain voting rights. Attorneys general in Alabama, Arizona, Arkansas, Georgia, Kentucky, Louisiana, Nebraska, South Carolina, Texas and Utah jointly submitted an amicus brief in support of Florida's case.
The states argue that they have a "substantial interest" in seeking money before someone gets the right to vote restored and that the case could set legal precedent.
"If States are limited in their ability to pursue reenfranchisement alongside their other interests, some States may well throw in the towel and prohibit any felon from regaining the right to vote," they wrote.
All of the attorneys general on the brief declined interview requests, as did the office of Florida Gov. Ron DeSantis.
Hinkle has granted class status to the 17 named plaintiffs, meaning that any decision would apply to hundreds of thousands of people in Florida who cannot pay the money they owe. The judge has hinted that if the state does not act, he might have to come up with a court-ordered solution for how to determine if someone is able to pay or not.
Hinkle has accused the state of trying to "run out the clock" of the case and has stated that he aims to resolve the issues before the November presidential election.
Because of COVID-19, the trial will largely take place via video and phone conference. Unusually for a federal trial, people across the nation will be able to listen in.
"This is the issue I worked hardest and longest on," said Howard Simon, the former director of the American Civil Liberties Union of Florida, who retired just after Amendment 4 passed in 2018. "I'll definitely be calling in."


npr--2020-04-27--New Zealand Says It Has Won 'Battle' Against COVID-19

New Zealand Says It Has Won 'Battle ' Against COVID-19 New Zealand 's Prime Minister Jacinda Ardern says that the island nation has defeated — for the present — the coronavirus as her government announced the lifting of most restrictions imposed to halt the spread of COVID-19 .
`` There is no widespread undetected community transmission in New Zealand .
We have won that battle , '' Ardern said Monday .
`` But we must remain vigilant if we are to keep it that way . ''
Asked if New Zealand had eliminated COVID-19 , Ardern replied : `` currently @ @ @ @ @ @ @ been trending down since April 5 , when 89 confirmed cases were announced .
On Sunday , there were no new cases announced for the first time in weeks , but another five were reported on Monday .
A total of 19 people have died in New Zealand from COVID-19 .
The country 's director-general of health , Ashley Bloomfield , said the small number of new cases in recent days `` does give us confidence that we have achieved our goal of elimination . ''
Bloomfield and Ardern said that declaring the @ @ @ @ @ @ @ be no new cases , but that the numbers would be manageable with the help of aggressive contact tracing , which the prime minister said had been scaled up `` significantly '' with the capacity to make up to 10,000 calls per day .
Ardern 's remarks came as New Zealand , a country of just 5 million people , downgraded its COVID-19 alert to level 3 — meaning most , but not all , businesses are being allowed to reopen .
Businesses and professions that require face-to-face contact , such as hairdressers @ @ @ @ @ @ @ gyms will remain closed until the alert level is reduced another notch , Ardern said .
`` Your business must be contact-less .
Your customers can pay online , over the phone or in a contact-less way , '' she said .
`` Delivery or pick-up must also be contact-less . ''
Exceptions include supermarkets , dairies , gas stations , pharmacies or other permitted health services , according to the New Zealand Herald .
For those who do return to the physical workplace , they should maintain 1 meter ( about 3 @ @ @ @ @ @ @ said .
`` COVID-19 has spread in workplaces , so the quid pro quo of being able to open is doing it in a way that does n't spread the virus , '' she said .
The prime minister also advised that if people can work from home , they should continue to do so .
New Zealand has garnered praise for largely putting aside politics in order to tackle the outbreak .
As NPR 's Julie McCarthy reports , Ardern , 39 , a mother of a 21-month-old , `` regularly appears @ @ @ @ @ @ @ a sweatshirt , commiserating with families enduring isolation in their 'bubble , ' as she calls their place of shelter , and assuring children the tooth fairy is still on the job .
When she imposed stringent stay-home rules in late March , she urged people to 'be strong and be kind . '
`` Like New Zealand , Australia has also seen a precipitous decline in new cases since a peak nearly a month ago .
Speaking on Sunday , Australia 's home affairs minister , Peter Dutton , suggested that New @ @ @ @ @ @ @ them even as restrictions on inbound air passengers from other countries remained .
`` You could look at an arrangement with New Zealand given they 're at a comparable stage as we are in the fight against this virus , '' Dutton told Sky News , as reported by Radio New Zealand .
`` You could look at other nations in our region if they 've enjoyed the same success , but New Zealand might be the natural partner . ''

New Zealand Says It Has Won 'Battle' Against COVID-19
Enlarge this image toggle caption Mark Mitchell/Pool/Getty Images Mark Mitchell/Pool/Getty Images
New Zealand's Prime Minister Jacinda Ardern says that the island nation has defeated — for the present — the coronavirus as her government announced the lifting of some restrictions imposed to halt the spread of COVID-19.
"There is no widespread undetected community transmission in New Zealand. We have won that battle," Ardern said Monday. "But we must remain vigilant if we are to keep it that way."
Asked whether New Zealand had eliminated COVID-19, Ardern replied: "currently."
The coronavirus has been trending down in New Zealand since April 5, when 89 confirmed cases were announced. On Sunday, there were no new cases announced for the first time in weeks, but another five were reported on Monday. A total of 19 people have died in New Zealand from COVID-19.
The country's director-general of health, Ashley Bloomfield, said the small number of new cases in recent days "does give us confidence that we have achieved our goal of elimination."
Bloomfield and Ardern said that declaring the virus eliminated did not mean there would be no new cases, but that the numbers would be manageable with the help of aggressive contact tracing, which the prime minister said had been scaled up "significantly" with the capacity to make up to 10,000 calls per day.
Ardern's remarks came as New Zealand, a country of just 5 million people, downgraded its COVID-19 alert to level 3 — meaning most, but not all, businesses are being allowed to reopen.
Businesses and professions that require face-to-face contact — such as hairdressers, salespeople, masseuses and public gyms — will remain closed until the alert level is reduced another notch, Ardern said.
"Your business must be contactless. Your customers can pay online, over the phone or in a contactless way," she said. "Delivery or pickup must also be contactless."
Exceptions include supermarkets, dairies, gas stations, pharmacies or other permitted health services, according to the New Zealand Herald.
For those who return to the physical workplace, they should maintain 1 meter (about 3 feet) of social distancing, Ardern said.
"COVID-19 has spread in workplaces, so the quid pro quo of being able to open is doing it in a way that doesn't spread the virus," she said.
The prime minister also advised that if people can work from home, they should continue to do so.
New Zealand has garnered praise for largely putting aside politics in order to tackle the outbreak.
As NPR's Julie McCarthy reports, Ardern, 39, a mother of a 21-month-old, "regularly appears on Facebook Live chats, dressed in a sweatshirt, commiserating with families enduring isolation in their 'bubble,' as she calls their place of shelter, and assuring children the tooth fairy is still on the job. When she imposed stringent stay-home rules in late March, she urged people to 'be strong and be kind.' "
Australia has also seen a precipitous decline in new cases since a peak nearly a month ago.
Speaking on Sunday, Australia's home affairs minister, Peter Dutton, suggested that New Zealand and Australia could reopen travel between them even as restrictions on inbound air passengers from other countries remained.
"You could look at an arrangement with New Zealand given they're at a comparable stage as we are in the fight against this virus," Dutton told Sky News, as reported by Radio New Zealand. "You could look at other nations in our region if they've enjoyed the same success, but New Zealand might be the natural partner."


npr--2020-04-27--Italy's Prime Minister Announces Gradual Easing Of COVID-19 Lockdown

Italy 's Prime Minister Giuseppe Conte announced Sunday that his country will soon begin the process of re-opening its economy after undergoing the longest novel coronavirus lockdown anywhere to date .
In a nationwide television address , Conte said that beginning May 4 , Italians would be allowed to use parks , visit relatives and attend funerals as part of a phased plan for lifting restrictions as the daily number of new COVID-19 cases trends downward from a peak of 6,557 on March 21 .
There have been more than 26,000 deaths in Italy from the disease since the country @ @ @ @ @ @ @ two months ago .
On Sunday , Italy reported 260 new deaths , its lowest daily total since March 14 .
Conte said if all goes well , stores and museums would reopen beginning May 18 and sports teams could resume group training .
Restaurants , cafes and hair salons would be allowed to reopen on June 1 .
He said classes at schools would resume in September .
The wearing of face masks in public and continued social distancing would be strictly enforced even as other restrictions were gradually lifted .
Italy @ @ @ @ @ @ @ responsibility and coexistence with the virus , '' Conte told the nation .
`` We can not continue beyond this lockdown — we risk damaging the country 's socioeconomic fabric too much , '' he said , adding that the `` damage '' to the national fabric if the shutdown is not lifted `` could be irreversible . ''
However , Conte warned that `` the curve of contagion can rise again , it will go out of control , deaths will climb and we 'll have irreparable damage '' to the economy @ @ @ @ @ @ @ to the guidelines .
The prime minister did not outline plans for religious services , but after Italy 's bishops complained , Conte 's office said it would release plans for a return to public worship as soon as possible .

Italy's Prime Minister Announces Gradual Easing Of COVID-19 Lockdown
Enlarge this image toggle caption Ernesto Ruscio/Getty Images Ernesto Ruscio/Getty Images
Italy's Prime Minister Giuseppe Conte announced Sunday that his country will soon begin the process of reopening its economy after undergoing the longest novel coronavirus lockdown anywhere to date.
In a nationwide television address, Conte said that beginning May 4, Italians would be allowed to use parks, visit relatives and attend funerals as part of a phased plan for lifting restrictions as the daily number of new COVID-19 cases trends downward from a peak of 6,557 on March 21.
There have been more than 26,000 deaths in Italy from the disease since the country's first cases were reported just over two months ago. On Sunday, Italy reported 260 new deaths, its lowest daily total since March 14.
Conte said if all goes well, stores and museums would reopen beginning May 18 and sports teams could resume group training. Restaurants, cafes and hair salons would be allowed to reopen on June 1.
He said classes at schools would resume in September.
The wearing of face masks in public and continued social distancing would be strictly enforced, even as other restrictions were gradually lifted.
Italy was embarking on an era of "responsibility and coexistence with the virus," Conte told the nation.
"We cannot continue beyond this lockdown — we risk damaging the country's socioeconomic fabric too much," he said, adding that the "damage" to the national fabric if the shutdown is not lifted "could be irreversible."
However, Conte warned that "the curve of contagion can rise again, it will go out of control, deaths will climb and we'll have irreparable damage" to the economy if the people do not carefully adhere to the guidelines.
The prime minister did not outline plans for religious services, but after Italy's bishops complained, Conte's office said it would release plans for a return to public worship as soon as possible.


npr--2020-04-26--Small Businesses Will Race For Dollars From 2nd Installment Of Federal Aid

Small Businesses Will Race For Dollars From 2nd Installment Of Federal Aid Businesses desperate for financial aid have exhausted a $ 349 billion federal loan program .
Banks and businesses will now vie for a second round of funding before the money runs out .
Get ready for another scramble as struggling small businesses try to grab hold of a financial lifeline .
The Federal Government is restarting an emergency loan program for small businesses tomorrow .
That program burned through its first $ 350 billion in less than two weeks .
After complaints that some of the money went @ @ @ @ @ @ @ of big banks , lawmakers directed that a chunk of the new money be funneled through community banks .
NPR 's Scott Horsley reports on how one small bank has been helping small business customers get to the front of the line .
SCOTT HORSLEY , BYLINE : In the last three weeks , Edward Barry and his team at Capital Bank made $ 172 million worth of loans to nearly 600 small businesses .
That 's about as much money as the Maryland-based bank ordinarily lends out in a whole year .
@ @ @ @ @ @ @ on those loans , Barry 's getting ready to do it all over again .
EDWARD BARRY : ( Laughter ) like being in a pie-eating contest where first prize is more pie .
HORSLEY : Barry understood early on in the coronavirus lockdown small businesses would be desperate for credit and that money for emergency loans would quickly run out .
Capital Bank has a long history of working with the Small Business Administration and mom-and-pop borrowers .
So the bank could anticipate what the government would be looking for .
Barry @ @ @ @ @ @ @ website before the rules were even finalized , giving their customers a head start .
BARRY : We started to kind of lay out end to end , what do we think needs to happen ?
- knowing there was a lot of empty boxes and said , well , what do we think the answers are ?
- and write them in pencil or in chalk .
And we 'll just write them in ink when the government gives us answers .
HORSLEY : This process was more challenging because most of @ @ @ @ @ @ @ Barry and the rest of his team were working out of their homes .
BARRY : I have three kids at home who are online doing their schoolwork .
I got two dogs and my wife .
And when it gets really crowded or noisy here , I tend to do my conference calls walking around my neighborhood .
HORSLEY : Barry pulled bankers off of other projects to work with small-business people who needed loans often at night and on weekends , people like Jennifer Taxson .
She 's the co-owner of @ @ @ @ @ @ @ to commercial and residential customers .
Taxson was forced to close her showroom last month and idle some of her seven employees .
She says the personal handholding made a big difference .
JENNIFER TAXSON : Working with our small , local bank , knowing who to call , getting guidance without being prompted on how this process works is a whole lot different than not knowing where you upload your documents , not knowing who you call , not hearing back from anybody .
HORSLEY : While many customers at big banks @ @ @ @ @ @ @ was approved in about a week .
And since she 's using the money to pay her employees , she does n't believe she 'll have to pay it back .
TAXSON : We just received the funds .
We will be bringing on everybody who we 've had to either furlough or partially furlough .
Next week , we 'll have a full staff of gainfully employed people .
HORSLEY : Barry says his typical small-business borrower has about a dozen employees .
He 's made loans for as little as $ @ @ @ @ @ @ @ complaints they were only lending money to preferred customers , about a third of Barry 's loans went to people who 'd never banked with him before .
The government is paying bankers both fees and interest to make these loans .
But Berry says it also feels like an opportunity for banks to do their part to help those who are hurting .
BARRY : They 're people you know , your neighbors , your friends , family members .
It 's your local restaurant , your local coffee shop , your @ @ @ @ @ @ @ keeps people working so hard .
HORSLEY : Barry and his colleagues have been busy preparing a new batch of applications for when the program restarts tomorrow with another $ 320 billion .
Once again , that money is likely to go quickly .
Scott Horsley , NPR News , Washington .

Small Businesses Will Race For Dollars From 2nd Installment Of Federal Aid
Businesses desperate for financial aid have exhausted a $349 billion federal loan program. Banks and businesses will now vie for a second round of funding before the money runs out.
LULU GARCIA-NAVARRO, HOST:
Get ready for another scramble as struggling small businesses try to grab hold of a financial lifeline. The Federal Government is restarting an emergency loan program for small businesses tomorrow. That program burned through its first $350 billion in less than two weeks. After complaints that some of the money went to big businesses or the preferred customers of big banks, lawmakers directed that a chunk of the new money be funneled through community banks. NPR's Scott Horsley reports on how one small bank has been helping small business customers get to the front of the line.
SCOTT HORSLEY, BYLINE: In the last three weeks, Edward Barry and his team at Capital Bank made $172 million worth of loans to nearly 600 small businesses. That's about as much money as the Maryland-based bank ordinarily lends out in a whole year. And while the ink is barely dry on those loans, Barry's getting ready to do it all over again.
EDWARD BARRY: (Laughter) like being in a pie-eating contest where first prize is more pie.
HORSLEY: Barry understood early on in the coronavirus lockdown small businesses would be desperate for credit and that money for emergency loans would quickly run out. Capital Bank has a long history of working with the Small Business Administration and mom-and-pop borrowers. So the bank could anticipate what the government would be looking for. Barry and his colleagues built their own application website before the rules were even finalized, giving their customers a head start.
BARRY: We started to kind of lay out end to end, what do we think needs to happen? - knowing there was a lot of empty boxes and said, well, what do we think the answers are? - and write them in pencil or in chalk. And we'll just write them in ink when the government gives us answers.
HORSLEY: This process was more challenging because most of the bank's branches were closed. Barry and the rest of his team were working out of their homes.
BARRY: I have three kids at home who are online doing their schoolwork. I got two dogs and my wife. And when it gets really crowded or noisy here, I tend to do my conference calls walking around my neighborhood.
HORSLEY: Barry pulled bankers off of other projects to work with small-business people who needed loans often at night and on weekends, people like Jennifer Taxson. She's the co-owner of a Washington business that sells light fixtures to commercial and residential customers. Taxson was forced to close her showroom last month and idle some of her seven employees. She says the personal handholding made a big difference.
JENNIFER TAXSON: Working with our small, local bank, knowing who to call, getting guidance without being prompted on how this process works is a whole lot different than not knowing where you upload your documents, not knowing who you call, not hearing back from anybody.
HORSLEY: While many customers at big banks were left hanging, Taxson's loan was approved in about a week. And since she's using the money to pay her employees, she doesn't believe she'll have to pay it back.
TAXSON: We just received the funds. We will be bringing on everybody who we've had to either furlough or partially furlough. Next week, we'll have a full staff of gainfully employed people.
HORSLEY: Barry says his typical small-business borrower has about a dozen employees. He's made loans for as little as $2,500. While some big banks drew complaints they were only lending money to preferred customers, about a third of Barry's loans went to people who'd never banked with him before. The government is paying bankers both fees and interest to make these loans. But Berry says it also feels like an opportunity for banks to do their part to help those who are hurting.
BARRY: They're people you know, your neighbors, your friends, family members. It's your local restaurant, your local coffee shop, your pizza parlor. And that's what keeps people working so hard.
HORSLEY: Barry and his colleagues have been busy preparing a new batch of applications for when the program restarts tomorrow with another $320 billion. Once again, that money is likely to go quickly. Scott Horsley, NPR News, Washington.
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NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.


npr--2020-04-27--El Salvador's President Takes On The Country's Gangs Amid Coronavirus Pandemic

El Salvador 's president authorized the country 's police and military to use lethal force against gang members , who over the weekend were allegedly responsible for the murders of dozens of people .
Along with the emergency orders , President Nayib Bukele put all incarcerated gang members on a 24-hour shutdown .
Bukele says the gangs are taking advantage of the police focus on enforcing the coronavirus lockdown instead of battling criminal elements .
Lethal force can be used in self-defense or to protect the lives of Salvadorans , he says .
Fifty-three people were killed over the weekend @ @ @ @ @ @ @ , a new one-day record for homicides since Bukele swept into office last June pledging to reduce the killings .
Murders had dropped dramatically in March , as El Salvador enacted some of the most restrictive lockdown measures in the region to combat COVID-19 .
Bukele says gang leaders ordered the murders from inside prisons .
He spent much of Monday , tweeting pictures of workers boarding up prison cells and says the gang members will no longer see sunlight and will be housed with rivals .
He warned the gangsters will regret @ @ @ @ @ @ @ made the decision to order the murders .
In one tweet , a 42-second video is played of the president surrounded by his top security officials all wearing face masks .
Bukele does not have one on , and appears relaxed while speaking with everyone .
In the background ominous loud music plays throughout the length of the clip .
El Salvador has done well combating the spread of the coronavirus , with more than 20,000 people tested .
According to government figures released on Monday , 323 cases have been confirmed and @ @ @ @ @ @

El Salvador's President Takes On The Country's Gangs Amid Coronavirus Pandemic
Enlarge this image toggle caption Marvin Recinos/AFP via Getty Images Marvin Recinos/AFP via Getty Images
El Salvador's president authorized the country's police and military to use lethal force against gang members, who over the weekend were allegedly responsible for the murders of dozens of people. Along with the emergency orders, President Nayib Bukele put all incarcerated gang members on a 24-hour shutdown.
Bukele says the gangs are taking advantage of the police focus on enforcing the coronavirus lockdown instead of battling criminal elements. Lethal force can be used in self-defense or to protect the lives of Salvadorans, he says.
Fifty-three people were killed over the weekend, with 29 murdered on Sunday alone, a new one-day record for homicides since Bukele swept into office last June pledging to reduce the killings. Murders had dropped dramatically in March, as El Salvador enacted some of the most restrictive lockdown measures in the region to combat COVID-19.
Bukele says gang leaders ordered the murders from inside prisons. He spent much of Monday, tweeting pictures of workers boarding up prison cells and says the gang members will no longer see sunlight and will be housed with rivals. He warned the gangsters will regret for the rest of their lives having made the decision to order the murders.
In one tweet, a 42-second video is played of the president surrounded by his top security officials all wearing face masks. Bukele does not have one on, and appears relaxed while speaking with everyone. In the background ominous loud music plays throughout the length of the clip.
El Salvador has done well combating the spread of the coronavirus, with more than 20,000 people tested. According to government figures released on Monday, 323 cases have been confirmed and 8 deaths attributed to COVID-19.


npr--2020-04-27--Virginia Gun Range Can Reopen — Governor Overstepped His Authority, Judge Rules

A Virginia gun range can remain open , despite Gov .
Ralph Northam 's order closing nonessential businesses throughout the state in response to the coronavirus pandemic , a state judge ruled Monday .
In a March executive order , Northam had included indoor shooting ranges among the businesses to be temporarily shuttered to stop the spread of COVID-19 .
In response , the shooting range SafeSide sued , asking a court to block the order .
Judge F. Patrick Yeatts granted the request , prohibiting law enforcement from blocking citizens ' access to the gun range .
Northam lacks @ @ @ @ @ @ @ Yeatts said , because of a state statute , modeled on the Second Amendment to the U.S. Constitution , giving citizens the right to bear arms .
`` During an emergency , the governor is given great deference , but [ the statute ] specifically limits his authority in relation to the right to keep and bear arms , '' Yeatts wrote .
`` The purpose of the right is to have a population trained with firearms in order to defend the Commonwealth , '' Yeatts wrote .
`` Proper training and practice @ @ @ @ @ @ @ the right to keep and bear arms . ''
`` The Court understands the Governor 's desire to protect the citizens of our great commonwealth , '' Yeatts said .
`` But in taking steps to stop the spread of COVID-19 , he took a step beyond what is allowed . ''
In a statement , Attorney General Mark Herring said that his office was considering how to respond .
`` Governor Northam 's efforts to save lives and slow the spread of COVID-19 are necessary and proving to be effective , but @ @ @ @ @ @ @ ability to shoot a gun indoors during this pandemic is worth risking further spread of the virus and making Virginia communities and families less safe , '' Herring said , according to the Associated Press .
University of Virginia law professor Richard Schragger told The Virginian-Pilot that the ruling only applies to the Lynchburg gun range — but the reasoning could apply to any subsequent lawsuits brought by other gun ranges in the state .
SafeSide was joined on the lawsuit by Gun Owners of America , the Association of Virginia Gun Ranges @ @ @ @ @ @ @ Philip Van Cleave , president of the Virginia Citizens Defense League , told the AP his group would try to get a broader ruling that applied statewide .

Virginia Gun Range Can Reopen — Governor Overstepped His Authority, Judge Rules
Enlarge this image toggle caption Steve Helber/AP Steve Helber/AP
A Virginia gun range can remain open, despite Gov. Ralph Northam's order closing nonessential businesses throughout the state in response to the coronavirus pandemic, a state judge ruled Monday.
In a March executive order, Northam had included indoor shooting ranges among the businesses to be temporarily shuttered to stop the spread of COVID-19. In response, the shooting range SafeSide sued, asking a court to block the order. Judge F. Patrick Yeatts granted the request, prohibiting law enforcement from blocking citizens' access to the gun range.
Northam lacks the authority to close gun ranges, Yeatts said, because of a state statute, modeled on the Second Amendment to the U.S. Constitution, giving citizens the right to bear arms. "During an emergency, the governor is given great deference, but [the statute] specifically limits his authority in relation to the right to keep and bear arms," Yeatts wrote.
"The purpose of the right is to have a population trained with firearms in order to defend the Commonwealth," Yeatts wrote. "Proper training and practice at a range ... is fundamental to the right to keep and bear arms."
"The Court understands the Governor's desire to protect the citizens of our great commonwealth," Yeatts said. "But in taking steps to stop the spread of COVID-19, he took a step beyond what is allowed."
In a statement, Attorney General Mark Herring said that his office was considering how to respond. "Governor Northam's efforts to save lives and slow the spread of COVID-19 are necessary and proving to be effective, but unfortunately, the gun lobby believes the ability to shoot a gun indoors during this pandemic is worth risking further spread of the virus and making Virginia communities and families less safe," Herring said, according to the Associated Press.
University of Virginia law professor Richard Schragger told The Virginian-Pilot that the ruling only applies to the Lynchburg gun range — but the reasoning could apply to any subsequent lawsuits brought by other gun ranges in the state.
SafeSide was joined on the lawsuit by Gun Owners of America, the Association of Virginia Gun Ranges and the Virginia Citizens Defense League. Philip Van Cleave, president of the Virginia Citizens Defense League, told the AP his group would try to get a broader ruling that applied statewide.


npr--2020-04-27--READ: Coronavirus Testing Guidelines From The White House

The White House released guidance on coronavirus testing on Monday , which reiterates the administration 's work on testing and @ @ @ @ @ further develop and implement their own testing plans .
The outline comes as the country @ @ @ @ @ with some states moving much quicker than others .
Testing is seen as a key @ @ @ @ @ A lack of widespread testing has also been a point of criticism for the administration @ @ @ @ @ on reopening the economy while cases in the U.S. continue to rise .
`` Having @ @ @ @ @ place will help States prevent and contain local outbreaks that may occur as economic and @ @ @ @ @ country , '' the administration 's document says .

READ: Coronavirus Testing Guidelines From The White House
Enlarge this image toggle caption Valerie Macon/AFP via Getty Images Valerie Macon/AFP via Getty Images
The White House released guidance on coronavirus testing on Monday, which reiterates the administration's work on testing and includes recommendations for states to further develop and implement their own testing plans.
The outline comes as the country inches closer to reopening, with some states moving much quicker than others. Testing is seen as a key part of that effort. A lack of widespread testing has also been a point of criticism for the administration — as has the focus on reopening the economy while cases in the U.S. continue to rise.
"Having these plans and programs in place will help States prevent and contain local outbreaks that may occur as economic and social activities expand across the country," the administration's document says.
Read the guidance here.


npr--2020-04-27--Supreme Court To Government: Pay Obamacare Insurers

The U.S. Supreme Court has told the federal government that it has to pay $ 12 billion to insurance companies , money that was promised in the Affordable Care Act as part of the start-up costs of Obamacare in the first three years of its existence .
The law , as enacted , promised to limit profits and losses for insurance companies in the first three years of the Obamacare program .
Some companies made more money than allowed by the formula , and had to pay some back to the government , and other companies lost money and were @ @ @ @ @ @ @ formula .
But in 2014 , the first year that the ACA 's plan was in place , the Republican-controlled Congress reneged on the promise to appropriate money for the companies that had lost money .
It did the same for the next two years as well , adding to appropriation bills a rider that barred the government from fulfilling the promise in the statute .
After President Trump was elected , his administration supported the GOP-led refusal to pay .
The insurance companies sued , and on Monday the Supreme Court ruled @ @ @ @ @ @ @ up .
The vote was 8-to-1 , with Justice Sonia Sotomayor writing for the majority that the decision reflects a principle `` as old as the nation itself .
The government should honor its obligations . ''
She noted that the language of the ACA was `` rare '' in that it permitted lawsuits to enforce the provisions at issue here , provisions that declare the government '' shall pay '' the losses suffered by insurance companies that participated over the first three years .
The lone dissenter was Justice Samuel Alito , @ @ @ @ @ @ @ bailout '' for the insurance industry , which `` took a calculated risk and lost . ''
Monday 's decision was the third involving Obamacare at the Supreme Court .
Conservative groups , and now the Trump administration , have consistently sought to invalidate or undermine the law — so far , with limited or no success .
But next year , the Supreme Court is scheduled to consider once again whether the law is unconstitutional .
Despite repeated efforts by Republicans in Congress and the Trump administration to either undermine or entirely @ @ @ @ @ @ @ has remained popular , likely because it has enabled millions of Americans , including those with pre-existing conditions , to obtain medical insurance and medical coverage for the first time .

Supreme Court To Government: Pay Obamacare Insurers
Enlarge this image toggle caption Patrick Semansky/AP Patrick Semansky/AP
The U.S. Supreme Court has told the federal government that it has to pay $12 billion to insurance companies, money that was promised in the Affordable Care Act as part of the start-up costs of Obamacare in the first three years of its existence.
The law, as enacted, promised to limit profits and losses for insurance companies in the first three years of the Obamacare program. Some companies made more money than allowed by the formula, and had to pay some back to the government, and other companies lost money and were owed money by the government under the formula.
But in 2014, the first year that the ACA's plan was in place, the Republican-controlled Congress reneged on the promise to appropriate money for the companies that had lost money. It did the same for the next two years as well, adding to appropriation bills a rider that barred the government from fulfilling the promise in the statute. After President Trump was elected, his administration supported the GOP-led refusal to pay.
The insurance companies sued, and on Monday the Supreme Court ruled that the federal government has to pay up.
The vote was 8-to-1, with Justice Sonia Sotomayor writing for the majority that the decision reflects a principle "as old as the nation itself. The government should honor its obligations."
She noted that the language of the ACA was "rare" in that it permitted lawsuits to enforce the provisions at issue here, provisions that declare the government"shall pay" the losses suffered by insurance companies that participated over the first three years.
The lone dissenter was Justice Samuel Alito, who called the decision "a massive bailout" for the insurance industry, which "took a calculated risk and lost."
Monday's decision was the third involving Obamacare at the Supreme Court. Conservative groups, and now the Trump administration, have consistently sought to invalidate or undermine the law — so far, with limited or no success. But next year, the Supreme Court is scheduled to consider once again whether the law is unconstitutional.
Despite repeated efforts by Republicans in Congress and the Trump administration to either undermine or entirely do away with the program, Obamacare has remained popular, likely because it has enabled millions of Americans, including those with pre-existing conditions, to obtain medical insurance and medical coverage for the first time.


npr--2020-04-27--Amazon Warehouse Safety 'Inadequate,' N.Y. Attorney General's Office Says

Amazon may have violated federal safety standards for providing `` inadequate '' protections to warehouse workers in New York , the state attorney general 's office says .
In a letter to Amazon obtained by NPR , the office of New York 's top lawyer Letitia James says the company may have also broken the state 's whistleblower laws for firing a warehouse worker who helped organize a protest in Staten Island .
`` While we continue to investigate , the information so far available to us raises concerns that Amazon 's health and safety measures taken in response to @ @ @ @ @ @ @ they may violate several provisions of the Occupational Safety and Health Act '' and other federal and state guidelines , James 's staff wrote in the letter , dated April 22 .
The New York attorney general 's office declined to comment .
Amazon on Monday did not directly respond to the letter , but cited previous comments it has made on the criticisms .
The company has maintained that workers ' accusations were unfounded and that it has taken `` extreme measures to keep people safe . ''
Amazon 's New York @ @ @ @ @ @ @ the company fired Staten Island worker Christian Smalls , who helped stage a protest demanding that the facility be closed following several confirmed cases of the coronavirus among staff .
Amazon has said Smalls was fired for violating quarantine and safety measures .
New York officials write that their preliminary findings `` raise serious concern that Amazon may have discharged [ Smalls ] in order to silence his complaints and send a threatening message to other employees that they should also keep quiet about any health and safety concerns . ''
Notably , @ @ @ @ @ @ @ general is also investigating `` other cases of potential illegal retaliation . ''
The state officials urged Amazon to reinstate Smalls and requested all internal Amazon communications since Feb. 1 concerning workers ' complaints , organizing , protests and demonstrations .
`` This Office has learned that many workers are fearful about speaking out about their concerns following the termination of Mr. Smalls ' employment , '' the letter said .
`` This is a particularly dangerous message to send during a pandemic , when chilling worker speech about health and safety practices @ @ @ @ @ @ @ and death . ''
Amazon spokesperson Rachael Lighty said in a statement that the company respects workers ' rights to protest , `` however , these rights do not provide blanket immunity against bad actions , particularly those that endanger the health , well-being or safety of their colleagues . ''
Amazon warehouse workers have staged a series of protests and walkouts in several states in recent weeks .
Organizing through the Athena advocacy coalition , workers have criticized the company 's sick leave policies and safety measures .
They have demanded that @ @ @ @ @ @ @ COVID-19 cases .
The New York attorney general 's office , in last week 's letter , called on Amazon to temporarily close such warehouses for `` adequate sanitization and disinfection , '' citing guidance and recommendations from the Centers for Disease Control and Prevention .
Dozens of Amazon 's facilities have registered coronavirus cases , including at least one death , as the company employs over 400,000 part-time and full-time workers in the U.S. As many businesses struggle and millions are losing jobs , Amazon is one of the few companies that @ @ @ @ @ @ @ grow during the pandemic .
Amazon has announced plans to add 175,000 new workers to keep up with skyrocketing demand for online shopping as much of the country holes up at home .
Smalls in Staten Island had filed a complaint with the New York State Department of Health on March 21 , according to the letter from the attorney general 's office .
The letter says Smalls raised concerns about conditions at the warehouse where he worked , about groups gathering in defiance of the six-foot social distancing rule , insufficient cleaning @ @ @ @ @ @ @ coming in and out of the facility .
Meanwhile , some employees have publicly criticized the company for firing several activist workers during the pandemic , including those who work at its Seattle headquarters .
Warehouse workers have a variety of demands .
Some have complained that they do n't get masks the company has promised and want Amazon to ease speed quotas to allow more time for hand-washing and other breaks .
Others have said they 've struggled to receive pay after being sent home with a fever and have raised alarms @ @ @ @ @ @ @ rid of unlimited unpaid leave .
Amazon was one of the few companies to offer this benefit , but starting May 1 it will instead ask workers who want to stay home to use their regular accrued time off or request a leave of absence .
`` The truth is masks , temperature checks , hand sanitizer , social distancing measures , increased time off , increased pay , and more are standard across our network because we care deeply about the health and safety of our employees , '' Amazon 's Lighty @ @ @ @ @ @ @ encourage anyone to compare the health and safety measures Amazon has taken , and the speed of their implementation , during this crisis with other retailers . ''
Editor 's note : Amazon is among NPR 's financial supporters .

Amazon Warehouse Safety 'Inadequate,' N.Y. Attorney General's Office Says
Enlarge this image toggle caption Angela Weiss/AFP via Getty Images Angela Weiss/AFP via Getty Images
Updated at 7:15 p.m. ET
Amazon may have violated federal safety standards for providing "inadequate" protections to warehouse workers in New York, the state attorney general's office says.
In a letter to Amazon obtained by NPR, the office of New York's top lawyer Letitia James says the company may have also broken the state's whistleblower laws for firing a warehouse worker who helped organize a protest in Staten Island.
"While we continue to investigate, the information so far available to us raises concerns that Amazon's health and safety measures taken in response to the COVID-19 pandemic are so inadequate that they may violate several provisions of the Occupational Safety and Health Act" and other federal and state guidelines, James's staff wrote in the letter, dated April 22.
The New York attorney general's office declined to comment. Amazon on Monday did not directly respond to the letter, but cited previous comments it has made on the criticisms. The company has maintained that workers' accusations were unfounded and that it has taken "extreme measures to keep people safe."
Amazon's New York warehouses have been under extra scrutiny since the company fired Staten Island worker Christian Smalls, who helped stage a protest demanding that the facility be closed following several confirmed cases of the coronavirus among staff. Amazon has said Smalls was fired for violating quarantine and safety measures.
New York officials write that their preliminary findings "raise serious concern that Amazon may have discharged [Smalls] in order to silence his complaints and send a threatening message to other employees that they should also keep quiet about any health and safety concerns."
Notably, the letter says New York's attorney general is also investigating "other cases of potential illegal retaliation." The state officials urged Amazon to reinstate Smalls and requested all internal Amazon communications since Feb. 1 concerning workers' complaints, organizing, protests and demonstrations.
"This Office has learned that many workers are fearful about speaking out about their concerns following the termination of Mr. Smalls' employment," the letter said. "This is a particularly dangerous message to send during a pandemic, when chilling worker speech about health and safety practices could literally be a matter of life and death."
Amazon spokesperson Rachael Lighty said in a statement that the company respects workers' rights to protest, "however, these rights do not provide blanket immunity against bad actions, particularly those that endanger the health, well-being or safety of their colleagues."
Amazon warehouse workers have staged a series of protests and walkouts in several states in recent weeks. Organizing through the Athena advocacy coalition, workers have criticized the company's sick leave policies and safety measures. They have demanded that Amazon temporarily shut down facilities with confirmed COVID-19 cases.
The New York attorney general's office, in last week's letter, called on Amazon to temporarily close such warehouses for "adequate sanitization and disinfection," citing guidance and recommendations from the Centers for Disease Control and Prevention.
Dozens of Amazon's facilities have registered coronavirus cases, including at least one death, as the company employs over 400,000 part-time and full-time workers in the U.S.
As many businesses struggle and millions are losing jobs, Amazon is one of the few companies that is hiring and has seen its business grow during the pandemic. Amazon has announced plans to add 175,000 new workers to keep up with skyrocketing demand for online shopping as much of the country holes up at home.
Smalls in Staten Island had filed a complaint with the New York State Department of Health on March 21, according to the letter from the attorney general's office. The letter says Smalls raised concerns about conditions at the warehouse where he worked, about groups gathering in defiance of the six-foot social distancing rule, insufficient cleaning of the facility, and infected workers coming in and out of the facility.
Meanwhile, some employees have publicly criticized the company for firing several activist workers during the pandemic, including those who work at its Seattle headquarters.
Warehouse workers have a variety of demands. Some have complained that they don't get masks the company has promised and want Amazon to ease speed quotas to allow more time for hand-washing and other breaks. Others have said they've struggled to receive pay after being sent home with a fever and have raised alarms about the company's decision to get rid of unlimited unpaid leave. Amazon was one of the few companies to offer this benefit, but starting May 1 it will instead ask workers who want to stay home to use their regular accrued time off or request a leave of absence.
"The truth is masks, temperature checks, hand sanitizer, social distancing measures, increased time off, increased pay, and more are standard across our network because we care deeply about the health and safety of our employees," Amazon's Lighty said in a statement. "We encourage anyone to compare the health and safety measures Amazon has taken, and the speed of their implementation, during this crisis with other retailers."
Editor's note: Amazon is among NPR's financial supporters.