vox--2020-07-08--Why Arizona is suffering the worst Covid-19 outbreak in the US

The US is struggling with a resurgence of the coronavirus in the South and West .
But the severity of Arizona ’ s Covid-19 outbreak is in a league of its own .
Over the week of June 30 , Arizona reported 55 new coronavirus cases per 100,000 people per day .
That ’ s 34 percent more than the second-worst state , Florida .
It ’ s more than double Texas , another hard-hit state .
It ’ s more than triple the US average .
Arizona also maintains the highest rate of positive tests of any state at @ @ @ @ @ @ @ than a quarter of people who are tested for coronavirus ultimately have it .
That ’ s more than five times the recommended maximum of 5 percent .
Such a high positive rate indicates that Arizona doesn ’ t have enough testing to match its big Covid-19 outbreak .
To put it another way : As bad as Arizona ’ s coronavirus outbreak seems right now , the state is very likely still undercounting a lot of cases , since it doesn ’ t have enough testing to pick up all the new @ @ @ @ @ @ @ country in coronavirus-related hospitalizations .
According to the Centers for Disease Control and Prevention , more than one in five inpatient beds in Arizona are occupied by Covid-19 patients — about 42 percent more than Texas and 65 percent more than Florida , the states with the next-highest share of Covid-19 patient-occupied beds .
With hospitalizations rapidly climbing , Arizona became the first in the country to trigger “ crisis care ” standards to help doctors and nurses decide who gets treatment as the system deals with a surge of patients .
Around @ @ @ @ @ @ @ intensive care unit beds are occupied , based on Arizona Department of Health Services data .
While reported deaths typically lag new coronavirus cases , the state has also seen its Covid-19 death toll increase over the past several weeks .
This is the result , experts say , of Arizona ’ s missteps at three crucial points in the pandemic .
The state reacted too slowly to the coronavirus pandemic in March .
As cases began to level off nationwide , officials moved too quickly to reopen in early and mid-May .
@ @ @ @ @ @ @ late May and then June , its leaders once again moved too slowly .
“ What you ’ re seeing is not only a premature opening , but one done so rapidly there was no way to ensure the health care and public health systems didn ’ t get stressed in this process , ” Saskia Popescu , an infectious disease epidemiologist based in Arizona , told me .
At the same time , recommended precautions against the coronavirus weren ’ t always taken seriously by the general public — with experts saying @ @ @ @ @ @ @ the state can be spotty .
That could be partly a result of Republican Gov .
Doug Ducey downplaying the threat of the virus : While he eventually told people to wear masks in mid-June , as of late May he claimed that “ it ’ s safe out there , ” adding , “ I want to encourage people to get out and about , to take a loved one to dinner , to go retail shopping.
” Ducey ’ s actions and comments “ gave the impression we were past Covid-19 @ @ @ @ @ @ @ , ” Popescu said , “ which I believe encouraged people to become lax in their masking [ and ] social distancing.
” After weeks of increases in coronavirus cases and hospitalizations , Ducey pulled back Arizona ’ s reopening on June 29 , closing downs bars , theaters , and gyms .
Experts say the move is a positive step forward , but also one that came too late : With coronavirus symptoms taking up to two weeks to develop , there are already infections out there that aren ’ t yet @ @ @ @ @ @ @ state can expect cases , hospitalizations , and , probably , deaths to continue to climb over the next few weeks .
Ducey acknowledged the sad reality : “ It will take several weeks for the mitigations that we have put in place and are putting in place to take effect , ” he said .
“ But they will take effect.
” Arizona now offers a warning to the rest of the world .
The state ’ s caseload was for months far below the totals in New York , Michigan , @ @ @ @ @ @ @ suffered the brunt of the virus in the US in the early months .
But by letting its guard down , Arizona became a global hot spot for Covid-19 — a testament to the need for continued vigilance against the coronavirus until a vaccine or similarly effective treatment is developed .
Arizona was slow to close and quick to reopen Arizona was initially close to close down .
While neighboring California instituted a stay-at-home order on March 19 , Ducey didn ’ t issue a similar order for Arizona until March 31 — @ @ @ @ @ @ @ seem like too much time , but experts say it really is : When the number of Covid-19 cases statewide can double within just 24 to 72 hours , days and weeks truly matter .
Arizona was also quick to reopen its economy .
After states started to close down , experts and the White House recommended that states see a decline in coronavirus cases for two weeks before they reopen .
Arizona never saw such a decline .
In fact , it arguably never even saw a real plateau .
The number @ @ @ @ @ @ @ steadily through April and into May , and then the exponential spike took off .
So it ’ s not quite right to say that Arizona is experiencing a “ second wave ” of the coronavirus .
It arguably never controlled the first wave , and the current rise of cases is a result of continued inaction as the initial wave of the virus continued spreading across the state .
( The Navajo Nation , which is partly in Arizona , was an initial coronavirus hot spot .
But its case count has @ @ @ @ @ @ @ it took strong measures against the virus . )
Arizona and other states experiencing a surge in Covid-19 now “ never got to flat , ” Pia MacDonald , an epidemiologist at the research institute RTI International , told me .
“ That means the states didn ’ t get to very good compliance with the public health interventions that we all need to take to make sure the outbreak doesn ’ t continue to grow.
” Despite the lack of a sustained decline in Covid-19 cases , Arizona moved forward with reopening @ @ @ @ @ @ @ too : Within weeks , the state not only let hospitals do elective surgeries but started to allow dine-in at restaurants and bars , gyms , and salons , among other high-risk indoor spaces , to reopen .
The short time frame prevented the state from seeing the full impact of each step of its reopening , even as it moved forward with additional steps .
Will Humble , executive director of the Arizona Public Health Association , argued it was this rate of reopening that really caused problems for the state .
@ @ @ @ @ @ @ 15 , ” Humble told me .
Referencing federal guidelines for reopening in phases , he added , Arizona effectively “ went from phase 0 to phase 3.
” It ’ s not just that Ducey aggressively reopened the state , but that he also prevented local governments from imposing their own stricter measures .
That included requirements for masks , which Ducey didn ’ t allow municipalities to impose until mid-June — weeks after Covid-19 cases started to rapidly rise .
Some of that is likely political .
As recommendations and requirements @ @ @ @ @ @ @ have suggested wearing a mask is emblematic of an overreaction to the coronavirus pandemic that has eroded civil liberties .
President Donald Trump has by and large refused to wear a mask in public , even saying that people wear masks to spite him and suggesting , contrary to the evidence , that masks do more harm than good .
While some Republicans are breaking from Trump on this issue , his comments and actions have helped politicize mask-wearing and other measures .
For example , there was an anti-mask rally in Scottsdale @ @ @ @ @ @ @ There , a local council member , Republican Guy Phillips , shouted George Floyd ’ s dying words — “ I can ’ t breathe !
” — before ripping his own mask off , according to the Washington Post .
( Phillips later apologized “ to anyone who became offended.
” ) Evidence supports the use of masks : Several recent studies found masks reduce transmission .
Some experts hypothesize — and early research suggests — that masks played a significant role in containing outbreaks in several Asian countries where their use @ @ @ @ @ @ @ Japan .
But for a Republican governor like Ducey , the politicization of the issue means a large chunk of his political base is resistant to the kind of measures needed to get the coronavirus under control .
And those same constituents are likelier to reject taking precautions against the coronavirus , even if they ’ re recommended by government officials or experts .
Ducey himself seemed to play into the politics : One day before Trump visited a plant in the state , and as the president urged states to reopen , @ @ @ @ @ @ @ ’ s reopening plans .
Other factors , beyond policy , likely played a role as well in the rise in cases .
While summer in other parts of the country lets people go outside more often — where the coronavirus is less likely to spread — triple-digit temperatures in Arizona can actually push people inside , where poor ventilation and close contact is more likely to lead to transmission .
Some officials have argued Black Lives Matter protests played a role in the new outbreak .
But the research and data so @ @ @ @ @ @ @ lead to a significant increase in Covid-19 cases , thanks to protests mostly taking place outside and participants embracing steps , such as wearing masks , that mitigate the risk of transmission .
In Arizona , the surge in coronavirus cases also began before the protests took off in the state .
Arizona saw its coronavirus cases start to increase by Memorial Day on May 25 .
The increase came hard — with the test positivity rate rising too , indicating early on that the increase was not merely the result of more @ @ @ @ @ @ @ soon followed .
Yet Ducey didn ’ t begin to scale back the state ’ s reopening until more than a month later — on June 29 .
This left weeks for the coronavirus to spread throughout the community .
The sad reality is Arizona will suffer the consequences of the governor ’ s slow action for weeks .
Because people can spread the virus without showing symptoms , can take up to weeks to show symptoms or get seriously ill , and there ’ s a delay in when new cases and @ @ @ @ @ @ @ to see weeks of new infections and deaths even after Ducey ’ s renewed restrictions .
“ Even if I put in 100 percent face mask use and everybody complied with it in Arizona right now , there would still be weeks of pain , ” Cyrus Shahpar , a director at the global health advocacy group Resolve to Save Lives , told me .
“ There are people out there spreading disease , and it takes time [ to pick them up as cases ] , from exposure to symptom onset to @ @ @ @ @ @ @ Experts argue the state still needs to go even further .
Humble advocated for more hospital staffing , a statewide mask requirement , more rigorous rules and better enforcement of the rules for reopening businesses , and improved testing capacity and contact tracing .
He also pointed to lack of timely testing in prisons as one area that hasn ’ t gotten enough attention and could lead to a blind spot for future Covid-19 outbreaks .
One potentially mitigating factor is the state ’ s infected have trended younger than they did in @ @ @ @ @ @ @ coronavirus outbreak , with people aged 20 to 44 making up roughly half of cases .
That could keep the death toll down a bit — though Covid-19 deaths in Arizona have already risen , and experts warn of the risks of long-term complications from coronavirus , including severe lung scarring , among young people as well .
Above all , experts say that the rise in cases was preventable and predictable .
The research suggests the lockdowns worked .
One study in Health Affairs concluded : The flipside , then , is @ @ @ @ @ @ @ to more virus transmission .
This is what researchers saw in previous disease outbreaks .
Several studies of the 1918 flu pandemic found that quicker and more aggressive steps to enforce social distancing saved lives in those areas .
But this research also shows the consequences of pulling back restrictions too early : A 2007 study in JAMA found that when St. Louis — widely praised for its response to the 1918 pandemic — eased its school closures , bans on public gatherings , and other restrictions , it saw a rise in @ @ @ @ @ @ @ looks in chart form , with the dotted line representing excess flu deaths and the black and gray bars showing when social distancing measures were in place .
The peak came after those measures were lifted , and the death rate fell only after they were reinstated .
This did not just happen in St. Louis .
Analyzing data from 43 cities , the JAMA study found this pattern repeatedly across the country .
Howard Markel , a co-author of the study and the director of the University of Michigan ’ s Center @ @ @ @ @ @ @ the results as a bunch of “ double-humped epi curves ” — officials instituted social distancing measures , saw flu cases fall , then pulled back the measures and saw flu cases rise again .
Arizona is now seeing that in real time : Social distancing worked at first .
But as the state relaxed social distancing , it saw cases quickly rise .
This is why experts consistently cautioned not just Arizona but other states against reopening too quickly .
It ’ s why they asked for some time — two weeks @ @ @ @ @ @ @ start to reopen .
It ’ s why they asked for states to take the reopening process slowly , ensuring that each relaxation didn ’ t lead to a surge in new Covid-19 cases .
Because Arizona and its leaders didn ’ t heed such warnings , it ’ s now suffering a predictable , preventable crisis — making it the state with the worst coronavirus epidemic in the country that ’ s suffered the most widespread coronavirus outbreak in the world .
Every day at Vox , we aim to answer your @ @ @ @ @ @ @ and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts @ @ @ @ @ @ @ moment requires .
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The US is struggling with a resurgence of the coronavirus in the South and West. But the severity of Arizona’s Covid-19 outbreak is in a league of its own.
Over the week of June 30, Arizona reported 55 new coronavirus cases per 100,000 people per day. That’s 34 percent more than the second-worst state, Florida. It’s more than double Texas, another hard-hit state. It’s more than triple the US average.
Arizona also maintained the highest rate of positive tests of any state at more than 25 percent over the week of June 30 — meaning more than a quarter of people who were tested for the coronavirus ultimately had it. That’s more than five times the recommended maximum of 5 percent. Such a high positive rate indicates Arizona doesn’t have enough testing to match its big Covid-19 outbreak.
To put it another way: As bad as Arizona’s coronavirus outbreak seems right now, the state is very likely still undercounting a lot of cases since it doesn’t have enough testing to pick up all the new infections.
The state also leads the country in coronavirus-related hospitalizations. According to the Centers for Disease Control and Prevention, more than one in five inpatient beds in Arizona are occupied by Covid-19 patients — about 42 percent more than Texas and 65 percent more than Florida, the states with the next-highest shares of Covid-19 patient-occupied beds. With hospitalizations rapidly climbing, Arizona became the first in the country to trigger “crisis care” standards to help doctors and nurses decide who gets treatment as the system deals with a surge of patients. Around 90 percent of the state’s intensive care unit beds are occupied, based on Arizona Department of Health Services data.
While reported deaths typically lag new coronavirus cases, the state has also seen its Covid-19 death toll increase over the past several weeks.
This is the result, experts say, of Arizona’s missteps at three crucial points in the pandemic. The state reacted too slowly to the coronavirus pandemic in March. As cases began to level off nationwide, officials moved too quickly to reopen in early and mid-May. As cases rose in the state in late May and then June, its leaders once again moved too slowly.
“What you’re seeing is not only a premature opening, but one done so rapidly there was no way to ensure the health care and public health systems didn’t get stressed in this process,” Saskia Popescu, an infectious disease epidemiologist based in Arizona, told me.
At the same time, recommended precautions against the coronavirus weren’t always taken seriously by the general public — with experts saying that, anecdotally, mask use in the state can be spotty. That could be partly a result of Republican Gov. Doug Ducey downplaying the threat of the virus: While he eventually told people to wear masks in mid-June, as of late May he claimed that “it’s safe out there,” adding, “I want to encourage people to get out and about, to take a loved one to dinner, to go retail shopping.”
Ducey’s actions and comments “gave the impression we were past Covid-19 and it was no longer an issue,” Popescu said, “which I believe encouraged people to become lax in their masking [and] social distancing.”
After weeks of increases in coronavirus cases and hospitalizations, Ducey pulled back Arizona’s reopening on June 29, closing downs bars, theaters, and gyms.
Experts say the move is a positive step forward, but also one that came too late: With coronavirus symptoms taking up to two weeks to develop, there are already infections out there that aren’t yet showing up in the data. The state can expect cases, hospitalizations, and, probably, deaths to continue to climb over the next few weeks.
Ducey acknowledged the sad reality: “It will take several weeks for the mitigations that we have put in place and are putting in place to take effect,” he said. “But they will take effect.”
Ducey’s office argued it took the action as was necessary at the time, based on the data it collected and its experts’ recommendations. “Our steps are in line with our facts on the ground that we’ve been tracking closely,” Patrick Ptak, a spokesperson for the governor’s office, told me.
Arizona now offers a warning to the rest of the world. The state’s caseload was for months far below the totals in New York, Michigan, and Louisiana, among the states that suffered the brunt of the virus in the US in the early months. But by letting its guard down, Arizona became a global hot spot for Covid-19 — a testament to the need for continued vigilance against the coronavirus until a vaccine or similarly effective treatment is developed.
Arizona was slow to close and quick to reopen
Arizona was initially slow to close down. While neighboring California instituted a stay-at-home order on March 19, Ducey didn’t issue a similar order for Arizona until March 31 — 12 days later.
That might not seem like too much time, but experts say it really is: When the number of Covid-19 cases statewide can double within just 24 to 72 hours, days and weeks matter.
Arizona was also quick to reopen its economy. After states started to close down, experts and the White House recommended that states see a decline in coronavirus cases for two weeks before they reopen. Arizona never saw such a decline. In fact, it arguably never even saw a real plateau. The number of daily new cases rose slowly and steadily through April and into May, and then the exponential spike took off.
So it’s not quite right to say that Arizona is experiencing a “second wave” of the coronavirus. It arguably never controlled the first wave, and the current rise of cases is a result of continued inaction as the initial wave of the virus spread across the state. (The Navajo Nation, which is partly in Arizona, was an initial coronavirus hot spot. But its case count has declined since May, in part because it took strong measures against the virus.)
Arizona and other states experiencing a surge in Covid-19 now “never got to flat,” Pia MacDonald, an epidemiologist at the research institute RTI International, told me. “That means the states didn’t get to very good compliance with the public health interventions that we all need to take to make sure the outbreak doesn’t continue to grow.”
Despite no sustained decline in Covid-19 cases, Arizona moved forward with reopening anyway. Ptak, the governor’s spokesperson, acknowledged that the state didn’t meet the two-week decline in cases, but he said the state had met another federal gating criteria for reopening by seeing a decline in the test positivity rate “week after week” throughout May.
Once the state started to reopen, it moved quickly. Within weeks, Arizona not only let hospitals do elective surgeries but started to allow dining in at restaurants and bars, and gyms and salons, among other high-risk indoor spaces, to reopen. The short time frame prevented the state from seeing the full impact of each step of its reopening, even as it moved forward with additional steps.
Will Humble, executive director of the Arizona Public Health Association, argued it was this rate of reopening that really caused problems for the state. “It was a free-for-all by May 15,” Humble told me. Referencing federal guidelines for reopening in phases, he added, Arizona effectively “went from phase 0 to phase 3.”
It’s not just that Ducey aggressively reopened the state, but that he also prevented local governments from imposing their own stricter measures. That included requirements for masks, which Ducey didn’t allow municipalities to impose until mid-June — weeks after Covid-19 cases started to rapidly rise. (Ptak claimed the governor acted once he received requests from mayors along the southern border to do so.)
Some of that is likely political. As recommendations and requirements for masks have expanded, some conservatives have suggested wearing a mask is emblematic of an overreaction to the coronavirus pandemic that has eroded civil liberties. President Donald Trump has by and large refused to wear a mask in public, even saying that people wear masks to spite him and suggesting, contrary to the evidence, that masks do more harm than good. While some Republicans are breaking from Trump on this issue, his comments and actions have helped politicize mask-wearing and other measures.
For example, there was an anti-mask rally in Scottsdale, Arizona, on June 24. There, a local council member, Republican Guy Phillips, shouted George Floyd’s dying words — “I can’t breathe!” — before ripping his own mask off, according to the Washington Post. (Phillips later apologized “to anyone who became offended.”)
Evidence supports the use of masks: Several recent studies found masks reduce transmission. Some experts hypothesize — and early research suggests — that masks played a significant role in containing outbreaks in several Asian countries where their use is widespread, like South Korea and Japan.
But for a Republican governor like Ducey, the politicization of the issue means a large chunk of his political base is resistant to the kind of measures needed to get the coronavirus under control. And those same constituents are likelier to reject taking precautions against the coronavirus, even if they’re recommended by government officials or experts.
Ducey himself seemed to play into the politics: One day before Trump visited a plant in the state, and as the president urged states to reopen, Ducey announced an acceleration of the state’s reopening plans.
Other factors, beyond policy, likely played a role as well in the rise in cases. While summer in other parts of the country lets people go outside more often — where the coronavirus is less likely to spread — triple-digit temperatures in Arizona can actually push people inside, where poor ventilation and close contact is more likely to lead to transmission.
Some officials have argued Black Lives Matter protests played a role in the new outbreak. But the research and data so far suggest the demonstrations didn’t lead to a significant increase in Covid-19 cases, thanks to protests mostly taking place outside and participants embracing steps, such as wearing masks, that mitigate the risk of transmission. In Arizona, the surge in coronavirus cases also began before the protests took off in the state.
Arizona is now stuck playing catch-up
Arizona saw its coronavirus cases start to increase by Memorial Day on May 25. The increase came hard — with the test positivity rate rising too, indicating early on that the increase was not merely the result of more testing in Arizona. Hospitalizations and deaths soon followed.
Yet Ducey didn’t begin to scale back the state’s reopening until more than a month later — on June 29. This left weeks for the coronavirus to spread throughout the community.
The sad reality is Arizona will suffer the consequences of the governor’s slow action for weeks. Because people can spread the virus without showing symptoms, can take up to weeks to show symptoms or get seriously ill, and there’s a delay in when new cases and deaths are reported, Arizona is bound to see weeks of new infections and deaths even after Ducey’s renewed restrictions.
“Even if I put in 100 percent face mask use and everybody complied with it in Arizona right now, there would still be weeks of pain,” Cyrus Shahpar, a director at the global health advocacy group Resolve to Save Lives, told me. “There are people out there spreading disease, and it takes time [to pick them up as cases], from exposure to symptom onset to testing to getting the testing results.”
Experts argue the state still needs to go even further. Humble advocated for more hospital staffing, a statewide mask requirement, more rigorous rules and better enforcement of the rules for reopening businesses, and improved testing capacity and contact tracing. He also pointed to the lack of timely testing in prisons as one area that hasn’t gotten enough attention and could lead to a blind spot for future Covid-19 outbreaks.
One potentially mitigating factor is the state’s infected have trended younger than they did in initial bouts of the US’s coronavirus outbreak, with people aged 20 to 44 making up roughly half of cases. That could keep the death toll down a bit — though Covid-19 deaths in Arizona have already risen, and experts warn of the risks of long-term complications from the coronavirus, including severe lung scarring, among young people as well.
Above all, experts say that the rise in cases was preventable and predictable.
The research suggests the lockdowns worked. One study in Health Affairs concluded:
Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1–5 days, 6.8 after 6–10 days, 8.2 after 11–15 days, and 9.1 after 16–20 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million).
The flipside, then, is likely true: Easing lockdowns likely led to more virus transmission.
This is what researchers saw in previous disease outbreaks.
Several studies of the 1918 flu pandemic found that quicker and more aggressive steps to enforce social distancing saved lives in those areas. But this research also shows the consequences of pulling back restrictions too early: A 2007 study in JAMA found that when St. Louis — widely praised for its response to the 1918 pandemic — eased its school closures, bans on public gatherings, and other restrictions, it saw a rise in deaths.
Here’s how that looks in chart form, with the dotted line representing excess flu deaths and the black and gray bars showing when social distancing measures were in place. The peak came after those measures were lifted, and the death rate fell only after they were reinstated.
This did not happen only in St. Louis. Analyzing data from 43 cities, the JAMA study found this pattern repeatedly across the country. Howard Markel, a co-author of the study and the director of the University of Michigan’s Center for the History of Medicine, described the results as a bunch of “double-humped epi curves” — officials instituted social distancing measures, saw flu cases fall, then pulled back the measures and saw flu cases rise again.
Arizona is now seeing that in real time: Social distancing worked at first. But as the state relaxed social distancing, it saw cases quickly rise.
This is why experts consistently cautioned not just Arizona but other states against reopening too quickly. It’s why they asked for some time — two weeks of falling cases — before states could start to reopen. It’s why they asked for states to take the reopening process slowly, ensuring that each relaxation didn’t lead to a surge in new Covid-19 cases.
Because Arizona and its leaders didn’t heed such warnings, it’s now suffering a predictable, preventable crisis — making it the state with the worst coronavirus epidemic in the country that’s suffered the most widespread coronavirus outbreak in the world.


vox--2020-07-08--A coronavirus consultant shares how she advises businesses on reopening

Dr. Dana Lerman was on the verge of launching a mobile Botox service with her business partner Andrea Stone .
They were hoping to improve the reputation of traveling Botox with their company Social Remedy , based in Denver , Colorado .
They had a website , lawyers , insurance , and a planned launch date of the first weekend of June .
Then the coronavirus hit .
“ My business partner and myself are very ambitious entrepreneurs , and we ’ re just not the type of people to sit and watch and just wait , ” Lerman , @ @ @ @ @ @ @ said .
They knew they needed to pivot for the times .
While their initial idea was to mobilize coronavirus testing ( people “ were sitting in their homes , terrified , ” Lerman said ) , the concept evolved when they couldn ’ t get insurance .
The Covid Consultants , a firm dedicated to advising entities from restaurants to nursing homes about how to reopen with minimal risk , was born .
Now , as states have begun to reopen , businesses are desperate to serve customers in person and gain @ @ @ @ @ @ @ shutdown .
Covid Consultants advises them on how to do so with minimal risk .
Even beyond Lerman ’ s company , there is a huge market for coronavirus consulting .
Many projects and deals from before the virus hit have been delayed , forcing consultants to adapt and businesses to seek help navigating the demands of the coronavirus .
Vox spoke with Lerman about the tips she has for businesses and Americans to deal with the coronavirus safely as the country reopens amid rising infection numbers and fears of a coming second @ @ @ @ @ @ @ wave issue .
This is a roller coaster , and this ride is not over anytime soon , ” she said .
This interview has been edited for clarity and length .
What do the Covid Consultants do , and why is there a demand for your business ?
Not only do you have these struggling businesses who are losing money left and right , but it ’ s impossible for them to get through these extensive guidelines .
These people are not medical experts ; they ’ re just trying to have @ @ @ @ @ @ @ re worried and scared and they want to make sure that they ’ re doing it safely or responsibly .
That ’ s where we decided we would come in .
We came together , created the Covid Consultants , and we are a consulting firm that helps businesses of any size and any function responsibly reopen .
We do these extensive on-site evaluations , looking top to bottom and helping them correctly interpret the guidelines and get through those .
We generate our own set of guidelines that compiles all the different @ @ @ @ @ @ @ understand that we ’ re all human beings , and we try to be realistic about expectations .
Another thing that we do is we help people not waste their resources .
Now , a lot of times , people think that Covid Consultants are going to come into our place of work and they ’ re gon na recommend that we get UVC [ ultraviolet germicidal irradiation ] lighting and foggers and all these really expensive things , but that ’ s actually the total opposite of what we do .
We @ @ @ @ @ @ @ responsibly use your resources and not be wasteful about them .
There is a lot of waste going around in a time when you really need to conserve those resources because everyone and their mother needs them .
How do you communicate and meet with your clients ?
We go to their place of business , we walk through , we evaluate from the moment you can visibly see the establishment .
We go to top to bottom .
We comment on signage , we comment on placement of hand sanitizers , furniture @ @ @ @ @ @ @ look at your cleaning products .
We run them through EPA [ Environmental Protection Agency ] websites to ensure that they ’ re coronavirus-certified .
What does the day-to-day of your job look like ?
For instance , yesterday we went to an assisted living facility and we met with the staff there , they gave us a tour , we discussed plans for the future .
We discussed generating our own guidelines for them , [ and ] specific questions that they might have for their particular facility .
Then , while @ @ @ @ @ @ @ is ringing off the hook , because we also sell PCR [ polymerase chain reaction ] tests .
How do you sell PCR tests ?
There ’ s PCR tests that look for active coronavirus , and then there ’ s antibody tests , which look for previous infection .
So we actually do both and continue to have antibody testing sites where we go to schools , athletic clubs , churches , and we offer those antibody testings to the community .
We own our own centrifuge and we centrifuge the specimens @ @ @ @ @ @ @ them overnight to Washington .
We get results within 48 hours .
We also , in terms of looking for active coronavirus or screening asymptomatic people , we actually have a relationship with travelers to Alaska , because right now you can not travel to Alaska , Hawaii , or French Polynesia without having a negative PCR test 72 hours prior to departure .
So we partner with a laboratory in which we send clients a postmarked box ; inside it is a specimen cup and directions .
It ’ s a saliva @ @ @ @ @ @ @ the cup , put it in the box , send it through FedEx , and that arrives in our laboratory in 24 hours , and we have results in 48 hours .
It ’ s a luxury service that people are really appreciative of .
There ’ s a lot of mixed information out there about antibody tests .
How effective are they ?
I think it depends on which antibody tests you ’ re using .
Obviously you want to use a test that is approved by the FDA under emergency use @ @ @ @ @ @ @ people that we test come in and say , “ I swear January , February , I was so sick .
I ’ ve never been sick like that before in my life .
It ripped through my whole office ; we all had it.
” And then you get back your negative antibody test .
What I think is happening is I think that they did have it , but you know we ’ ll never know because of the test inefficiencies that we were previously dealing with when this first happened @ @ @ @ @ @ @ ’ re seeing now in some of the early data that ’ s coming out about antibody testing is that the antibodies don ’ t last long .
So these people very well may have had it and their antibodies just went away .
The common cold is [ a ] coronavirus .
It ’ s just a different kind of coronavirus .
You can get the common cold several times in the season , and that ’ s because you probably developed these antibodies ; they ’ re short-lived , and then @ @ @ @ @ @ @ re susceptible again .
What is some general advice you give business owners about reopening ?
You already know those tips .
People know them .
But we ’ re human beings , and they don ’ t act on them .
I can go into facility after facility , a restaurant or whichever kind of place , when they see me come in , they put their mask on .
And to me , you know , I think it ’ s lovely , thank you for putting your mask on to @ @ @ @ @ @ @ got there , you didn ’ t have your mask on .
So people know what to do ; it ’ s just challenging to do it .
I ’ m human , and I understand .
I don ’ t like wearing a mask all day either .
It ’ s really uncomfortable , and it ’ s annoying to have to go wash your hands all the time and to not hug your friends and to maintain a social distance of 6 feet from all people .
That is not how @ @ @ @ @ @ @ that is how we need to live , at least right now , and I ’ m sure for the near future , at least , because this is not going anywhere , unfortunately .
This is going to be here for a while .
Can you tell me a little bit more about that ?
You ’ re seeing these cases and people talk about waves , but this is not a wave issue .
This is a roller coaster , and this ride is not over anytime soon .
I ’ @ @ @ @ @ @ @ partners and I talk about this all the time .
I would love for there to not be a need for my services .
That would be really great for me , because I ’ m also a human .
I ’ m a mom , I want to send my kids to school , I want them to be able to go to their jiujitsu class and be face to face with their music teachers , but this is just not the reality .
We are all subject to this coronavirus , @ @ @ @ @ @ @ together .
People need to wear masks .
What a lot of people don ’ t know is that it ’ s not about you .
It ’ s not about an individual person .
It ’ s about transmitting it throughout the community , and that ’ s what people are really failing to understand .
What have you noticed about restaurants reopening ?
I went to my first restaurant last week , and I ate like I hadn ’ t had food in months .
I sat outside because I think @ @ @ @ @ @ @ inside .
I strongly recommend outdoor eating over indoor eating , any day of the week .
But I look inside , and I see that the tables are not 6 feet apart .
That ’ s a real easy measure to implement — just rearrange the furniture .
A lot of people don ’ t even want to go to a restaurant ; a lot of people are not ready .
But for those people who are ready , they should be able to walk into a place that has their best @ @ @ @ @ @ @ knows what they ’ re doing .
Again , it ’ s not a challenge .
Just move the tables apart .
So that ’ s one thing .
Providing hand sanitizer when you walk in , that ’ s another thing .
Having menus that are not reusable .
I personally have been to restaurants where I ’ ll look over and see someone ordering , looking at their menu , and they literally sneeze right into the menu .
Then they leave that menu , and whether or not they wipe @ @ @ @ @ @ @ then the next person comes and opens , it touches it , and then goes and eats .
So that is how people get sick .
And it ’ s not just coronavirus right ; it ’ s influenza , it ’ s all the other viral illnesses that are out there , and bacterial illnesses .
Minimizing touchpoints is important , wearing masks when you can .
What do customers need to know about restaurants reopening ?
Just because it ’ s allowed doesn ’ t mean it ’ s safe .
@ @ @ @ @ @ @ We have friends who recently went out to eat together .
They ’ re a group of 20-year-old kids .
They did everything right , and a few days after that dinner , one of our friends learned that a few people at that dinner got coronavirus .
While she knew she was exposed , she didn ’ t understand that she was supposed to quarantine .
So people don ’ t even know the basic rules .
If you went to dinner with people , and then a few days later you @ @ @ @ @ @ @ with coronavirus , that means that you could potentially have it too .
And you could be asymptomatic and you need to stay home for 14 days and seek testing .
But when you don ’ t know that , and you go out into the community , that ’ s how it ’ s spread around .
It ’ s also understanding that when you go to a restaurant , that is a risk in and of itself .
I ’ m not at all discouraging it , it ’ s just @ @ @ @ @ @ @ .
If the people at your dinner table all have coronavirus the next day , that means you need to act on that .
How do you advise restaurants on reopening ?
It ’ s about employees and it ’ s about restaurants ’ patrons .
We recommend that employees get temperature screened when they come to work [ and ] fill out a form of whether or not they have any symptoms , and if they have any symptoms at all they go home .
Make sure your employees are safe at @ @ @ @ @ @ @ [ the ] virus to your other employees or people who come and eat at the restaurant .
You might have a restaurant waiter or waitress who ’ s over 65 or who has diabetes or hypertension or heart disease .
Those people are at increased risk of coronavirus , and maybe you wait until the next phase of reopening to bring back that vulnerable employee .
We recommend that they have clear signage on the front door , this is what we expect of our customers .
Wear a mask when you @ @ @ @ @ @ @ hands , use our provided hand sanitizer upon entry .
Please do not come into our restaurant if you have a fever or if you have symptoms of coronavirus or if you ’ ve recently been exposed to someone with coronavirus .
Things like that .
We also recommend that , like I said , they get rid of their reusable menus , condiments that are used by many people .
We would prefer there are touchless condiment dispensers .
I don ’ t know if people can buy those yet , but @ @ @ @ @ @ @ While I do not want to create waste and I think this is gon na be an awful consequence of our times , I think right now that makes more sense than having a reusable ketchup bottle that everyone is grabbing .
So it ’ s really those kinds of measures and socially distancing the tables .
I think that those are the most important things .
How has the experience of starting the Covid Consultants been ?
It ’ s just such an outrageous time as a physician and as an entrepreneur @ @ @ @ @ @ @ been leveled .
I mean , before , it was so hard to come up with something novel and interesting , and because you ’ re competing with years and years of people doing the same thing over and over .
But then when you have a viral pandemic and you happen to be an infectious disease physician from New York , it ’ s just so wild to me how I can have such an impact and help so many people .
Even if Covid Consultants shuts down today and goes no @ @ @ @ @ @ @ think it ’ s my greatest accomplishment in my life .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic @ @ @ @ @ @ @ constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

Dr. Dana Lerman was on the verge of launching a mobile Botox service with her business partner Andrea Stone. They were hoping to improve the reputation of traveling Botox with their company Social Remedy, based in Denver, Colorado. They had a website, lawyers, insurance, and a planned launch date of the first weekend of June. Then the coronavirus hit.
“My business partner and myself are very ambitious entrepreneurs, and we’re just not the type of people to sit and watch and just wait,” Lerman, an infectious disease specialist and entrepreneur, said. They knew they needed to pivot for the times.
While their initial idea was to mobilize coronavirus testing (people “were sitting in their homes, terrified,” Lerman said), the concept evolved when they couldn’t get insurance. The Covid Consultants, a firm dedicated to advising entities from restaurants to nursing homes about how to reopen with minimal risk, was born.
Now, as states have begun to reopen, businesses are desperate to serve customers in person and gain back revenue that was lost during the shutdown. Covid Consultants advises them on how to do so with minimal risk. Even beyond Lerman’s company, there is a huge market for coronavirus consulting. Many projects and deals from before the virus hit have been delayed, forcing consultants to adapt and businesses to seek help navigating the demands of the coronavirus.
Vox spoke with Lerman about the tips she has for businesses and Americans to deal with the coronavirus safely as the country reopens amid rising infection numbers and fears of a coming second wave.
“This is not a wave issue. This is a roller coaster, and this ride is not over anytime soon,” she said.
This interview has been edited for clarity and length.
What do the Covid Consultants do, and why is there a demand for your business?
Not only do you have these struggling businesses who are losing money left and right, but it’s impossible for them to get through these extensive guidelines. These people are not medical experts; they’re just trying to have their business survive, and they’re worried and scared and they want to make sure that they’re doing it safely or responsibly. That’s where we decided we would come in. We came together, created the Covid Consultants, and we are a consulting firm that helps businesses of any size and any function responsibly reopen.
We do these extensive on-site evaluations, looking top to bottom and helping them correctly interpret the guidelines and get through those. We generate our own set of guidelines that compiles all the different ones and makes them readable. We understand that we’re all human beings, and we try to be realistic about expectations. Another thing that we do is we help people not waste their resources.
Now, a lot of times, people think that Covid Consultants are going to come into our place of work and they’re gonna recommend that we get UVC [ultraviolet germicidal irradiation] lighting and foggers and all these really expensive things, but that’s actually the total opposite of what we do. We go in and we help you to responsibly use your resources and not be wasteful about them. There is a lot of waste going around in a time when you really need to conserve those resources because everyone and their mother needs them.
How do you communicate and meet with your clients?
We go to their place of business, we walk through, we evaluate from the moment you can visibly see the establishment. We go to top to bottom. We comment on signage, we comment on placement of hand sanitizers, furniture. The list is endless. We look at your cleaning products. We run them through EPA [Environmental Protection Agency] websites to ensure that they’re coronavirus-certified.
What does the day-to-day of your job look like?
For instance, yesterday we went to an assisted living facility and we met with the staff there, they gave us a tour, we discussed plans for the future. We discussed generating our own guidelines for them, [and] specific questions that they might have for their particular facility. Then, while we are doing that, our phone is ringing off the hook, because we also sell PCR [polymerase chain reaction] tests.
How do you sell PCR tests?
There’s PCR tests that look for active coronavirus, and then there’s antibody tests, which look for previous infection. So we actually do both and continue to have antibody testing sites where we go to schools, athletic clubs, churches, and we offer those antibody testings to the community. We own our own centrifuge and we centrifuge the specimens on site, and then we ship them overnight to Washington. We get results within 48 hours.
We also, in terms of looking for active coronavirus or screening asymptomatic people, we actually have a relationship with travelers to Alaska, because right now you cannot travel to Alaska, Hawaii, or French Polynesia without having a negative PCR test 72 hours prior to departure. So we partner with a laboratory in which we send clients a postmarked box; inside it is a specimen cup and directions. It’s a saliva test, so our clients spit in the cup, put it in the box, send it through FedEx, and that arrives in our laboratory in 24 hours, and we have results in 48 hours. It’s a luxury service that people are really appreciative of.
There’s a lot of mixed information out there about antibody tests. How effective are they?
I think it depends on which antibody tests you’re using. Obviously you want to use a test that is approved by the FDA under emergency use access, and then a lot of people that we test come in and say, “I swear January, February, I was so sick. I’ve never been sick like that before in my life. It ripped through my whole office; we all had it.” And then you get back your negative antibody test.
What I think is happening is I think that they did have it, but you know we’ll never know because of the test inefficiencies that we were previously dealing with when this first happened. But I think that what we’re seeing now in some of the early data that’s coming out about antibody testing is that the antibodies don’t last long. So these people very well may have had it and their antibodies just went away. The common cold is [a] coronavirus. It’s just a different kind of coronavirus. You can get the common cold several times in the season, and that’s because you probably developed these antibodies; they’re short-lived, and then once they go away, you’re susceptible again.
What is some general advice you give business owners about reopening?
You already know those tips. People know them. But we’re human beings, and they don’t act on them.
I can go into facility after facility, a restaurant or whichever kind of place, when they see me come in, they put their mask on. And to me, you know, I think it’s lovely, thank you for putting your mask on to protect me, but also before I got there, you didn’t have your mask on. So people know what to do; it’s just challenging to do it. I’m human, and I understand. I don’t like wearing a mask all day either. It’s really uncomfortable, and it’s annoying to have to go wash your hands all the time and to not hug your friends and to maintain a social distance of 6 feet from all people. That is not how we are used to living, but that is how we need to live, at least right now, and I’m sure for the near future, at least, because this is not going anywhere, unfortunately. This is going to be here for a while.
Can you tell me a little bit more about that?
You’re seeing these cases and people talk about waves, but this is not a wave issue. This is a roller coaster, and this ride is not over anytime soon. I’m just being realistic, and my partners and I talk about this all the time. I would love for there to not be a need for my services. That would be really great for me, because I’m also a human. I’m a mom, I want to send my kids to school, I want them to be able to go to their jiujitsu class and be face to face with their music teachers, but this is just not the reality. We are all subject to this coronavirus, and that should really be bringing people together. People need to wear masks.
What a lot of people don’t know is that it’s not about you. It’s not about an individual person. It’s about transmitting it throughout the community, and that’s what people are really failing to understand.
What have you noticed about restaurants reopening?
I went to my first restaurant last week, and I ate like I hadn’t had food in months. I sat outside because I think that sitting outdoors is safer than sitting inside. I strongly recommend outdoor eating over indoor eating, any day of the week.
But I look inside, and I see that the tables are not 6 feet apart. That’s a real easy measure to implement — just rearrange the furniture. A lot of people don’t even want to go to a restaurant; a lot of people are not ready. But for those people who are ready, they should be able to walk into a place that has their best interest at heart and is educated and knows what they’re doing. Again, it’s not a challenge. Just move the tables apart. So that’s one thing.
Providing hand sanitizer when you walk in, that’s another thing. Having menus that are not reusable. I personally have been to restaurants where I’ll look over and see someone ordering, looking at their menu, and they literally sneeze right into the menu. Then they leave that menu, and whether or not they wipe that down, who knows, and then the next person comes and opens, it touches it, and then goes and eats. So that is how people get sick. And it’s not just coronavirus right; it’s influenza, it’s all the other viral illnesses that are out there, and bacterial illnesses. Minimizing touchpoints is important, wearing masks when you can.
What do customers need to know about restaurants reopening?
Just because it’s allowed doesn’t mean it’s safe. That’s a huge misunderstanding. We have friends who recently went out to eat together. They’re a group of 20-year-old kids. They did everything right, and a few days after that dinner, one of our friends learned that a few people at that dinner got coronavirus. While she knew she was exposed, she didn’t understand that she was supposed to quarantine. So people don’t even know the basic rules.
If you went to dinner with people, and then a few days later you find out that they were all sick with coronavirus, that means that you could potentially have it too. And you could be asymptomatic and you need to stay home for 14 days and seek testing. But when you don’t know that, and you go out into the community, that’s how it’s spread around. It’s also understanding that when you go to a restaurant, that is a risk in and of itself. I’m not at all discouraging it, it’s just you have to know how to act. If the people at your dinner table all have coronavirus the next day, that means you need to act on that.
How do you advise restaurants on reopening?
It’s about employees and it’s about restaurants’ patrons. We recommend that employees get temperature screened when they come to work [and] fill out a form of whether or not they have any symptoms, and if they have any symptoms at all they go home. Make sure your employees are safe at work, they’re not transmitting [the] virus to your other employees or people who come and eat at the restaurant. You might have a restaurant waiter or waitress who’s over 65 or who has diabetes or hypertension or heart disease. Those people are at increased risk of coronavirus, and maybe you wait until the next phase of reopening to bring back that vulnerable employee.
We recommend that they have clear signage on the front door, this is what we expect of our customers. Wear a mask when you’re not eating, wash your hands, use our provided hand sanitizer upon entry. Please do not come into our restaurant if you have a fever or if you have symptoms of coronavirus or if you’ve recently been exposed to someone with coronavirus. Things like that.
We also recommend that, like I said, they get rid of their reusable menus, condiments that are used by many people. We would prefer there are touchless condiment dispensers. I don’t know if people can buy those yet, but reusing those little packets with ketchup. While I do not want to create waste and I think this is gonna be an awful consequence of our times, I think right now that makes more sense than having a reusable ketchup bottle that everyone is grabbing. So it’s really those kinds of measures and socially distancing the tables. I think that those are the most important things.
How has the experience of starting the Covid Consultants been?
It’s just such an outrageous time as a physician and as an entrepreneur because the entrepreneurial playing field has just been leveled. I mean, before, it was so hard to come up with something novel and interesting, and because you’re competing with years and years of people doing the same thing over and over. But then when you have a viral pandemic and you happen to be an infectious disease physician from New York, it’s just so wild to me how I can have such an impact and help so many people. Even if Covid Consultants shuts down today and goes no further, besides my children, I think it’s my greatest accomplishment in my life.


vox--2020-07-08--Trump is trying to kick out foreign students amid the pandemic

Many foreign students have fled the US amid the pandemic , going back to their home countries while they await word from university administrators about whether they will be able to come back to campus in the fall .
But some have stayed in the US — and a new Trump policy would force them to either return home , transfer to programs with in-person classes , or potentially face deportation .
The news has been a blow to students like João Cardoso , a rising senior at Yale University from Portugal on an F-1 student visa , for whom @ @ @ @ @ @ @ option .
His mother lives in a one-room apartment , and he is locked into a lease that doesn ’ t expire until next May .
Yale subsidizes his housing as part of his financial aid package ; if he were to leave the country , that money would disappear , and so would his ability to make rent .
Yale has allowed seniors to return to campus in the fall , adopting a hybrid model in which a small number of classes are in-person while the rest are online .
Cardoso ’ @ @ @ @ @ @ @ senior thesis from the safety of his apartment while tuning into online classes for his major , astronomy .
But foreign students on temporary F-1 and M-1 visas like Cardoso will no longer have the option of staying near campus while solely taking classes online .
“ The news was absolutely devastating because I don ’ t have the safety of staying here anymore , ” he said .
“ I ’ m pissed .
I ’ m mad at what they ’ ve done .
I think it ’ s really counterproductive.
@ @ @ @ @ @ @ secretary of Homeland Security , told CNN that the policy change was meant to “ encourage schools to reopen ” — part of the Trump administration ’ s goal of forcing American life to resume even as Covid-19 continues to spread and the death toll mounts .
Foreign students who have made significant sacrifices and commitments , both financial and personal , to study in the US are thus being used as political leverage .
Harvard and MIT filed a lawsuit in Massachusetts federal court on Wednesday morning challenging the policy , claiming @ @ @ @ @ @ @ students , instructors and other members of their communities — especially those who are immunocompromised and face higher risk of complications from Covid-19 — safe amid rising cases nationwide .
“ We believe that the ICE order is bad public policy , and we believe that it is illegal , ” Harvard President Larry Bacow said in a statement Wednesday .
It ’ s just the latest way that President Donald Trump , who has criticized universities for “ taking the easy way out ” by canceling in-person classes amid the pandemic , @ @ @ @ @ @ @ years , he has sought to clamp down on visa programs that allow foreign students to gain work experience post-graduation , preside over sting operations to weed out student visa fraud , and make it easier for students to fall out of legal status .
Foreign student enrollment , which totaled about 1 million students nationwide in 2014 , has consequently been on a steady decline since his election .
That has dealt a blow to universities that rely on their talents and tuition and to the US economy — foreign students generate @ @ @ @ @ @ @ annually and support more than 300,000 jobs , according to the think tank New American Economy .
Students may have to self-deport under ICE ’ s new policy Before the pandemic , ICE had a longstanding policy of barring international students from living in the US while pursuing online-only curriculums .
To maintain a valid visa , foreign students must pursue the number of credits necessary to complete whatever their school deems to be a “ full course of study.
” For students on F-1 visas , only a single online class can @ @ @ @ @ @ @ and , for students in technical and vocational programs on M-1 visas , none count .
ICE changed its policy as universities suspended in-person classes starting in early March to stop the spread of coronavirus , temporarily waiving limits on how many online courses foreign students can take for the spring and summer semesters .
The exemption would remain “ in effect for the duration of the emergency ” related to Covid-19 , the agency said at the time .
But the national emergency is by no means over , and universities have @ @ @ @ @ @ @ they can safely hold classes in the fall without becoming “ super spreaders.
” ICE nevertheless announced that it was updating the policy change on Monday such that students pursuing online-only curriculums would no longer be allowed to remain in the US , just hours after Harvard announced that it would be holding classes entirely online in the fall .
That still offers schools more flexibility than the agency ’ s pre-pandemic policy , Cuccinelli told CNN on Tuesday .
And it could still be subject to change since the agency has yet @ @ @ @ @ @ @ final rule in the Federal Register .
“ We ’ re expanding the flexibility massively to a level never done before so that schools can use hybrid models , ” he said , adding that “ anything short of 100 percent online ” would allow foreign students to stay in the US .
But schools say that the policy change , as described by ICE , will hamper their careful plans to reopen and leave their students with no option but to leave the country .
ICE suggested that students can transfer to @ @ @ @ @ @ @ that ’ s impossible within weeks of the start of the fall semester .
And for many students , the prospect of returning to their home countries to take classes online is “ impossible , impracticable , prohibitively expensive , and/or dangerous , ” according to Harvard and MIT ’ s suit .
Raúl Romero , a student at Kenyon College from Venezuela , said that returning to his home country would mean going back to a socioeconomic and political crisis that has displaced thousands and led to increases in violent crime , @ @ @ @ @ @ @ nonetheless expressed worry that Harvard and MIT ’ s lawsuit could fail — given that ICE had a longstanding policy of barring foreign students from pursuing online-only curriculums pre-pandemic , it ’ s harder to argue that this decision was “ arbitrary and capricious ” and violated the Administrative Procedure Act .
But the litigation could still delay the implementation of this policy change until the worst of the pandemic has passed .
“ This is not the clearest litigation compared to some of the other things we ’ re litigating for the @ @ @ @ @ @ @ a long time , a regulation that existed that limits online courses that you can take as a foreign student , ” said Ron Klasko , an immigration attorney based in Philadelphia who has litigated a number of cases successfully challenging the Trump administration ’ s immigration policies .
On the campaign trail in 2015 , Trump voiced support for keeping foreign students in the US .
But once he took office , Trump pursued a number of policies taking aim at them instead .
Trump has imposed restrictions on visa programs that @ @ @ @ @ @ @ in the US long-term , including the sought-after H-1B visa program for skilled workers .
It ’ s a pipeline for foreign talent , particularly in the fields of computer science , engineering , education , and medicine .
During the pandemic , Trump signed a proclamation temporarily blocking the entry of foreign workers coming to the US on H-1Bs and other visas through the end of the year .
According to a senior administration official , he ’ s also pursuing reforms to the program that would make it harder for entry-level @ @ @ @ @ @ @ qualify .
More than 85,000 immigrants get H-1B visas for skilled workers annually , including thousands for workers at tech giants such as Google and Amazon .
Recipients are currently selected by lottery , but Trump is proposing to instead prioritize workers with the highest wages and raise the program ’ s minimum wage requirements .
For foreign students deciding to attend American universities , the prospect of being able to work in the US post-graduation is a major draw .
Absent that ability , they might decide against choosing to attend school @ @ @ @ @ @ @ sought to clamp down on student visa fraud , using what many advocates consider to be questionable methods .
ICE came under fire in November after announcing that it had been operating a fake university designed to lure in immigrants seeking to obtain student visas fraudulently — but the students claimed they were the ones who had been deceived .
Some 250 students at the University of Farmington in Farmington Hills , Michigan , were consequently arrested .
The University of Farmington wasn ’ t a real educational institution : Although ICE advertised @ @ @ @ @ @ @ , it did not have any teachers , curriculum , classes , or other educational activities .
Its primary selling point , prosecutors said , is a ticket to an F-1 visa .
But attorneys for the students affected say that these operations are entrapment , designed to trick unknowing international students into paying thousands of dollars to a university , while having no way of knowing that their actions are illegal .
The Trump administration also tried to make it easier for students to face penalties for violating the terms of their @ @ @ @ @ @ @ issued a memo in 2018 that meant that mistakes so minor as failing to file an address change report or having to drop a course could have prevented students from applying for a new visa or barred them from reentering the US for a period of up to 10 years , Klasko said .
That memo , however , was blocked in federal court before it could go into effect .
Trump ’ s attempts to target foreign students have already led to a decline of almost 11 percent in enrollment since the @ @ @ @ @ @ @ largely be attributed to their perception that the US is less welcoming toward foreign students .
That ’ s a loss for both universities and the businesses who rely on their talent and economic power .
Foreign students tend to pay more in tuition than Americans and the loss of that revenue could hurt the quality of US higher education more broadly , universities have argued .
At the graduate level , many serve as research and teaching assistants , now aiding critical research on the coronavirus pandemic , and some grad programs @ @ @ @ @ @ @ and social sciences without them .
Post-graduation , many international students go on to become entrepreneurs or pursue careers in fields requiring specialized skills , particularly in STEM fields where there are well-documented labor shortages .
Nearly a quarter of founders of billion-dollar American startups came to the US initially as international students , according to the National Foundation for American Policy .
Absent that talent , many businesses may have to resort to candidates that are less qualified , institute training and reskilling programs for their employees or outsource work abroad , @ @ @ @ @ @ @ at the Fletcher School of Law and Diplomacy at Tufts University , said .
Even if international students go back to their home countries post-graduation , they still indirectly contribute to the US economy .
Many become contact points for American businesses looking to build a relationship with companies abroad or expand their business abroad .
And US-educated graduates populating foreign governments may pursue US-friendly policy .
“ It is the American-trained , American-educated graduates that become the primary interlocutors , ” Chakravorti said .
But as Chakravorti has observed among his own @ @ @ @ @ @ @ have soured many foreigners on attending university in the US or staying in the country after they graduate .
When Cardoso was accepted to Yale , he was seriously considering finding a job in the US post-graduation , but the past three years have dissuaded him .
He speaks German fluently , so he could get a job in Germany instead as a software developer and wouldn ’ t even need to apply for a new visa since he is a European Union citizen .
For him , staying in the US isn @ @ @ @ @ @ @ heartache .
“ I ’ m out of here as soon as possible , ” he said .
“ I ’ m completely disappointed with this country in so many ways.
” Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more @ @ @ @ @ @ @ brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

Many foreign students have fled the US amid the pandemic, going back to their home countries while they await word from university administrators about whether they will be able to come back to campus in the fall. But some have stayed in the US — and a new Trump policy would force them to either return home, transfer to programs with in-person classes, or potentially face deportation.
The news has been a blow to students like João Cardoso, a rising senior at Yale University from Portugal on an F-1 student visa, for whom going home isn’t really an option.
His mother lives in a single rented room, and he is locked into a lease that doesn’t expire until next May. Yale subsidizes his housing as part of his financial aid package; if he were to leave the country, that money could disappear, and so would his ability to make rent.
Yale has allowed seniors to return to campus in the fall, adopting a hybrid model in which a small number of classes are in-person while the rest are online. Cardoso’s plan was to finish up his senior thesis from the safety of his apartment while tuning into online classes for his major, astronomy.
But foreign students on temporary F-1 and M-1 visas like Cardoso will no longer have the option of staying near campus while solely taking classes online.
“The news was absolutely devastating because I don’t have the safety of staying here anymore,” he said. “I’m pissed. I’m mad at what they’ve done. I think it’s really counterproductive.”
Ken Cuccinelli, the acting deputy secretary of Homeland Security, told CNN that the policy change was meant to “encourage schools to reopen” — part of the Trump administration’s goal of forcing American life to resume even as Covid-19 continues to spread and the death toll mounts. Foreign students who have made significant sacrifices and commitments, both financial and personal, to study in the US are thus being used as political leverage.
Harvard and MIT filed a lawsuit in Massachusetts federal court on Wednesday morning challenging the policy, claiming it overlooked universities efforts’ to keep students, instructors and other members of their communities — especially those who are immunocompromised and face higher risk of complications from Covid-19 — safe amid rising cases nationwide.
“We believe that the ICE order is bad public policy, and we believe that it is illegal,” Harvard President Larry Bacow said in a statement Wednesday.
It’s just the latest way that President Donald Trump, who has criticized universities for “taking the easy way out” by canceling in-person classes amid the pandemic, has targeted foreign students. In recent years, he has sought to clamp down on visa programs that allow foreign students to gain work experience post-graduation, preside over sting operations to weed out student visa fraud, and make it easier for students to fall out of legal status.
Foreign student enrollment, which totaled about 1 million students nationwide in 2014, has consequently been on a steady decline since his election. That has dealt a blow to universities that rely on their talents and tuition and to the US economy — foreign students generate an estimated $32 billion in revenue annually and support more than 300,000 jobs, according to the think tank New American Economy.
Students may have to self-deport under ICE’s new policy
Before the pandemic, ICE had a longstanding policy of barring international students from living in the US while pursuing online-only curriculums. To maintain a valid visa, foreign students must pursue the number of credits necessary to complete whatever their school deems to be a “full course of study.” For students on F-1 visas, only a single online class can count towards their full course of study and, for students in technical and vocational programs on M-1 visas, none count.
ICE changed its policy as universities suspended in-person classes starting in early March to stop the spread of coronavirus, temporarily waiving limits on how many online courses foreign students can take for the spring and summer semesters. The exemption would remain “in effect for the duration of the emergency” related to Covid-19, the agency said at the time.
But the national emergency is by no means over, and universities have been working for months to determine how they can safely hold classes in the fall without becoming “super spreaders.” ICE nevertheless announced that it was updating the policy change on Monday such that students pursuing online-only curriculums would no longer be allowed to remain in the US, just hours after Harvard announced that it would be holding classes entirely online in the fall.
That still offers schools more flexibility than the agency’s pre-pandemic policy, Cuccinelli told CNN on Tuesday. And it could still be subject to change since the agency has yet to publish the changes in a temporary final rule in the Federal Register.
“We’re expanding the flexibility massively to a level never done before so that schools can use hybrid models,” he said, adding that “anything short of 100 percent online” would allow foreign students to stay in the US.
But schools say that the policy change, as described by ICE, will hamper their careful plans to reopen and leave their students with no option but to leave the country. ICE suggested that students can transfer to programs that are not online-only, but that’s impossible within weeks of the start of the fall semester.
And for many students, the prospect of returning to their home countries to take classes online is “impossible, impracticable, prohibitively expensive, and/or dangerous,” according to Harvard and MIT’s suit. Raúl Romero, a student at Kenyon College from Venezuela, said that returning to his home country would mean going back to a socioeconomic and political crisis that has displaced thousands and led to increases in violent crime, starvation and poverty.
Venezuelan students have no home to return to. Cancelling visas and putting thousands under risk of deportation is insane. Thank you ICE, let me pack my things and go back to a humanitarian crisis while continuing my liberal arts classes in Caracas online. — Raúl Romero (@Raul_RomeroM) July 7, 2020
Some attorneys have nonetheless expressed worry that Harvard and MIT’s lawsuit could fail — given that ICE had a longstanding policy of barring foreign students from pursuing online-only curriculums pre-pandemic, it’s harder to argue that this decision was “arbitrary and capricious” and violated the Administrative Procedure Act. But the litigation could still delay the implementation of this policy change until the worst of the pandemic has passed.
“This is not the clearest litigation compared to some of the other things we’re litigating for the reason that there are has been for a long time, a regulation that existed that limits online courses that you can take as a foreign student,” said Ron Klasko, an immigration attorney based in Philadelphia who has litigated a number of cases successfully challenging the Trump administration’s immigration policies.
How Trump has previously targeted students
On the campaign trail in 2015, Trump voiced support for keeping foreign students in the US. But once he took office, Trump pursued a number of policies taking aim at them instead.
When foreigners attend our great colleges & want to stay in the U.S., they should not be thrown out of our country. — Donald J. Trump (@realDonaldTrump) August 18, 2015
Trump has imposed restrictions on visa programs that provide a pathway for students to remain in the US long-term, including the sought-after H-1B visa program for skilled workers. It’s a pipeline for foreign talent, particularly in the fields of computer science, engineering, education, and medicine.
During the pandemic, Trump signed a proclamation temporarily blocking the entry of foreign workers coming to the US on H-1Bs and other visas through the end of the year. According to a senior administration official, he’s also pursuing reforms to the program that would make it harder for entry-level workers just graduating from US universities to qualify.
More than 85,000 immigrants get H-1B visas for skilled workers annually, including thousands for workers at tech giants such as Google and Amazon. Recipients are currently selected by lottery, but Trump is proposing to instead prioritize workers with the highest wages and raise the program’s minimum wage requirements.
For foreign students deciding to attend American universities, the prospect of being able to work in the US post-graduation is a major draw. Absent that ability, they might decide against choosing to attend school in the US.
Trump has also sought to clamp down on student visa fraud, using what many advocates consider to be questionable methods. ICE came under fire in November after announcing that it had been operating a fake university designed to lure in immigrants seeking to obtain student visas fraudulently — but the students claimed they were the ones who had been deceived. Some 250 students at the University of Farmington in Farmington Hills, Michigan, were consequently arrested.
The University of Farmington wasn’t a real educational institution: Although ICE advertised the university as offering graduate STEM courses, it did not have any teachers, curriculum, classes, or other educational activities. Its primary selling point, prosecutors said, is a ticket to an F-1 visa.
But attorneys for the students affected say that these operations are entrapment, designed to trick unknowing international students into paying thousands of dollars to a university, while having no way of knowing that their actions are illegal.
The Trump administration also tried to make it easier for students to face penalties for violating the terms of their visas. US Citizenship and Immigration Services issued a memo in 2018 that meant that mistakes so minor as failing to file an address change report or having to drop a course could have prevented students from applying for a new visa or barred them from reentering the US for a period of up to 10 years, Klasko said. That memo, however, was blocked in federal court before it could go into effect.
How Trump’s attacks on students harm American innovation
Trump’s attempts to target foreign students have already led to a decline of almost 11 percent in enrollment since the fall of 2016. That drop can largely be attributed to their perception that the US is less welcoming toward foreign students.
That’s a loss for both universities and the businesses who rely on their talent and economic power. Foreign students tend to pay more in tuition than Americans and the loss of that revenue could hurt the quality of US higher education more broadly, universities have argued. At the graduate level, many serve as research and teaching assistants, now aiding critical research on the coronavirus pandemic, and some grad programs could not exist in the STEM fields and social sciences without them.
Post-graduation, many international students go on to become entrepreneurs or pursue careers in fields requiring specialized skills, particularly in STEM fields where there are well-documented labor shortages. Nearly a quarter of founders of billion-dollar American startups came to the US initially as international students, according to the National Foundation for American Policy.
Absent that talent, many businesses may have to resort to candidates that are less qualified, institute training and reskilling programs for their employees or outsource work abroad, Bhaskar Chakravorti, dean of global business at the Fletcher School of Law and Diplomacy at Tufts University, said.
Even if international students go back to their home countries post-graduation, they still indirectly contribute to the US economy. Many become contact points for American businesses looking to build a relationship with companies abroad or expand their business abroad. And US-educated graduates populating foreign governments may pursue US-friendly policy.
“It is the American-trained, American-educated graduates that become the primary interlocutors,” Chakravorti said.
But as Chakravorti has observed among his own students, Trump’s immigration policies have soured many foreigners on attending university in the US or staying in the country after they graduate.
When Cardoso was accepted to Yale, he was seriously considering finding a job in the US post-graduation, but the past three years have dissuaded him. He speaks German, so he could get a job in Germany instead as a software developer and wouldn’t even need to apply for a new visa since he is a European Union citizen. For him, staying in the US isn’t worth the hassle or the heartache.
“I’m out of here as soon as possible,” he said. “I’m completely disappointed with this country in so many ways.”


vox--2020-07-08--The Supreme Court just gave Republicans a powerful new weapon against Obamacare

The US Supreme Court issued its ruling in Little Sisters v. Pennsylvania Wednesday , holding the Affordable Care Act gives the Trump administration broad authority to grant exceptions to a federal regulation requiring employers to provide birth control coverage to their employees .
On the surface , Justice Clarence Thomas ’ s majority opinion appears to be focused exclusively on birth control , and it also endorses a policy that could cease to exist in less than a year .
The immediate upshot of Little Sisters is to let stand Trump administration rules allowing employers opposed to birth control to @ @ @ @ @ @ @ employees .
If presumptive Democratic nominee Joe Biden becomes president next year , however , his administration could repeal the Trump administration ’ s policy and implement a new policy more favorable to contraception coverage .
But dig just one inch below the surface of Justice Thomas ’ s opinion , and it has deeply radical implications : Little Sisters opens up a new front in the seemingly endless judicial war on Obamacare .
And it gives Republicans a new weapon it can use to attack the landmark legislation President Obama signed more @ @ @ @ @ @ @ s opinion does not simply allow the Trump administration to limit many individuals ’ access to birth control , it could also allow courts to dismantle a key provision of Obamacare that ensures patients receive preventive care without having to pay out-of-pocket costs .
At the very least , Thomas ’ s decision is an existential threat to the legal requirement that health plans cover contraceptive care .
The fight over the birth control mandate , briefly explained The Affordable Care Act requires health insurance plans to provide a minimal level of coverage @ @ @ @ @ @ @ to “ not impose any cost sharing requirements ” for certain forms of care .
Among other things , the law provides that “ with respect to women , ” health plans must provide “ such additional preventive care and screenings ... as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
” Pursuant to this authority to lay out such “ comprehensive guidelines , ” the Obama-era Health Resources and Services Administration ( HRSA ) required health plans to provide cost-free coverage of all contraceptive methods approved by @ @ @ @ @ @ @ “ birth control mandate ” triggered immediate objections from religious groups opposed to birth control , and there have been several rounds of litigation seeking to exempt religious employers from the birth control requirement .
HRSA has also repeatedly revised its rules governing birth control to allow some employers that object to contraception to deny such coverage to their employees .
The most recent rules , promulgated by the Trump administration , allows employers that are not publicly traded to refuse to provide birth control coverage if they object to birth control — @ @ @ @ @ @ @ a “ sincerely held moral ” conviction .
Little Sisters holds that the Trump administration acted within its discretion under the Affordable Care Act when it created this broad exception to the birth control mandate .
Obamacare “ grants sweeping authority to HRSA to craft a set of standards defining the preventive care that applicable health plans must cover .
But the statute is completely silent as to what those ‘ comprehensive guidelines ’ must contain , or how HRSA must go about creating them , ” Thomas claims .
Accordingly , the @ @ @ @ @ @ @ to decide what counts as preventive care and screenings , ” and equally broad discretion to “ identify and create exemptions from its own Guidelines.
” The new front in the war on Obamacare To understand why this reading of Obamacare is so significant , one must first understand Justice Neil Gorsuch ’ s dissenting opinion in Gundy v. United States ( 2019 ) , which called for strict new limits on Congress ’ power to delegate rulemaking authority to federal agencies .
Though Gorsuch ’ s opinion in Gundy was technically a @ @ @ @ @ @ @ Court ’ s Republican majority have indicated that they agree with that opinion .
So the Gundy dissent can fairly be read as a majority opinion in waiting .
Current law permits Congress to empower federal agencies to issue binding regulations , so long as Congress “ lay [ s ] down by legislative act an intelligible principle to which the person or body authorized to [ exercise the delegated authority ] is directed to conform.
” In Gundy , however , Gorsuch suggested that this “ intelligible principle ” standard risks giving @ @ @ @ @ @ @ ’ s explanation of what new limits he would impose on federal agencies is vague , and it ’ s hard to find a clear legal rule in his Gundy opinion .
Nevertheless , Gorsuch writes that a federal law permitting agencies to regulate must be “ ‘ sufficiently definite and precise to enable Congress , the courts , and the public to ascertain ’ whether Congress ’ s guidance has been followed.
” Which brings us back to Little Sisters .
By claiming that Obamacare ’ s provision allowing HRSA to create @ @ @ @ @ @ @ virtually unbridled discretion , ” Thomas is speaking Gorsuch ’ s language .
And , just in case the implications of Thomas ’ s opinion are not clear , he makes those implications explicit .
“ No party has pressed a constitutional challenge to the breadth of the delegation involved here , ” Thomas writes , before citing Gundy .
“ The only question we face today is what the plain language of the statute authorizes.
” Thomas , in other words , is inviting future litigants to argue that the birth control @ @ @ @ @ @ @ does so in an opinion joined by all five justices who have previously spoken favorably towards Gorsuch ’ s Gundy opinion .
If you are a lawyer who hates Obamacare , it ’ s not hard to guess what you ’ re supposed to do next .
It ’ s worth noting , moreover , that the Affordable Care Act does not simply require insurers to cover women ’ s “ preventive care and screenings ” as provided for by HRSA ’ s guidelines .
It also requires health plans to provide cost-free @ @ @ @ @ @ @ services ” as determined by “ the current recommendations of the United States Preventive Services Task Force.
” It requires coverage of immunizations recommended by “ the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
” And it gives HRSA authority to decide which “ evidence-informed preventive care and screenings ” for infants , children , and adolescents must be covered without out-of-pocket costs , among other things .
All of these provisions of the Affordable Care Act are potentially threatened by Thomas ’ s opinion in Little @ @ @ @ @ @ @ we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our @ @ @ @ @ @ @ , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

The US Supreme Court issued its ruling in Little Sisters v. Pennsylvania Wednesday, holding the Affordable Care Act gives the Trump administration broad authority to grant exceptions to a federal regulation requiring employers to provide birth control coverage to their employees.
On the surface, Justice Clarence Thomas’s majority opinion appears to be focused exclusively on birth control, and it also endorses a policy that could cease to exist in less than a year.
The immediate upshot of Little Sisters is to let stand Trump administration rules allowing employers opposed to birth control to refuse to provide contraceptive coverage to their employees. If presumptive Democratic nominee Joe Biden becomes president next year, however, his administration could repeal the Trump administration’s policy and implement a new policy more favorable to contraception coverage.
But dig just one inch below the surface of Justice Thomas’s opinion, and it has deeply radical implications: Little Sisters opens up a new front in the seemingly endless judicial war on Obamacare. And it gives Republicans a new weapon it can use to attack the landmark legislation President Obama signed more than a decade ago.
Thomas’s opinion does not simply allow the Trump administration to limit many individuals’ access to birth control, it could also allow courts to dismantle a key provision of Obamacare that ensures patients receive preventive care without having to pay out-of-pocket costs. At the very least, Thomas’s decision is an existential threat to the legal requirement that health plans cover contraceptive care.
The fight over the birth control mandate, briefly explained
The Affordable Care Act requires health insurance plans to provide a minimal level of coverage. It also requires those health plans to “not impose any cost sharing requirements” for certain forms of care. Among other things, the law provides that “with respect to women,” health plans must provide “such additional preventive care and screenings ... as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.”
Pursuant to this authority to lay out such “comprehensive guidelines,” the Obama-era Health Resources and Services Administration (HRSA) required health plans to provide cost-free coverage of all contraceptive methods approved by the Food and Drug Administration. This “birth control mandate” triggered immediate objections from religious groups opposed to birth control, and there have been several rounds of litigation seeking to exempt religious employers from the birth control requirement.
HRSA has also repeatedly revised its rules governing birth control to allow some employers that object to contraception to deny such coverage to their employees. The most recent rules, promulgated by the Trump administration, allows employers that are not publicly traded to refuse to provide birth control coverage if they object to birth control — either on religious grounds or due to a “sincerely held moral” conviction.
Little Sisters holds that the Trump administration acted within its discretion under the Affordable Care Act when it created this broad exception to the birth control mandate.
Obamacare “grants sweeping authority to HRSA to craft a set of standards defining the preventive care that applicable health plans must cover. But the statute is completely silent as to what those ‘comprehensive guidelines’ must contain, or how HRSA must go about creating them,” Thomas claims. Accordingly, the statute gives HRSA “virtually unbridled discretion to decide what counts as preventive care and screenings,” and equally broad discretion to “identify and create exemptions from its own Guidelines.”
The new front in the war on Obamacare
To understand why this reading of Obamacare is so significant, one must first understand Justice Neil Gorsuch’s dissenting opinion in Gundy v. United States (2019), which called for strict new limits on Congress’ power to delegate rulemaking authority to federal agencies. Though Gorsuch’s opinion in Gundy was technically a dissent, all five members of the Court’s Republican majority have indicated that they agree with that opinion. So the Gundy dissent can fairly be read as a majority opinion in waiting.
Current law permits Congress to empower federal agencies to issue binding regulations, so long as Congress “lay[s] down by legislative act an intelligible principle to which the person or body authorized to [exercise the delegated authority] is directed to conform.” In Gundy, however, Gorsuch suggested that this “intelligible principle” standard risks giving agencies “unbounded policy choices.”
Gorsuch’s explanation of what new limits he would impose on federal agencies is vague, and it’s hard to find a clear legal rule in his Gundy opinion. Nevertheless, Gorsuch writes that a federal law permitting agencies to regulate must be “‘sufficiently definite and precise to enable Congress, the courts, and the public to ascertain’ whether Congress’s guidance has been followed.”
Which brings us back to Little Sisters. By claiming that Obamacare’s provision allowing HRSA to create the birth control mandate gives HRSA “virtually unbridled discretion,” Thomas is speaking Gorsuch’s language. And, just in case the implications of Thomas’s opinion are not clear, he makes those implications explicit.
“No party has pressed a constitutional challenge to the breadth of the delegation involved here,” Thomas writes, before citing Gundy. “The only question we face today is what the plain language of the statute authorizes.”
Thomas, in other words, is inviting future litigants to argue that the birth control mandate itself is unconstitutional. And he does so in an opinion joined by all five justices who have previously spoken favorably towards Gorsuch’s Gundy opinion. If you are a lawyer who hates Obamacare, it’s not hard to guess what you’re supposed to do next.
It’s worth noting, moreover, that the Affordable Care Act does not simply require insurers to cover women’s “preventive care and screenings” as provided for by HRSA’s guidelines.
It also requires health plans to provide cost-free coverage for certain “evidence-based items or services” as determined by “the current recommendations of the United States Preventive Services Task Force.” It requires coverage of immunizations recommended by “the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.” And it gives HRSA authority to decide which “evidence-informed preventive care and screenings” for infants, children, and adolescents must be covered without out-of-pocket costs, among other things.
All of these provisions of the Affordable Care Act are potentially threatened by Thomas’s opinion in Little Sisters.