Wonkbook: The growing U.S. fight against Ebola

August 29, 2014

Welcome to Wonkbook, Wonkblog’s morning policy news primer by Puneet Kollipara (@pkollipara). To subscribe by e-mail, click here. Send comments, criticism or ideas to Wonkbook at Washpost dot com. To read more by the Wonkblog team, click here. Follow us on Twitter and Facebook.


(Reuters)

Wonkbook’s Number of the Day: 4.2 percent. That's the Commerce Department's revised estimate for the U.S. economy's annualized rate of growth in the second quarter.

Wonkbook’s Chart of the Day: Americans still feel the economy has a long way to go to come back from the Great Recession.

Wonkbook's Top 5 Stories: (1) The expanding U.S. fight against Ebola; (2) pressure yields campus sexual-assault measures; (3) the growing GOP Medicaid expansion train; (4) an improving economy that people still don't feel; and (5) the debate over children and guns.

1. Top story: The growing U.S. fight against Ebola 

WHO warns that Ebola cases could top 20,000. "More than 20,000 people may be infected with Ebola before the outbreak in West Africa is controlled, and curbing the epidemic will cost at least $490 million, according to a World Health Organization plan. The number of people falling ill is accelerating, with more than 40 percent of the infections happening in the past 21 days, the Geneva-based United Nations agency said today. In some areas, the number of cases may be two to four times higher than reported, the WHO said in its so-called road map that lays out the plan to deal with the worst Ebola outbreak on record." Simeon Bennett in Bloomberg.

NIH officials say clinical trials on vaccine to begin soon. "The early-stage human trial is set to begin next week at the National Institutes of Health Clinical Center in Bethesda and will test both the safety of the vaccine and its ability to generate an immune response in patients. The initial trial will include about 20 adults, and officials said they hope to have initial safety data by the end of the year — a scientific and ethical necessity before distributing any new drug widely....At the same time, the NIH and other groups, such as the British-based public health charity Wellcome Trust, are trying to line up similar human Ebola vaccine trials in the United Kingdom, Gambia and Mali beginning as early as next month." Brady Dennis in The Washington Post.

Mutations will make it tougher to stop the outbreak, study says... "The Ebola virus sweeping through West Africa has mutated repeatedly during the current outbreak, a fact that could hinder diagnosis and treatment of the devastating disease, according to scientists who have genetically sequenced the virus in scores of victims. The findings...also offer new insights into the origins of the largest and most deadly Ebola outbreak in history, which has killed more than 1,500 people in four countries and shows few signs of slowing. It also provided another reminder of the deep toll the outbreak has taken on health workers and others in the affected areas, as five of the paper’s more than 50 co-authors died from Ebola before publication." Brady Dennis in The Washington Post.

...but these findings could help with vaccine development. "This detailed genetic mapping also could eventually make a bit of a difference in the way doctors spot and fight the disease, especially with work in preliminary vaccines....Researchers have already checked that still-not-tested vaccine against some of the more than 350 mutations in this strain of Ebola to make sure the changes the disease is making won't undercut science's hurried efforts to fight it, said Pardis Sabeti, a scientist at Harvard University and its affiliated Broad Institute." Seth Borenstein in the Associated Press.

Burial practices aren't just spreading the virus. They're making it harder for public-health responders to do their work. "Burials of people who have died of Ebola are taking as long as five days in Liberia as a shortage of ambulances and fuel compound the fear and isolation that are stoking the worst outbreak of the virus on record. A lack of vehicles and a fuel shortage are also hampering the ability of the World Health Organization and its allies to reach affected communities and investigate new cases, said Rick Brennan, director of the WHO’s department of emergency risk management and humanitarian response." Simeon Bennett in Bloomberg.

They are the body collectors: A perilous job in a time of Ebola. "'When I wake up in the morning, I will pray to God to give me strength and focus,' says 21-year-old Sorie Fofana. His job is collecting the bodies of those who die from Ebola in Monrovia, Liberia's capital city of roughly 1 million people. Before, Fofana was an artist, making designs for T-shirts. The new job pays better — $1,000 a month. But every morning, the lanky, laid-back Fofana has to steel himself to go out and do the job." Nurith Aizenman in NPR.

How the outbreak could spawn a food crisis. "The Ebola health crisis threatens to turn into a much broader 'food crisis' in some of the world's most impoverished countries, according to the United Nations' World Food Program. The program is scaling up its operations in West Africa to provide food to 1.3 million people in Guinea, Liberia and Sierra Leone. The food will go to people being treated for Ebola; their relatives; and those who have been quarantined by their governments, in an effort to halt the spread of Ebola....Farmers are leaving their crops as they flee areas ravaged by Ebola....People are not able to travel and trade freely, as countries close borders and international airlines cancel flights....People are also not able to hunt for bush meat." Liz Szabo in USA Today.

Other public-health reads:

White House orders biosafety review at federal labs. Jocelyn Kaiser in Science.

SEPKOWITZ: A vaccine may do little to help the current crisis. "In other words, the vaccine being studied almost certainly will have no impact on the current West Africa crisis. Given the pace of useable science, even with the compressed, hurry-up-already system the candidate vaccine is being ushered through, preliminary results on safety and the vaccine’s ability to provoke a meaningful immune response will not be available until the end of the calendar year — at a point when the now 6-month long epidemic likely will have finally fizzled out." Kent Sepkowitz in The Daily Beast.

Top opinion

BARRO: Don't want me to recline? You can pay me. "Obviously, it’s improper to throw water at another passenger on a flight, even if he deserves it. But I’ve seen a distressing amount of sympathy for Mr. Knee Defender, who wasn’t just instigating a fight but usurping his fellow passenger’s property rights. When you buy an airline ticket, one of the things you’re buying is the right to use your seat’s reclining function. If this passenger so badly wanted the passenger in front of him not to recline, he should have paid her to give up that right." Josh Barro in The New York Times.

CASSIDY: The good news about Medicare and the budget. "What’s new is that the problem no longer appears to be a hopeless one. The experience of the past decade shows that the rate of growth of health-care spending doesn’t have to accelerate from year to year; it isn’t an immutable law of political economy that Medicare must always grab a bigger slice of government spending....That doesn’t mean that we’ve solved the challenge of financing the aging of the boomers: we haven’t. Even if the recent trends persist, we’ll still need to raise extra revenues or trim spending. But, for the first time in a long time, there’s reason for guarded optimism.." John Cassidy in The New Yorker.

DAYEN: The SEC could have fixed our broken rating agencies. It whiffed. "The rules contain a massive loophole, because they don’t extend disclosure to 'private placements,' where bonds get sold privately to sophisticated investors rather than on the public market. Banks could simply shift their sales into private placements to avoid the requirement. Too much of the financial industry relies on duping investors about the quality of investments. The SEC is supposed to be the first line of defense against that, but has failed in that mission repeatedly in recent years. That feeds skepticism about its seriousness in combating fraud at the rating agencies, especially since it refused to alter the inherently flawed compensation model. As long as the rating agencies get paid by issuers, they’ll have incentives to please them with high ratings." David Dayen in The New Republic.

AVI-YONAH: Why corporate taxes are good for you. "Burger King’s proposed move to Canada is just the latest in a series of 'inversion' transactions....These increasingly common transactions have led some observers to question whether we need to tax corporations at all. For example, Greg Mankiw, President George W. Bush’s economic adviser, argues in The New York Times that the United States should abolish the corporate tax and replace it with a tax on consumption. Even liberal pundits like Matthew Yglesias have toyed with the idea....This view, though fashionable, couldn’t be more misguided. We shouldn’t scrap the corporate tax — we should protect it." Reuven S. Avi-Yonah in Politico Magazine.

GLECKMAN: CBO projections map the coming fiscal battle. "While CBO’s updated deficit forecast got most of the attention...the more interesting story is what is expected to happen to federal spending under current law....Think of the CBO report as a map of the coming field of battle. As always, the budget agency’s projections assume current law. That means the sequester’s automatic spending cuts for much of government resume as scheduled after fiscal 2015. Without those cuts, spending would be $874 billion higher over the next decade (plus $156 billion in interest on the added debt)....It is already easy to see where the pressure points will come when Congress and President Obama once again square off over spending." Howard Gleckman in Forbes.

Caffeine interlude: This is your brain on coffee.

2. How federal and public pressure may help curb campus sexual assaults

U.S. scrutiny of campus sexual assaults has found its way to the states. "When Congress reconvenes after its August recess, a bipartisan group of lawmakers will continue their push to pass legislation aimed at curbing campus sexual assaults. The Obama administration has taken on the issue, making public recommendations for how colleges should respond to the problem and more aggressively pursuing institutions that mishandle sexual assault cases. But...the issue is also increasingly commanding the attention of policy makers at the state level. Echoing concerns made by their federal counterparts, lawmakers and other officials in a handful of states are pursuing new ways to crack down on campus sexual assaults." Michael Stratford in Inside Higher Ed.

California passes a 'yes means yes' standard to tackle campus sexual assaults. "The California Senate passed a first-in-the-nation bill Thursday to define what amounts to consensual sexual activity in colleges in the state....California’s bill comes after more than a year of pressure from the federal government, Congress, and student activists for higher education institutions to do more....Colleges and universities have been changing their policies for months in response to federal pressure. And after recent changes in the Violence Against Women Act that require colleges to explicitly report their prevention efforts, many colleges will be unveiling new policies and programs this fall where they never existed before. The so-called 'affirmative consent' standard that California’s legislature has introduced in the latest bill is not a new concept." Eliza Gray in Time Magazine.

More colleges are buying sexual-assault insurance. "As schools grow more aware of the risk of sexual attacks on campus, some have implemented educational programs for students or reformed how they handle accusations of abuse. A few colleges are doing something else....They’re buying new insurance policies designed to protect them when sexual misconduct scandals arise....Most schools still don’t have standalone sexual misconduct policies, because their liability insurance covers sexual violence claims that fall under Title IX....Often that covers claims of abuse, sexual assault, or rape and also provides services to help victims, investigate allegations, and cover litigation expenses." Alyssa Abkowitz in Bloomberg Businessweek.

A scripted response on sexual assaults. "Proposed federal rules expected to be published in November would require institutions to offer prevention programs to new students, as well as employees, but many campuses have already begun....Stepping up prevention is just one way colleges are responding to pressure from activists and government officials....While some colleges are creating programs of their own, many are buying online courses produced by technology companies and other groups....A screening of the online prevention programs reveals a number of similarities among five of the most popular ones." Monica Vendituoli in The Chronicle of Higher Education.

A cottage industry has emerged on preventing the assaults. "A quick search for terms like 'campus safety' and 'sexual assault' on the Apple App Store reveals dozens of applications marketed toward worried college students....And it's not just mobile apps. From risk management firms to educational programs to products like fingernail polish that can detect date rape drugs, students and administrators have an increasing number of supposed prevention methods to choose from. Driven by a greater level of legal and federal scrutiny in recent years, a cottage industry is growing around campus sexual assault." Jake New in Inside Higher Ed.

Other education reads:

What's the key issue in Jindal's Common Core lawsuit? "In a lawsuit filed Wednesday, Louisiana Gov. Bobby Jindal claims that the Obama administration improperly impinged on local school administrators by encouraging states to adopt the Common Core standards....Some dismissed his suit as lacking merit, saying that the administration gave states leeway to shun Common Core if they chose. All the same, the governor's case raises anew an important question about the Common Core that divides its supporters and its detractors: whether the initiative is just a set of standards that specify what students should learn, or a curriculum that details how they should learn it." Max Ehrenfreund in The Washington Post.

Why Jindal had to sue: Think ahead to 2016. "Jindal's lawsuit the latest in a string of moves against Common Core. In June, he issued an executive order instructing state officials to implement a new educational standard. Here's the potential payoff: Imagine an opponent going after Jindal during a debate in Iowa next year, pointing out his early support for Common Core. His comeback: 'I sued President Obama over Common Core. I'm no cheerleader.' Now picture that same line in TV ad. Not a bad counterargument for him to make. More generally, it's a good thing in Republican circles to be suing the Obama administration — on any issue, really." Sean Sullivan in The Washington Post.

Common Core repeal costs Oklahoma its NCLB waiver. Caitlin Emma in Politico.

A new year, a new approach to school policing. Chris Opfer in The Atlantic CityLab.

Kids say the darndest things interlude: Boy goes crazy because his mom is pregnant again.

3. The GOP is increasingly hoping on the Medicaid expansion bandwagon

Pennsylvania’s Republican governor expands Medicaid. " Corbett, whose reelection campaign is suffering, joins Republican governors like Jan Brewer of Arizona and New Jersey's Chris Christie who oppose the ACA but have taken the law's billions of dollars to expand coverage to its poorest citizens....Iowa and Arkansas used private insurance to expand their Medicaid programs, as some states have sought flexibility from the federal government....Indiana Gov. Mike Pence (R), a rumored 2016 presidential candidate, is also seeking the federal government's permission to expand Medicaid through an existing state program providing health savings accounts to low-income adults. Pennsylvania's expansion will be contracted through managed care plans, which are already used in the state's Medicaid program." Jason Millman in The Washington Post.

Or is it Medicaid expansion? "Corbett, who is lagging in the polls in his bid for re-election this fall, said his plan, Healthy Pennsylvania, is not expansion under so-called Obamacare. The governor 'has been clear that he would not expand Medicaid because it is an unsustainable entitlement program,' a statement from his office said on Thursday. However, federal officials said the approval made Pennsylvania the 27th state to expand Medicaid under Obamacare." Hilary Russ and David Morgan in Reuters.

Explainer: Here's how Pennsylvania is expanding Medicaid. Adrianna McIntyre in Vox.

GOP increasingly hopping on Medicaid expansion bandwagon... "The decision has significant impact for Pennsylvania residents: By saying yes to Obamacare’s Medicaid expansion, as many as 600,000 low-income state residents would gain subsidies to purchase health coverage. (According to Gallup, about 10% of state residents are currently uninsured.) And it’s another signal that GOP governors, who’ve resisted the ACA’s coverage expansion for a mix of political and policy reasons, are steadily coming around to the idea. Why? More federal funds and lower rates of uninsurance, for starters." Dan Diamond in Forbes.

...and shying away from Obamacare repeal. "Heading into the first congressional election since millions of Americans gained coverage under the health law, many Republican candidates are taking a more nuanced approach to how they criticize the law. Rather than just calling for repeal, they are following Ayres’ recommendations to focus on arguments about how the law is hurting consumers, government budgets or the economy. And while political ads on television are still common, the number of new ads about the law has declined since spring when the administration rebounded from the troubled launch of healthcare.gov." Phil Galewitz in Kaiser Health News.

ACA will benefit more small businesses in the fall. "Three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own. SHOP exchanges were supposed to open nationwide on Oct. 1, the same day as exchanges offering health insurance for individuals. But the Obama administration postponed the SHOP launch, citing the need to fix serious technical problems with the exchanges for individuals....Also, insurance companies encouraged business owners to renew their plans before the October 2013 deadline to avoid having to sign up for a new policy during the first year of the controversial ACA rollout." Christine Vestal in Pew Stateline.

A deadline looms for many to keep their Obamacare, but a glitch may hamper them. "Hundreds of thousands of people risk losing their new health insurance policies if they don't resubmit citizenship or immigration information to the government by the end of next week — but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying. Consumers are being forced to send their information multiple times, and many can't access their accounts at all....The Centers for Medicare and Medicaid Services sent letters to about 310,000 consumers two weeks ago, telling them they need to submit proof of their citizenship or immigration status by Sept. 5 or their insurance will be canceled at the end of the month." Jayne O'Donnell in USA Today.

Other health care reads:

Why won't doctors move to rural America? Olga Khazan in The Atlantic.

More data to be withheld from database of physician payments. Charles Ornstein in ProPublica.

Long read: The dawn of the post-clinic abortion. Emily Bazelon in The New York Times Magazine.

It's really hard to measure the effects of abortion restrictions in Texas. Amelia Thomson-DeVeaux in FiveThirtyEight.

Obamacare spurs focus on faster drug development. Daniela Hernandez in Kaiser Health News and Wired.

States expand access to overdose reversal drug. Arian Campo-Flores and Zusha Elinson in The Wall Street Journal.

The expansion of mental health care hits obstacles. Abby Goodnough in The New York Times.

'Friends' interlude: A mini-reunion.

4. The economy keeps getting better, but try telling that to workers

U.S. second-quarter growth revised higher; jobless claims fall again. "Gross domestic product expanded at a 4.2 percent annual rate instead of the previously reported 4.0 percent pace, the Commerce Department said on Thursday. Both business spending and exports were revised higher, while a buildup in business inventories was smaller than previously estimated — a mix of growth that provides a stronger underpinning for the remainder of the year. Separate reports showing a second straight weekly decline in the number of Americans filing new claims for jobless benefits and a jump in home purchase contracts also suggested underlying momentum in the economy." Lucia Mutikani in Reuters.

But are most people feeling it? "Despite the faster overall growth rate, businesses still seem to be benefiting more from the economy’s upward trajectory than many individual consumers are. The revision on Thursday, for example, lowered the estimate of workers’ wage and salary growth slightly in the first half of 2014, with income rising 5.8 percent in the second quarter. Corporate profits, on the other hand, jumped 8 percent in the second quarter, the Commerce Department said. That split could change if unemployment continues to drop and the labor market tightens enough to give employees more bargaining power to demand higher pay." Nelson D. Schwartz in The New York Times.

Why it still feels like the recession hasn't ended. "From the start of the recession in 2007 to today, the average price of the things you buy...has risen by 15 percent. This, in itself, isn't a problem at all. The problem is that wages haven't kept pace with that increase. In fact, for all but the top wage earners, real (inflation-adjusted) earnings are actually down over the same period....These figures are from a recent Economic Policy Institute report on our mediocre wage growth....And they provide important context for a new Rutgers University poll...showing increasing pessimism in the aftermath of the Great Recession." Christopher Ingraham in The Washington Post.

People are quitting their jobs. That's good news. "Want to make Janet Yellen happy? Quit your job. The Federal Reserve Board Chair watches a lot of economic data as she and her colleagues on the Federal Open Market Committee make their decisions about setting interest rates and winding down the current economic stimulus program. One of the data points that Yellen has said she pays attention to is the rate at which workers quit their jobs. It may seem counterintuitive, but in the Fed’s view, it’s a good sign when an increasing number of people voluntarily leave their jobs. The thinking is that when jobs are scarce and people are worried about finding work, they are less willing to abandon an existing employment arrangement." Rob Garver in The Fiscal Times.

K.C. Fed sees improvements in job market in new gauge. "The bank said that its Kansas City Fed Labor Market Conditions Indicators activity measure moved to -0.6 in July, something the report deemed a 'substantial improvement' from the low of -2.1 seen in December 2009, in the depths of the greatest economic and financial downturn seen since the Great Depression. The new gauge also tracks labor market momentum, and found gains there as well. The Kansas City Fed said the biggest contributors to improvement in the job market were the rising number of job openings." Michael S. Derby in The Wall Street Journal.

Other economic/financial reads:

A mall with two minimum wages provides a real-world experiment. Steve Henn in NPR.

Evictions soar in hot market; renters suffer. Shaila Dewan in The New York Times.

Businesses find ways to avoid corporate taxes, but a fix seems unlikely. David Gelles in The New York Times.

ALS Ice Bucket Challenge interlude: What you need to know about ALS before you take the challenge.

5. The debate over children and guns

Should children be allowed to use guns? "Gun-control advocates...said it highlighted the dangers of children having access to firearms. In a rare moment of agreement, some gun rights advocates also took the incident as a warning that perhaps such young children should not be allowed to handle such a notoriously difficult and deadly weapon. But the pro-gun advocates added that, when done safely, there are benefits to teaching even very young children to shoot certain guns. Youngsters learn hand-eye coordination. They learn what to do if they stumble upon a weapon on the playground. And they learn how to defend themselves if they are ever attacked." Sandhya Somashekhar and Mark Berman in The Washington Post.

Explainer: 4 blunt points. " A 9-year-old girl in Arizona being taught to fire an Uzi machine gun lost control of the weapon and killed her shooting instructor. The Internet has a video. This is the kind of horrible incident that invites overheated debate. Herewith four blunt points—framed as questions and intended to shed light before the ideologues go ballistic." Paul M. Barrett in Bloomberg Businessweek.

Meanwhile, it looks as though the Obama gun bubble has burst. "On Wednesday, gunmaker Smith & Wesson (SWHC) reported lousy earnings, and its stock price fell 14 percent. It’s down 34 percent on the year. Sturm Ruger (RGR), the other publicly traded U.S. gunmaker, has fared even worse: It’s stock is down 42 percent this year. As my colleague Kyle Stock put it yesterday, people aren’t buying guns. But there’s more to the story. Until this year, guns were selling like crazy. Sales had skyrocketed throughout the Obama presidency. Now, suddenly it looks like America has reached 'peak gun'—and the Obama gun bubble is bursting." Joshua Green in Bloomberg Businessweek.

Other legal reads:

White House nominates Botticelli, a recovering alcoholic, to be drug czar. Katie Zezima in The Washington Post.

Hillary Clinton cites racial inequities in first comments on Ferguson. Peter Nicholas in The Wall Street Journal.

Oklahoma inmate died from injection in botched execution, not heart attack, autopsy finds. Matt Pearce and Tina Susman in Los Angeles Times.

Lack of data makes it hard for background checks to work properly. Sarah Ferris in The Washington Post.

Governor of Utah says state should defend anti-polygamy law in wake of decision. Lindsay Whitehurst in the Associated Press.

Elders interlude: Elders react to Oculus Rift.

Wonkblog roundup

Contraception, Obamacare subsidies and ice buckets: Health care’s summer to remember. Jason Millman.

Pennsylvania’s Republican governor expands Medicaid. Jason Millman.

The core question in Bobby Jindal’s Common Core lawsuit. Max Ehrenfreund.

Yes, the stimulus worked: highway spending would have fallen 20% without it. Matt O'Brien.

There’s a big gap between what men and women make in the restaurant industry. Roberto A. Ferdman.

This is why it feels like the recession never ended. Christopher Ingraham.

Et Cetera

America’s coal heartland is in economic freefall — but only the most desperate are fleeing. Chico Harlan in The Washington Post.

Obama picks Texas-based U.S. prosecutor as first Latina to head ICE. Todd J. Gillman in Dallas Morning News.

VA wait times have decreased, new data show. Meghan Hoyer in USA Today.

The head-on politics of going around Congress on climate change. Michael Catalini and Ben Geman in National Journal.

The FCC's next CTO is a net-neutrality expert. Nancy Scola in The Washington Post.

A new way to save gas: Talking cars. Jason Plautz in National Journal.

Shell launches its latest bid for Arctic oil exploration. Jennifer A. Dlouhy in the Houston Chronicle.

Got tips, additions, or comments? E-mail us.

Wonkbook is produced with help from Michelle Williams and Ryan McCarthy.

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