with Paulina Firozi

Presumptive presidential nominee Joe Biden and Sen. Kamala Harris (D-Calif.), fought tooth and nail over Medicare-for-all during the primary race.

She slammed him for backing only incremental reforms that would leave some Americans uncovered. He called her Medicare-for-all plan “malarkey” and called it a “have-it-every-which-way approach.”

Now, as running mates, the pair will have to adopt a cohesive consistent message on health-care. And that means Harris must move to her political right on the subject.

Biden spent much of the primary season touting the Affordable Care Act and defending himself from attacks by Harris and the other progressive candidates for refusing to support a dramatic health-care overhaul like Medicare-for-all. Harris had been one of the first senators to sign on when Sen. Bernie Sanders (I-Vt.) first proposed his single-payer bill back in 2017. 

But Harris proposed her own twist on Medicare-for-all, amid tricky questions about ditching private coverage.

Her proposal showed she’s not entirely comfortable with a Sanders-style purist stance on the issue. 

It would preserve a role for private plans by allowing insurers to continue participating in the Medicare program, similar to how Medicare Advantage (an alternative to traditional Medicare) currently works. It would still amount to a massive expansion of the federal government’s role in health insurance. But it eased back from Sanders’s vision of Medicare-for-all, which would do away with the private insurance industry entirely.

Larry Levitt, executive vice president at the Kaiser Family Foundation:

Kaiser Health News's Julie Rovner:

Conservative health policy analyst Chris Jacobs:

Trump tweeted this campaign ad, which says Harris ran for president “embracing Bernie's plan for socialized medicine.”

Harris struggled early in her campaign to articulate a consistent position on private coverage.

It’s a delicate political subject, considering more than half the country is enrolled in private plans, and one that the candidates vigorously debated throughout the primary season.

Harris told CNN in January 2019 that she would eliminate private insurers as part of putting Medicare-for-all in place. But several months later, she stressed that she doesn’t want to do away with “supplemental insurance.”

“No, no, no, no, it does not get rid of insurance,” Harris told CNN’s Jake Tapper. “It doesn’t get rid of supplemental insurance.”

At the first presidential debate in June 2019, Harris shot up her hand when the candidates were asked whether they support abolishing private health insurance. But afterward, Harris said she misunderstood the question to be about whether she personally would give up her private plan.

Harris didn’t let her waffling get in the way of targeting Biden over the issue.

At an August debate, a few days after she had released her own Medicare-for-all plan, Harris pounced on the fact that Biden’s plan probably wouldn’t result in every single American enrolling in coverage.

“Under our plan, we will ensure that everyone has access to health care,” Harris told Biden. “Your plan, by contrast, leaves out almost 10 million Americans. Understand that the people of America want access to health care and do not want cost to be their barrier to getting it.”

Under Biden’s proposal, people could buy a government-sponsored plan if they lack coverage through their workplace or just don’t like it or can’t afford it. It would also cap every American’s health-care premiums at 8.5 percent of their income and effectively lower deductibles and co-payments. Biden recently said he also wants to lower the Medicare enrollment age by five years, to 60.

In responding to Harris’s criticisms, Biden focused on how Medicare-for-all would replace employer-sponsored coverage with government plans. Many Democrats have distanced themselves from discussing that outcome in detail, because it doesn’t poll well.

“The senator has had several plans so far,” Biden said at the debate. “If you noticed, there is no talk about the fact that … you will lose your employer-based insurance … to be very blunt and to be very straightforward, you can’t beat President Trump with double-talk on this plan.”

Ahh, oof and ouch

AHH: Peter Marks, a little-known Food and Drug Administration official, will decide when a coronavirus vaccine is safe and effective. 

Marks – who leads the FDA’s Center for Biologics Evaluation and Research, which is responsible for reviewing vaccines – is likely to determine in the next several months whether a candidate can be effectively administered to tens of millions of Americans. He is trusted with “among the most critical decisions in the history of the agency, one with sweeping health, economic and political consequences,” Laurie McGinley writes in this profile

Trump has been critical of federal health officials he believes are politically unhelpful to him, and has also claimed a vaccine will be available soon. Yet one close associate of Marks told Laurie the official “won’t play the political game one way or another” on vaccines. 

“The way the vaccine decision is handled could have an impact on the presidential election and whether enough people are willing to get vaccinated to curb the pandemic and revive the economy," Laurie writes. "If safety problems are missed, it could be disastrous for this crisis and undermine public confidence in all vaccines…Thrust into this crucible is a 57-year-old Brooklyn native who oversees a team of experts charged with scrutinizing every bit of data on coronavirus vaccine candidates … That makes Marks the most important government employee most people have never heard of.” 

OOF: Facebook said it removed 7 million posts that included coronavirus misinformation on its site and on Instagram. 

The social media giant also said it’s placing warnings on posts that are misleading but not harmful enough to take down, Rachel Lerman reports. 

“Facebook and fellow big social media sites Twitter and YouTube have been scrambling to keep up with the flood of posts promoting fake cures or harmful speculation about the spread of the virus since early this spring,” she reports. “Facebook put policies in place to try to regulate covid-19 posts, but its moderation teams that monitor such posts have also been disrupted as offices remain closed. Facebook sent its content moderators home in March, a move that led to fewer posts being removed in certain rulebreaking areas between April and June.” 

The company removed one of Trump’s posts for violating its coronavirus misinformation policy for the first time earlier this month. The post highlighted a video clip of an interview he gave on Fox News during which he wrongly claimed children are “almost immune” to the virus. 

OUCH: New York’s official nursing home death count may be higher than the official tally. 

The state only counts residents who died while on nursing home property, leaving out those who may have died after being transported to hospitals, the Associated Press’s Bernard Condon, Matt Sedensky and Meghan Hoyer report. The current official nursing home death toll is just over 6,600, but there could be thousands more. 

But Gov. Andrew Cuomo (D) has refused to release the number, prompting spectulation the state is manipulating figures to make them appear lower.

“How big a difference could it make? Since May, federal regulators have required nursing homes to submit data on coronavirus deaths each week, whether or not residents died in the facility or at a hospital,” the AP writes. "Because the requirement came after the height of New York’s outbreak, the available data is relatively small. According to the federal data, roughly a fifth of the state’s homes reported resident deaths from early June to mid July — a tally of 323 dead, 65 percent higher than the state’s count of 195 during that time period.”

Cuomo has dismissed questions about the state’s nursing home death count and claimed New York has done better than other states. 

“Look at the basic facts where New York is versus other states,” Cuomo said during a briefing this week. “You look at where New York is as a percentage of nursing home deaths, it’s all the way at the bottom of the list.”

The new normal

Recent polls signal the nation is exhausted and suffering from the effects of the pandemic and of coronavirus fatigue. 

A Gallup poll published last week found just 13 percent of adults are satisfied with the way things are going in the United States, the lowest level in nine years. A Gallup survey in mid-July found 73 percent of adults said the pandemic is growing worse. Another July poll, from the Kaiser Family Foundation, also said most adults think the worst is still ahead. 

“Parents lie awake, their minds racing with thoughts of how to balance work with their newfound role as home-schoolers,” Brady Dennis, Jeremy Duda and Joel Achenbach write. “Frontline health workers are bone tired, their nerves frayed by endless shifts and constant encounters with the virus and its victims. Senior citizens have grown weary of isolation. Unemployed workers fret over jobs lost, benefits that are running out, rent payments that are overdue. Minority communities continue to shoulder the disproportionate burden of the contagion’s impact, which in recent weeks has killed an average of about 1,000 people a day.”

They add: “The metaphor of a marathon doesn’t capture the wearisome, confounding, terrifying and yet somehow dull and drab nature of this ordeal for many Americans, who have watched leaders fumble the pandemic response from the start. Marathons have a defined conclusion, but 2020 feels like an endless slog — uphill, in mud.” 

The Trump administration's efforts

The Trump administration is considering blocking citizens and permanent residents from entering the United States at the Mexico border.

The draft proposal, which administration officials say is an effort to curb the spread of the coronavirus, is on shaky legal ground. 

“While the executive branch has broad authority to close border crossings or restrict travel in the event of a spreading disease outside U.S. territory, it is less clear how the Trump administration could justify such restrictions on U.S. citizens when infection already is spreading rampantly inside the United States,” Nick Miroff and Josh Dawsey report. “… The Trump administration already has tried to ban nonessential travel across the border, but it has little ability to enforce measures that would bar Americans from entering. About 400,000 people continue to go back and forth each day, officials said, about half the pre-pandemic volume.”

Two officials involved in the discussions said officials at the White House and at the Department of Homeland Security have been talking about potential restrictions for weeks. 

Nick and Josh add: “They said the measures probably would be issued in the form of an order by the Centers for Disease Control and Prevention, not unlike the public health emergency used to implement a policy of mass expulsions for unauthorized migrants attempting to enter.”

Many health-care workers are losing out on paid sick leave.

It's because the Trump administration has expanded how health-care providers are categorized, a government watchdog found. 

“Congress passed the Families First Coronavirus Response Act back in March to ensure workers at small- and medium-size companies were able to take paid leave if they or a family member became sick with the coronavirus. The law exempts health-care providers as well as companies with more than 500 employees,” Eli Rosenberg reports. “But an Office of the Inspector General report noted that a move by the Labor Department to more broadly expand how they categorize health-care providers ended up leaving far more workers without a guarantee of paid sick leave than the agency’s estimate of 9 million.”

The report found the Labor Department’s interpretation of “health care provider” includes anyone who works at doctor’s offices, clinics, testing facilities or hospitals, including temporary sites. The agency also exempted companies that contract with clinics and hospitals. 

Eli adds: “The report also suggested the Labor Department is not doing enough to enforce the paid-sick-leave provisions, as well as its existing laws on pay and overtime issues.”

Around the world

After 102 days without any community transmission, New Zealand reported four new coronavirus cases. 

The development prompted New Zealand Prime Minister Jacinda Ardern to impose new restrictions from Wednesday afternoon through midnight on Friday and to ask residents to stay home, Jennifer Hassan reports. “Aucklanders have been asked to wear masks when accessing essential services, while the rest of the country is asked to wear a face covering in places where social distancing is hard to practice,” Jennifer adds. Those living outside the city would also be barred from traveling into Auckland.

The nation has received wide recognition for how it has addressed the pandemic, and has recorded 22 deaths. 

Coronavirus latest

Here are a few more stories to catch up on this morning: 

In the states: 
  • Florida and Georgia recorded their highest single-day death tolls since the pandemic began as coronavirus-related deaths in the United States surpassed 1,300 yesterday, Meryl Kornfield and Jacqueline Dupree report.
  • Omaha city leaders unanimously adopted a face mask mandate last night. Until the ordinance was adopted, it was the largest U.S. city without a requirement that residents wear face coverings in public spaces, Reis Thebault writes.
The ongoing debate over reopening schools: 
  • The University of North Carolina at Chapel Hill launched a partly in-person, partly remote school year as the pandemic rages on, with about 5,800 students in dorms and others living nearby off campus, Nick Anderson reports. “This is an early glimpse of what higher education looks like in Pandemic America at a prominent state university that insists on getting large numbers of students back to campus months after the coronavirus forced them to scatter,” Nick adds. “There are countless gallons of hand sanitizer and buckets of disinfecting wipes.”
More to know: 
  • A Duke University study found some face-covering alternatives, like such as gaiters, may be worse than not wearing a mask. “Of the 14 masks and other coverings tested, the study found that some easily accessible cotton cloth masks are about as effective as standard surgical masks, while popular alternatives such as neck gaiters made of thin, stretchy material may be worse than not wearing a mask at all,” Allyson Chiu reports.

Sugar rush

Researchers at Duke University created a visual aid to demonstrate the efficacy of varying masks. (Duke Health)