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The Health 202: Democrats press forward on paid medical leave, but there are plenty of obstacles

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with Paige Winfield Cunningham

The United States is the only wealthy country without paid parental leave.

But Democrats are ramping up efforts to change that.

There is growing momentum on Capitol Hill to create a new federal program funding paid family and medical leave. 

House Ways and Means Committee Chairman Richard E. Neal (D-Mass.) recently introduced draft legislation including universal paid family and medical leave, and President Biden has included paid leave as a priority in his new spending and tax plan.

But with Democrats controlling only the slimmest of margins in Congress, their long push for paid family leave could fall short once again.

Here’s what they're hoping to do.

Neal's draft and the White House proposal, introduced as part of Biden’s $1.8 trillion “American Families Plan,” and are broadly similar. They would both guarantee 12 weeks of paid leave for workers to spend time with new children, recover from illnesses or care for family members. 

Biden’s plan would offer the lowest-wage workers 80 percent of their average pay, while Neal’s plan would offer 85 percent. The benefits under both plans decrease as incomes rise.

But the White House plan would phase in the benefits gradually, only guaranteeing the 12 weeks of leave a decade into the program — a feature that helps bring down the price tag of the president’s overall package. 

The administration estimates its paid-leave program would cost $225 billion over the next decade. That’s less than half the cost of a longstanding Democratic proposal for paid family leave, known as the Family Act and sponsored by Rep. Rosa L. DeLauro (D-Conn.) and Sen. Kirsten Gillibrand (D-N.Y.). While there are no Congressional Budget Office estimates for Neal’s plan, it would follow a similar structure as the Family Act, making full benefits available as soon as the program got up and running.

Another major difference: While the White House would fund its plan through higher taxes on the wealthy and increased tax enforcement, Neal’s plan is vague about funding — an omission that would probably have to change before it could be passed.

“Let’s have a conversation about what we are desirous of,” Neal told the Republican, a paper based in Springfield, Mass. “Then let’s talk about how to pay for it.”

Democrats are unlikely to see Republican support for their plans.

Republicans have increasingly said they back some kind of paid parental leave, but that doesn’t mean they'd vote for the recent proposals. 

During the Trump administration, Congress passed a bill funding paid family and medical leave for federal workers — a measure pushed by Trump’s daughter Ivanka. But efforts to create a broader national program for nongovernment workers fizzled. 

A bill from Republican Sens. Mitt Romney (Utah) and Marco Rubio (Fla.) would have created a paid parental leave program by allowing parents to tap into their Social Security benefits after the birth of a child. But the proposal didn't gain traction with Democrats, who criticized the fact that it covered only parental leave, not medical leave, and required workers to choose between paid leave and retirement benefits.

The Family Act, the paid-leave plan that Democrats have repeatedly introduced in recent congressional sessions that bears a close resemblance to Neal’s plan, only boasted one Republican — Rep. Christopher Smith of New Jersey — among its 219 co-sponsors last year.

“I don’t think there’s Republican support for this type of proposal,” said Angela Rachidi, an expert on poverty at the conservative American Enterprise Institute. She expects that Republicans will balk at the high price tag and the expansive benefits that go well beyond parental leave.

That leaves lawmakers with the option of reconciliation.

Without Republican support, Democrats probably will need to pass any family leave bill through a special budget reconciliation process that requires only 50 votes in the Senate.

But there are a number of rules about what can and can’t go through that process, and those rules are already shaping the proposals. It’s one of the reasons, for instance, why Neal’s plan would operate out of the Treasury Department rather than the Social Security Administration.

Federal rules limit the use of the reconciliation process for legislation that affects Social Security, and although there’s disagreement over whether this would actually preclude a paid-leave program administered by the Social Security Administration, Democrats on the House Ways and Means Committee have opted to avoid the issue entirely.

Even with reconciliation, it may not be easy to get a bill through.

Democrats will still be operating with the slimmest of majorities in Congress, at a time when some moderate Democrats have started to balk at the cost of Biden’s agenda. 

Sen. Joe Manchin III (W.Va.) has called the price tag on Biden’s overall American Families Plan “uncomfortable.”

Paid leave would be a big shift for American workers. 

Nine states and D.C. have enacted paid-leave policies funded through employer or employee payroll contributions. Research suggests the policies have not significantly hurt business profitability and that employers view them as neutral or positive.

But most workers don’t get paid leave from the government or from their employer. Supporters of paid leave say that affects everything from child care to workforce participation.

“If you can’t get the time off to take care of your family, you’re just going to leave the labor force altogether. That has been happening all these years, but people haven’t always tuned in,” said Kathleen Romig, of the liberal Center for Budget and Policy Priorities.

Ahh, oof and ouch

AHH: A senior CDC official who raised the alarm about the coronavirus is set to resign.

Nancy Messonnier, a senior health expert at the Centers for Disease Control and Prevention, told colleagues in an email Friday that she was resigning from the agency. She will serve as an executive director for pandemic and public health systems at the Skoll Foundation, a California health philanthropy. The move comes after Messonnier was replaced last month at the helm of the agency’s vaccine task force, as part of a larger reorganization under CDC Director Rochelle Walensky, The Post’s Isaac Stanley-Becker and Lena H. Sun report

Messonnier gained prominence last year after she told Americans the new coronavirus would upend their lives, a warning that sent stocks plunging and earned her Trump's wrath. After participating in early public briefings, the Trump administration pulled her from the spotlight — a move that Biden aides criticized during his presidential campaign. 

“Ultimately, the career health official left not because of political pressure but because of lack of support from top CDC leaders, two agency officials said, speaking on the condition of anonymity to describe internal matters,” Isaac and Lena write.

OOF: Trump’s mental health chief is now serving as a senior civil servant at DEA.

Elinore McCance-Katz, who served as Trump’s assistant secretary for mental health and substance abuse, was hired at the Drug Enforcement Agency as a legislative policy analyst focused on drug diversion, the illegal use of drugs, The Post’s Dan Diamond reports

“Good-government watchdogs cautioned that the move appeared to be ‘burrowing,’ where political appointees take jobs as permanent civil servants and appear to skirt the normal hiring process,” Dan writes.

McCance-Katz, a former Yale University psychiatrist, repeatedly spoke out against measures to curb the spread of the coronavirus while serving as head of the Substance Abuse and Mental Health Services Administration under Trump. She argued that social distancing measures would worsen Americans’ mental health and that the risks of the virus had been overstated.

McCance-Katz’s role at the DEA could put her in a position to shape the administration’s response to drug enforcement, especially with Biden’s nominee to run DEA awaiting Senate confirmation.

OUCH: Dartmouth has accused 17 medical students of cheating on online exams.

The allegations came after Dartmouth said there was evidence that the students had accessed its learning management software, Canvas, during remote tests, raising the possibility that they had looked up course material during the exams. But a New York Times investigation, which included a review of the software code and interviews with technology experts, found that the technology used to pinpoint cheating could lead to erroneous conclusions in some cases.

“Dartmouth’s drive to root out cheating provides a sobering case study of how the coronavirus has accelerated colleges’ reliance on technology, normalizing student tracking in ways that are likely to endure after the pandemic,” the New York Times’s Natasha Singer and Aaron report.

“The allegations have prompted an on-campus protest, letters of concern to school administrators from more than two dozen faculty members and complaints of unfair treatment from the student government, turning the pastoral Ivy League campus into a national battleground over escalating school surveillance during the pandemic,” they write.

How the coronavirus spreads

Updated CDC guidance emphasizes airborne transmission.

New guidance on the agency’s website emphasizes that the virus may be transmitted through very fine respiratory droplets and aerosol particles, The Post's Meryl Kornfield reports. Although the risk of contracting the virus is greatest in proximity to an infectious individual, the CDC says that infection is possible at distances of more than six feet, especially in poorly ventilated indoor spaces. The language represents a shift from guidance that had said the virus was spread mostly through “close contact, not airborne transmission.”

Critics say that the agency has not done enough to emphasize this mode of transmission.

Zeynep Tufekci, an associate professor at the University of North Carolina at Chapel Hill who writes about health and technology, points out that there was evidence early on of airborne transmission of the virus over distances greater than six feet as outbreaks emerged on a cruise ship and in a choral practice.

“If the importance of aerosol transmission had been accepted early, we would have been told from the beginning that it was much safer outdoors, where these small particles disperse more easily, as long as you avoid close, prolonged contact with others," Tufekci writes in New York Times.

“We would have tried to make sure indoor spaces were well ventilated, with air filtered as necessary,” she adds. "Instead of blanket rules on gatherings, we would have targeted conditions that can produce superspreading events: people in poorly ventilated indoor spaces, especially if engaged over time in activities that increase aerosol production, like shouting and singing. We would have started using masks more quickly, and we would have paid more attention to their fit, too. And we would have been less obsessed with cleaning surfaces."

Emergency physician Kashif Pirzada:

Joseph Allen, director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health, who emphasized airborne transmission in a Washington Post op-ed in May last year:

More in coronavirus news

  • Anthony S. Fauci, the nation’s leading infectious-disease expert, said that wearing masks could become a seasonal practice to stem the spread of common infectious viruses, The Post’s Paulina Villegas reports. “We’ve had practically a nonexistent flu season this year merely because people were doing the kinds of public health things that were directed predominantly against covid-19,” Fauci told NBC’s “Meet the Press.”

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