Coronavirus cases TRANSCRIPT: 4/2/20, All in w/ Chris Hayes

Ashish Jha, Jared Polis, Chuck Schumer, Alexis Madrigal, Margot Sanger-Katz, Don Berwick


ARI MELBER, MSNBC HOST: We are wishing many, many more reunions like that

to people touched by this around the world. That does it for our special

coverage. I`m Ari Melber signing off. But don`t go anywhere, “ALL IN” with

Chris Hayes starts now.


CHRIS HAYES, MSNBC HOST: Good evening from New York. I`m Chris Hayes.

There`s a strange sort of time-lapse playing out throughout the country

right now. Places that have been hit first and hardest by the coronavirus

are further along the curve of growth. And those places are fairly dense

urban areas, big metropolises, and they are in really bad shape.


The grim reality of this virus is that everyone, every single state is

headed there. Here are the latest numbers. We now have more than 240,000

cases in this country, more than 5,800 deaths from the virus. More than

half the cases aren`t just three states. New York, which has more than

92,000 cases along with New Jersey and California.


We are also seeing disturbing surges in a number of other states. We`ve

been keeping an eye on and tracking for the last week at least, including

Florida, Michigan, Louisiana. Here`s the thing. The way this virus works is

that not everyone will have exactly the same epidemic at the same time. But

the actual way the virus spreads in the community is the same everywhere.

It`s the same virus, the same human bodies and that is why it is critical

there is a cohesive federal national response.


Last week, the governor of Alabama, Kay Ivey, who has taken some strong

steps down there, explained why she had not issued a shelter in place order

for residents first state opting instead for less restrictive measures.

This is what she said “You all, we are not Louisiana, we are not New York

State, and we are not California.” That`s right. You are not yet. It is

just a matter of time.


New York City ER doctor this morning offered a message to anyone who

believes they might escape the worst of it.





ago, had only 300 cases. New York today has 30,000. The cities around

America with 300 cases should realize the only difference between them and

New York is two weeks.




HAYES: So far, the places that have been hit the hardest, like I said,

fairly dense areas and blue states. But the country as a whole is headed in

that direction. This is the way the math of this works. It`s the way it`s

worked in every country. It`s a way it`s been working here. Every one of

the states that are behind on that curve are going to be in a similar



They`re going to need ventilators and hospital beds and personal protective

equipment, and they will be facing fatality numbers that seemed unthinkable

just a few weeks ago. And right now, a lot of states are refusing to see

what is plainly in front of their face. These 11 states have not issued

statewide stay at home orders. Some have localized orders in place.


One thing in common with all these states, they all have Republican

governors. Other states like Florida, and Texas, and Georgia only issued

stay at home orders recently. In Florida for example, just hours after

republican Governor Ron DeSantis finally issued the statewide state order,

he signed a religious exemption basically blocking local governments from

closing down church and synagogue ceremonies during the outbreak.


In Georgia, the state where the CDC is located, Republican Governor Brian

Kemp finally issued a stay at home order today claiming he just learned

that people without symptoms can spread the disease. As New York Times

reports, in areas where public officials have resisted or delayed stay at

home orders, people change their habits far less.


This Times graphic shows where people were still traveling last week. Gray

means no travel and red means closer to normal travel, and you can see that

a much of the Northeast there was essentially virtually no travel. Look at

the south look at the plain states. As you can see people in southern

states were far less inclined to change of behavior because they were not

getting the same messages from their leaders.


And there is reason to believe that parts of those states could get hit

even worse than what we`re seeing in the worst-hit states today, places

like New York. As the Atlantic points out, the coronavirus poses a unique

risk to the American South. Residents, on the whole, have high rates of

conditions like lung and heart disease and obesity, which makes the virus

far more deadly.


Take for example, the state of Mississippi. That state right now seems to

have the nation`s highest rate of people hospitalized for the coronavirus

at 31 percent. And the virus there is not expected to peak for nearly two

months. A week ago, the state`s Republican Governor Tate Reeves actually

overruled – get this – he overruled local safety measures to fight the

virus reopening restaurants and department store. The governor announced

Shelter in Place Order yesterday, which does not go into effect until

tomorrow at 5:00 p.m.


As a nation, we could have mitigated some of the worst of what has to come

with a strong, decisive, unified federal response. We just didn`t have one.

We know that. President Donald Trump refuses and refused and is refusing to

take a leadership role. Just today, he was whining about state requests for

life-saving medical supplies, and tweeting, “Remember, we are a backup for



That is Donald Trump`s idea of leadership. The federal government is a

backup, kind of Articles of Confederation kind of situation. And that is

why this crisis is already, already far worse than it ever should have



Joining me now is Dr. Ashish Jha, Global Health professor and the Director

of the Harvard Global Health Institute. He`s one of the – one of the most

informed people I know on this pandemic. Let me – let me start playing

devil`s advocate against myself in that monologue and see your response,

which is, look, the places we`ve seen these really bad outbreaks, in New

York, particularly, these are very dense places, they have high levels of

public transportation, people are living close to each other. That was true

in the city of Wuhan where we saw really bad outbreaks. Maybe it just

really won`t be that bad in vast swathes of rural America where folks

aren`t that close to each other. What do you say to that?



remarkable, Chris. And by the way, thank you for having me on. You know,

when the outbreak began in China, we said, well, this is a China problem.

Then it moves to the rest of East Asia, and we said, well, it`s an Asian

problem. Then for a little while, it was always Europe and all their crazy

health systems, it`s a European problem.


Then last week, we were this is a New York, California, Washington state

problem. Like at some point, we`re going to have to just accept the fact

that it`s a human problem, and it hits different places and different

densities at different times. But the idea that the number of people who

are infected won`t be the same in all these places defies logic.


The virus will spread, it might go a little more slowly in a rural area

than it does in a dense city, but it`s coming to a town near you. And like

the lesson we keep having this sort of denial of is going to be somebody

else`s problem. And I think finally this week, I got a sense that more or

less every American, certainly more or less every political leader started

realizing that the – that the problem is there as well and not just in New

York or California problem.


HAYES: So we have now hit a point where we`ve kind of ramped up testing

although plateaued, our death rate is growing at a just an unspeakable rate

that I just find really upsetting profoundly. Where are we right now on

this trajectory as of today?


JHA: Yes. So I think there is a national picture and then we really have to

realize that what we have done because of a lack of federal leadership is

we have turned this into 50 outbreaks, and different states have different

patterns. So nationally, we are still early days, exponential rise in

number of cases, long march towards more and more deaths, unfortunately

until we plateau. But it`s going to shift, right?


So, I think in New York, we`re going to see a peak – there`s some evidence

of the number of cases are starting to plateau. We have seen fabulous

progress in Northern California and Washington from all the shelter in

place orders. I am deeply worried about Florida, deeply worried about

Georgia, deeply worried about Louisiana.


And South Carolina, we just saw some data this afternoon. Their

hospitalization rates are really starting to pick up. You show the data for

other states. So, this is going to become now a 50-state game – it`s not a

game – 50 state epidemic and that`s a much harder thing to manage than a

single national epidemic.


HAYES: This is what it seems to me what I`m sort of losing sleep over as I

think about this problem here distinct from other places is other places

had regional outbreaks. Daegu in South Korea and Wuhan and Hubei province

in China, and Lombardi in the north in Italy, and then the national

government sort of maybe try to regional lockdown, realize that wasn`t

going to work, and sort of implemented a national strategy.


No place has had the kind of multi-geographic spread to deal with, I think

it`s fair to say, than we have. We have – we have something distinct now

that no other country has really had to wrestle with. Is that a fair



JHA: It is a fair characterization. And look, there are – kind of look at

some positives here – there are a few upsides of that regional approach.

Like we had some states that move pretty early well before the federal

government was ready to move, right? And again, we`re talking about

California, Washington State, Ohio with this Republican governor. Other

places have moved early, and I think the citizens of those states are going

to do better. But yes, this is no way to run up pandemic response.


HAYES: Well, and I guess the final point here is that one can imagine that

the one other benefit of this to the extent there is one, although it`s

hard to see one, is that you could move resources around. I mean, if you`re

– if you have different places peaking at different times, and New York

right now needs, you know, ventilators and PPE, and it needs actual

frontline medical workers, and then six weeks from now, that`s the case in

Alabama, you can imagine a universe in which the federal government was

coordinating moving those resources, right?


JHA: Yes. So, I`ve actually made that case that we need to do that. Again,

it`s the one of the silver linings and this is New York is going to be

next. So let`s put all of our resources towards getting New York through.

And then when New York is through its peak, let`s move those resources. I

think New York doctors and nurses will be happy to go elsewhere to take

care of people.


We can turn that sort of fragmentation to our advantage. It requires a

coordinator. It requires somebody looking at the entire national picture

and helping make this happen. Right now it`s ad hoc one on one basis. It`s

going to be very inefficient.


HAYES: All right Dr. Ashish Jha who is always illuminating on this, thank

you so much for your time. I really, really appreciate it.


JHA: Thanks for having me.


HAYES: I want to turn now to someone who has been fighting to keep the

people of his state healthy in the midst of this crisis, Governor Jared

Polis of Colorado. Governor, first let me – let me ask you where your

state is right now, how you assess where you are in that sort of time-lapse

we`re seeing between say New York out front and maybe some other states

that are much further behind.


GOV. JARED POLIS (D-CO): Yes. Colorado is closer to New York in that

continuum. Over 3,700 cases, that`s just the confirmed positives. Like many

other states, we haven`t even been able to keep up and we expect the number

of positives is probably between eight and 15,000 or more Coloradans. We

know that 25 to 50 percent are mildly, if they`re at all symptomatic.


We just are approaching about 100 deaths. I think we have 99. We`ll

probably have 100 today. A deputy sheriff in El Paso County passed away

today, younger man in his 40s, even younger than me. So we`re really seeing

this. We`re working on surging the hospital capacity. We have in a stay at

home order. And bringing everybody along on that as what`s critical, Chris.


It`s not so much about the order, it`s about the psychology, the social

license for that order, and really convincing people and maximizing the

likelihood in their individual decisions that they are staying at home.


HAYES: Has that been – has that been a challenge for you?


POLIS: It`s been the real challenge behind this. I think everybody knows

that there`s not any enforcement mechanism in terms of law enforcement. One

of the things I said at one of our announcements was, you know, the

ultimate enforcers, the Grim Reaper, you`re putting yourself and your own

life on the line, the lives of your neighbors, your aunts, your uncles,

your parents, if you`re not staying home and engaging in social isolation.

Of course, we`re doing what we can with local authorities to close

playgrounds and other sites that people might congregate.


But really, we have to bring the country, our state`s our residents,

Republican, Democrat, Independent, rural, urban, along with us in this

journey to see the urgency of staying at home.


HAYES: There are three states near you that don`t have stay at home orders,

Utah, Wyoming, Nebraska, does it – is there – is there any regional

concern about the spillover effects if there are states that that continue

to have folks sort of out and about?


POLIS: Absolutely. In fact, we`re even worried about that within our state,

we`ve had to several times warm our Denver Metro area residents, don`t go

to your second home in the mountains. Not only do that some of those

mountain and world-class Mountain Resort communities have a higher

infection rate because they have a lot of international travel leading up

to this, but that will further spread the virus.


Of course, we`re worried about people from some of our neighboring states

or even other states that don`t have that kind of stay at home order that

might come to Colorado, just as we`re also aware of – worried about, you

know, travels from across the world. But we have an endemic here, so our

first priority is reducing the spread in Colorado, and the best way we can

do that is, of course, step up, testing, isolation. In the meantime, stay

at home.


HAYES: Final question is about the state`s budget and economics. We saw

those 6.6 million claims for unemployment today. States are going to have

to put budgets together and they`re going to have 40, 50 percent hits the

revenue. I have no idea they`re going to be paying out unemployment



New York Governor Andrew Cuomo has worked out a budget deal. It`s going to

cut Medicaid in the midst of this. And I know that states – I think every

state has to balance its budget. What is your thinking about the finances

here? It seems to me that unless there is significant rescue money for

states, we are going to take this and compounded over the years and create

an enduring recession.


POLIS: Well, I`m even more worried about families who can`t make their

rent, who can`t put food on the table, who aren`t able to return to work.

That`s why staying at home is so important so people can get back to work

sooner and get back to earning a living sooner.


It`s also important to point out economic productivity and work is not the

enemy here, it`s physical proximity. So we need to maximize the opportunity

to earn a living, maximize our economic output without increasing physical

proximity. We`re, of course also worried about the hole in our state

budget, the hole in city budgets, but it really starts with families and

works its way up.


And we`re glad that there`s some help in the in the aid package that the

federal government passed, $1,200 for families, money for state

governments, money for hospitals, but we`re also – we also know that

Congress will need to do more and then days and weeks ahead.


HAYES: Yes, they will need to do more. Governor Jared Polis of Colorado,

thank you so much for taking a bit of time with us this evening. Next,

Senate Minority Leader Chuck Schumer on the administration`s willful

ignorance that escalated the National Emergency and the many warnings

ignored along the way, he`ll tell us what to do now.




HAYES: Republican governor – Georgia Governor Brian Kemp is being

ridiculed widely because just yesterday after weeks of wall to wall media

coverage of the coronavirus, he claimed he just learned that people without

symptoms can still spread the virus. This led to the social media hashtag

CDC is in Atlanta, trending today, the very agency that has been explaining

the risks to the virus the American people.


The Centers for Disease Control is in Georgia. It`s about a 20-minute drive

from the governor`s mansion. Here`s the thing. We have known about

asymptomatic transmission of the coronavirus for months. At a briefing on

January 31st, 62 days ago, Dr. Anthony Fauci said, and I quote, “You know

that in the beginning, we were not sure if there were asymptomatic

infection, which would make it a much broader outbreak from what we are

seeing. Now, we know for sure that there are.”


On March 6th, Governor Kemp even toured CDC headquarters in Atlanta with

President Trump and the director of the CDC. This is just one example of

the just insane aversion to repeated scientific warnings by experts about

precisely what we are encountering now. It has been missed signal after

missed signal after missed signal. And here are just a few.


The Nation reports that three years ago the Pentagon specifically warned

the White House about the significant threat posed by a novel respiratory

disease, which is exactly what coronavirus is. Yahoo! News reports in 2018,

the CDC warned the country was not ready to respond to a pandemic.


And just two months ago, the U.S. Army projected between 80,000 and 150,000

Americans could die if the coronavirus got out of control. That`s just two

months ago. The U.S. Army, they knew what was going to happen. And now the

White House is modeling that up to 240,000 people could die if we do

everything right. So the U.S. Army`s worst-case scenario from just two

months ago has become our best-case scenario.


Joining me now someone who did call for early action, Senate Democratic

Leader Chuck Schumer of New York, who back on January 26th, called for the

Department of Health and Human Services to declare a public health

emergency over the coronavirus. Senator, first, I want to start with your

exchange with the President. The President had a lot of harsh words for you

today. He wrote you a letter that was strange in the way that everything he

writes is strange. Why was he so angry at you? What was this about?


SEN. CHUCK SCHUMER (D-NY): Well, let me give you a little background. I

have heard for the last few weeks throughout New York and throughout

America, the desperate shortage of the kinds of things our frontline

workers need, whether it be masks or ventilators or PPE or anything else.


And so about two weeks ago, I called the president and said, why don`t you

invoke the Defense Production Act? That`s an act on the books from the

Truman administration. And it says that the military can commandeer both

manufacturing and distribution when there`s a national emergency or a war.

The President said he do it and then three hours later, he said no.


And now he hasn`t done it, and we sort of have this patchwork where

governors and mayors, my governor, my mayor, they`re doing good jobs, but

they`re going around looking for ventilators, looking for masks. It`s

uncoordinated, and it`s a patchwork.


So this morning I sent the president a letter and said, why don`t you

invoke the Defense Production Act and put in place a military person,

somebody who knows command and control, someone who knows logistics,

someone who knows a quarter mastering, to not only commandeer factories and

supply chains to make the stuff that we need, desperately need, but also to

distribute it in the places that are most needed, so not the 50 governors

will be hunting and pecking.


And then I spoke to the president late this afternoon and explained it and

the result is this letter. And so I`m just appalled. You know, I`d say to

the President, just stop the pettiness. People are dying. And so President

Trump, we need leadership, we need to get the job done. Stop the pettiness.

Let`s get it done. Let`s roll up our sleeves.


I sent the letter with the best of intensions trying to improve a very bad

situation that Dr. Jha was talking about a few minutes ago.


HAYES: You know, it`s come up a lot in our reporting and people I`ve been

talking to you both on the show and elsewhere about how haywire insane this

market has gotten. There`s all these sketchy middlemen, there`s deliveries

that state governors think they`re going to get that then don`t show up,

they get rerouted at the last second because someone outbids them.


So what you`re saying is, not only is the Defense Production Act, there

should be some kind of essentially unified acquisition process for the

whole of the country that is getting this material and distributing it in

such – in such a way so that you don`t have this weird bidding war that`s



SCHUMER: Exactly. And it`s a mystery to me why the President doesn`t invoke

this. It`s desperately needed, most experts agree that it`s needed, and

lives are at stake. We have in New York, we have these nurses and doctors

and health care workers risking their lives without the proper equipment.

And this is going to happen in other parts of the country too.


So you need this kind of command and control for not only manufacturing but

for distribution so it goes to the places that it`s most needed.


HAYES: So there`s a lot right now that Americans are sort of depending on

the federal government for. It`s a strange situation. It`s unlike anything

I think anyone has seen in their lifetime, frankly, in terms of that. The

rescue bill that was just passed, there`s a few different ways in which

that we`ll get – that help will get to Americans, but there`s some

reporting today about the $1,200 cash assistance different than the

unemployment insurance, when that`s going to get to people?


The IRS now estimating April 13th, I think, at the earliest for those who

already have direct deposit information with the IRS, but that it could

take as long as five months, five months to actually write the checks for

people that don`t have direct deposit. Is there any way that can be sped

up. That seems insufficient.


SCHUMER: It`s hard – Chris, I just heard that this afternoon. It`s hard to

believe that it would take five months. And on another front, you know, the

most major infusion that people who are losing their jobs will get is from

our unemployment insurance on steroids. Today we called on the

administration to get those checks to the unemployment offices and in

people`s hands who have lost their jobs, have to pay the rent, buy the

groceries in two weeks. I think that`s doable if they do it right, and if

they put all the muscle behind it that they should.


HAYES: Well, there just seems to me at a broader level, right. There`s a

real question here of competence and state capacity, right? So there`s some

conceptual soundness to a lot of things that are in that rescue bill, but

it really does seem like devils in the details here, particularly when

you`re looking at the Small Business Administration overseeing $350 billion

in loans. I mean, how confident are you that the help is going to get to

who it needs to get to as quickly as it needs to get to them?


SCHUMER: Well, we`re going to have to watch them like hawks. Obviously,

this is a huge enterprise $2 trillion in this whole proposal. It`s about as

much as the whole federal budget. It`s done in a week and it has to get out

quickly. Jobs are at stake, businesses are at stake, and whatever effort it



I suggested to the Small Business Administration that they just hire

whoever they need to get the money out quickly. I`ve suggested to Secretary

Scalia at the Department of Labor, which is in charge of the unemployment

insurance, that they do the same. We put over $1 billion into the

unemployment situation so they could hire people, get the computers going,

and get those checks out ASAP.


Now, we`ll have to watch them like hawks to see if they can do it. But as

you said, there is some question. Look at what we talked about with the DPA

of the competence of them getting it done. So we`re going to have to just

watch and push and pro and prod.


HAYES: Well, in terms of that oversight, the Speaker announcing the idea of

a select committee today. I don`t know if – I think she needs unanimous

consent for that, so she can`t call it into being unilaterally. But A, do

you – do you support that and B, what do you make of Secretary of Treasury

Steve Mnuchin basically saying we don`t need oversight, and the President

signing a signing statement that essentially scraps a lot of the oversight

that`s in the bill?


SCHUMER: Well, that`s what they proposed originally. The bill that

McConnell put on the floor that we Democrats resisted had three problems.

There was no real money. There wasn`t enough money for our hospitals and

healthcare systems. We call for a marshall plan for hospitals and clinics

and community health centers, and we got $150 billion.


The second thing we said is instead of putting corporations put first, put

workers first, and that`s where we got the small business. And most

important, this huge expansion of unemployment where people will get their

full salaries through July 31st, most of them. And it affects people who

have not been affected in the past, freelancers, part-timers, you know,

people – individual employees, people who need the work.


But the third thing we did is we put some real limits on these corporate –

on these corporate loans. We put – I worked closely with Elizabeth Warren.

We put three levels of both oversight, and we guaranteed transparency. So

anyone of these contracts that is either approved or rejected, the whole

contract has to be published within 14 days of the contract being either

approved or disapproved in additional to the smaller thing, but we put in a

provision that said President Trump couldn`t get any of this money because

left to his own devices, Lord knows.


But there is some real oversight there. Two of the three levels of

oversight don`t depend on the president, and we`re going to go at it. But I

think what Speaker Pelosi has done is exactly right. When you have this

much money with this administration, which seems to favor the wealthy, the

powerful, who`s your friend, there`s no – there`s no level of oversight is

too much. So to have this extra level is a very good thing.


HAYES: All right, Senator Chuck Schumer from what appears to be his

Brooklyn home in…




HAYES: A great neighborhood in a great city…


SCHUMER: I`ve been in this house, Chris, with – I`ve only seen four people

since I got back from Washington – my wife, my daughter, my son-in-law and

my 1.5-year-old grandson. And let me tell you, I`m working almost 24/7, but

the most exhausting time is the one hour I`m in charge of chasing him

around the house.




HAYES: I`m sure that`s true.


Well, come back. Keep giving us updates. I appreciate it. Thank you so

much, senator.


SCHUMER: Thank you, Chris.


HAYES: Ahead, the testing failures continue from kit shortages around the

country to troubling new reporting about how accurate or inaccurate the

results might be. That story coming up.







all feel about your dad and his giving you this music as you were growing



BRANFORD MARSALIS, SAXOPHONIST: Well, I think that the most important thing

about dad is really not that he drilled us in music, music, music, music

but more so he made us see life in a certain way. We have a certain outlook

on how we`re supposed to carry ourself in the world and see other people

and treat other people that I think really has a profound effect on what we

play musically. And I think that`s really more important than anything that

he`s ever given us.






HAYES: Ellis Marsalis was a jazz legend, as you can see there, a patriarch

of a musical family famous throughout American life, often described as

jazz`s royal family. Last night came word that Ellis, aged 85, had died

from complications of COVID-19 in his beloved hometown of New Orleans, one

of more than 5,000 Americans who how now lost their life to this virus,

each one a full world, a full universe.


The scope and the magnitude of these losses and this grief are slowly

dawning on all of us, slowly coming into focus for us as a society.


This week we also lost Dr. Frank Gabrin, a two-time cancer survivor, who

worked in New Jersey as an emergency room doctor treating patients with the

disease basically until his dying days.


And Hilda Churchill who was nearly 109 years old. She lived a remarkable

life. She survived the 1918 flu pandemic, which actually killed her baby

sister as well as two world wars.


We also lost Romi Cohen who during World War II, saved 56 families from the

Nazis in what was then Czechoslovakia, joined the underground resistance

there when he was just 15-years-old.


And Dez Ann Romain, just 36-years-old, 36, a woman who emigrated to New

York as a teenager, became the principle of Brooklyn Democracy academy

where she was beloved by teachers and by students.


And then there`s the legendary playwright and author Terrence McNally, an

out gay man who wrote about gay life in America, particularly surviving the

AIDS epidemic. McNally was a cancer survivor who last year won a Tony Award

for lifetime achievement in the theater. He died last week of complications

from Coronavirus at age 81.




TERRENCE MCNALLY, PLAYWRIGHT: I think the most imperative message of art is

live, be involved with life, live it, fully, connect with other people,

engage with the world around you and do something, matter.






HAYES: As Eugene Robinson of The Washington Post put it, the testing

failure is the original sin of America`s Coronavirus response. Now, in the

last month of so, testing capacity has ramped up enormously, but we have

now hit a snag. Daily testing appears to have plateaued, though it went up

again today. Huge parts of the country, though, just doesn`t have access to

the tests they need and so they are being rationed.


And then today we got reporting that maybe a third of infected patients are

getting negative test results. The most dogged investigate journalism on

testing has has come from two writers at The Atlantic, Alexis Madrigal and

Robinson Meyer, who both actually, along with another Atlantic colleague,

co-founded the COVID Tracking Project which tracks and publishes testing

data from across the country, it`s how we know how many tests we`re doing.


And Alexis Madrigal joins me now.


Alexis, we saw this really impressive effort. We started way behind. We

were behind the eight ball. Testing has ramped up quite a bit. It seems

sort of stuck now. Where are we right now? And what are the obstacles to

getting it further up?


ALEXIS MADRIGAL, THE ATLANTIC: Yeah, we`re doing about 100,000 tests a day,

a little more today, a few over the past few days. It is a big ramp up, but

it`s also not as much as we need it, and there are key supply chain

constraint and and swabs and then the chemicals that are used to do the

tests. And there is also incredible variability across the country. And

also most likely there are inequities in who is able to access these tests.


HAYES: Well, what are those inequities?


MADRIGAL: Well, you know, I think one of the things you`re seeing is that

people who have better access to health care and more money can get tests

more easily. And that means that low income communities, black and brown

people across this country may or may not be getting the kinds of treatment

that they need. And one of the ways we`re seeing that is my Atlanta

colleagues have been tracking stories across the south and wondering

whether places like Louisiana, which are showing unusually high death rates

among younger people, that some of that may be because of problems in the

health care system that are related to these health disparities.


HAYES: There`s also this huge issue right now in California which is a real

laggard in testing. If you look at the places that are sort of testing the

least, California stands out because it started very early and it has been

fairly proactive along other lines. And you wrote a piece about how

basically there is just this a huge backlog, right. Lab turn around time is

PPE is what Gref Barrett (ph) said, the acting laboratory medicine chair at

the University of Washington, more than a day is a tragedy, three to five

is OK for outpatients who can – if they can sit at home, but it doesn`t

address the problem in a hospital, meaning you have got people being tested

in California, there`s like 50,000 or 60,000 pending tests. Why is that?


MADRIGAL: You know, here is what we think happened. After the CDC`s failure

in testing in February, in March the Trump administration really tried to

throw this over to the private testing companies. It`s a pretty

concentrated industry. You`ve basically got Quest and LabCorp control most

of that market.


When the demand for testing surged, Quest and LabCorp started accepting

lots and lots and lots of specimens. They started to build up a big

backlog, and Quest, at least, didn`t stop accepting specimens. There were

two kinds of tests that they could do, one called a laboratory developed

test, and then later on the sort of more manufactured test from companies

like Roche. Roche has high throughput, the laboratory develop tests are not

, but they accepted a ton of specimens that only can use the materials for

the laboratory developed tests.


So they have got this glut, you know, like a python that ate a deer that

they need to work through the system. And we think that`s a pig problem in



But it`s not the only problem, something else is going on here, and we`re

still digging on it, for why California`s throughput, specifically, is so

bad, the lowest per capita testing rate for the states that report

completely that we know of through the COVID tracking project.


HAYES: There is all this talk about new tests. I mean, the president is

sort of doing his kind of monorail salesman act and showing some device in

this some talk about a test that is going to be – tell you in two minutes

or 10 minutes, like how close are we to sort of the point of care testing

like you have, say, for the normal flu?


MADRIGAL: Well, you know, those machines now exist. (inaudible) and Abbott

(ph) has been producing them. There are other companies that are going to

do the same.


The problem is we don`t know what is going to happen with those machines.

You know, there is reporting from The Washington Post yesterday indicating

that perhaps many of those machines would be sent to rural areas and places

in the south, which depending on where they get placed, would make sense.

On the other hand, it also sounds like the Trump administration sending

these machines to Trump country and some of the hardest hit places in the

country are decidedly not Trump country.


HAYES: Final question, quickly, the Wall Street Journal article today on

false negatives. Do we have a way of auditing the accuracy of these tests



MADRIGAL: The problem is it`s going to be variable across labs and it`s

going to be variable across actually individual people. The main problem

that we think exists is actually in the swabbing. I talked with Michael

Mina earlier, a Harvard epidemiologist and this was kind of the problem

that he highlighted that literally shoving the thing in your nose is a very

difficult thing to do and not all of the human beings actually doing that

work are going to do it in the same way.


HAYES: That`s a great point. Alexis Madrigal, thank you for all of your

fantastic reporting. It`s been really, really important.


Coming up, what to do if you`re among the growing millions of Americans who

have lost their job and their health insurance during the Coronavirus

crash, and why the Trump administration is denying pleas to open up the

Obamacare exchange, next.




HAYES: Well, we got the worst weekly jobless claim number anyone has ever

seen in history today. More than 6.6 million new initial jobless claims,

double what it was the week before. A lot of those people have probably

just lost their employer-sponsored health insurance in the middle of a

global pandemic just as worldwide COVID cases pass the one million mark.


Joining me now to talk about the implications of that, Margot Sanger-Katz

who writes about health care policy for The New York Times`s The Upshot.


And Margot, let`s start with folks who had employer-sponsored health

insurance and were just laid off, and now they don`t have it, what are the

options there for them? What can they do to make sure that they`re covered?


MARGOT SANGER-KATZ, THE NEW YORK TIMES: So those people actually have quite

a few options. There`s been a lot of publicity, because the Trump

administration declined to reopen the Obamacare markets for people who want

to buy insurance now, and I think people have gotten sort of the wrong

message from that. So if you`ve lost your job-based coverage, first of all,

you have access to Cobra, that means you could buy from your employer,

continue to buy the insurance that you already had. That is a pretty

expensive option and it may not be the best for everyone, but it could be

good if you`re undergoing ongoing treatment for a disease and you really

want to stick with all of the same doctors, and all of your same

prescriptions. You should talk to the company you used to work about that.


Another other option is you can go to the Obamacare marketplace. So there

is a provision in the law that says if you lose your job-based coverage,

then you`re automatically qualified for something called a special

enrollment period where you can go to and shop for a plan

and you will get a plan with potentially some subsidies based on how much

you earned. And if your income had become low enough as a result of losing

your job, or maybe just getting cut back in your income, if you have less

work than you had before, it is possible that you may qualify for Medicaid

coverage, that is going to vary a little bit by state because not every

state has expanded Medicaid to adults, but if you have a relatively low

income, it would make sense to check in with your state Medicaid agency and

see if you qualify.


So not everyone is going to have a lot of options, but I think because of

Obamacare, there are more options for people who have lost their job-based

coverage than there had been in previous economic downturns.


HAYES: So on this question of opening up the enrollment period nationally,

right, that – the reason that matters, is the category of people that are

losing their employer-provided insurance because they got laid off, they –

the law says they can sign up. It would be the millions of people who don`t

have health insurance who are now looking – staring down the barrel of a

pandemic who can`t get health insurance now, can`t go and buy it because

the enrollment period is closed, right?


SANGER-KATZ: Yes, that`s exactly right. If you`re someone who didn`t buy

health insurance before and now you`re looking at this pandemic and

thinking wow, I would really like to have some coverage to protect me in

case I got sick or someone in my family gets sick, you have fewer options

than someone who had coverage through work and now has lost it.


But again, you know, several states have opened these special enrollment

periods, 11 states plus the District of Columbia, so in those places you

can go in for any reason, and buy insurance through the Obamacare

exchanges. And in the other states, you really are a little bit more out of



The Trump administration could have chosen to open up the exchanges, they

were facing a lot of pressure to do it, even health insurers wanted them to

do it, health care providers wanted them to do it, a lot of consumer

groups, governors, but they decided not to do it. And so it does mean that

some people who are uninsured now really don`t have a lot of options.


HAYES: Margot Sanger-Katz, who does great reporting for The New York Times

on health care, that was extremely illuminating because there has been a

lot of confusion, so thank you so much for taking the time to walk us

through that.


SANGER-KATZ: So glad I`m helpful.


HAYES: I want to now bring in Don Berwick. He`s the former administrator of

the Centers for Medicare and Medicaid Services and a health policy expert.

Don, you heard what Margot said there that some people are probably going

to get onto Medicaid in these states. It`s going to depend on what the sort

of qualifying income is, but I look at this and I think to myself the

Medicaid system is going to be overwhelmed right now. I mean, there`s real

worry, right, about whether Medicaid can handle the influx of patients and

the states can afford what`s about to happen.



SERVICES: Absolutely.


First, for what Margot was talking about, in terms of people that have

employer-based insurance and lose their jobs, there is still a bit of a

procedure to go through if the enrollment period is open, it gets a lot

easier and those people will find it easier to get insurance, but you`re

absolutely right, Medicaid is for people that aren`t in that position and

of course this administration has steadily weakened Medicaid. In their 2020

budget, they proposed to take away $200 billion of federal support for

state Medicaid programs. They put in work requirements. There are new

enrollment barriers. And there`s the public charge rule, which affects



So, unfortunately, the Medicaid system has been significantly weakened. And

it`s the main safety net. And it`s supposed to be counter-cyclical, so at

times when things are worse the federal government offers more help, not

less. This administration is holding back on offering the kind of help that

needs to be offered to people right now.


HAYES: There`s also, of course, the cost question.


So, there`s one story of a guy who went in and got tested. He traveled to a

place where the virus is early in the days of the sort of U.S. epidemic and

his patient responsibility, according to his insurer, was close to $2,000

just – that was the test fee. And then there`s the treatment right now. I

mean, if you had major complications, if you`re intubated, your in ICU,

that could run as much as $74,000, $42,000 with no complications.


There`s real worry about – if we`re looking at millions of cases what this

does to the entire insurance system and to people`s financial lives.


BERWICK: Absolutely.


First, we still have 28 million people in this country with no insurance at

all, no other western Democracy can say that. These people can be seriously



Of course, hospitals suffer, because they don`t get paid. Also, the

extension of support for COVID diagnosis, which is now federal support for

free testing, in the federally-supported systems, does not apply to free

treatment. And so if you don`t have coverage, you are really up a tree.

We`re asking for big trouble for millions of people.


HAYES: And millions of people, and also my – the hospital economics here

are so strange. I`m reading stories about hospitals laying people off right

now, because the profit center for hospitals, the sort of revenue center

are elective surgeries, which are now all being canceled. So you have got

this perverse situation, where hospital economics are crunching hospitals

right at the time we need them to have the most people online.


BERWICK: I spoke to a multi-hospital system executive just this afternoon.

They`re looking at $300 million a month of loss. So unless the federal

government pitches in to help hospitals the way they are helping airlines,

we are going to have a very weakened health care system.


I don`t know what people expect, this takes resources to save lives.


HAYES: In a broad sense, I mean I have to say, as I was talking through

this sort of flow chart for people today, between Cobra, Medicaid and the

ACA and whether there is open enrollment, it is bringing into relief some

of the huge holes in the system we have, and the kind of Rube Goldberg

nature of the American health care system as this virus doesn`t care about

any of those – any of those obstacles.


BERWICK: Yeah, the virus didn`t happen to time itself with the normal

enrollment period, so we have to be a little more generous. We have a very

weak system when you look at coverage. 28 million people uninsured and that

has steadily risen since the low point in 2016. You had the most insurance

in this country, now it has been eroded steadily by millions. The insurance

coverage is weaker and weaker, more out-of-pocket payments. And now, the

administration is allowing basically junk insurance plans. They look cheap,

but they`re not going to be cheap for someone who has problems with the



So this is a time when we really need to take stock as a country and say

are we really providing the kind of security that our people need, not just

in a pandemic, but in normal life. These catastrophes hang over us all the



HAYES: That`s right. Don Berwick, it is always a pleasure to talk to you,

sir. Thank you very much.


That is All In for this evening. The Rachel Maddow Show starts right now.

Good evening, Rachel.








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