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

Guests: 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.

(BEGIN VIDEO CLIP)

NATE LINK, CHIEF MEDICAL OFFICER, BELLEVUE HOSPITAL: New York two weeks 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.

(END VIDEO CLIP)

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 situation.

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 them."

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 been.

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?

ASHISH JHA, DIRECTOR, HARVARD GLOBAL HEALTH INSTITUTE: It`s really 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 characterization?

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 insurance.

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.

(COMMERCIAL BREAK)

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 happened.

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 takes.

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...

SCHUMER: It is.

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.

(LAUGHTER)

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.

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FRED ROGERS, CREATOR, MR. ROGERS NEIGHBORHOOD: And I just wonder how you- all feel about your dad and his giving you this music as you were growing up

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.

(MUSIC)

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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.

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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.

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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 California.

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 writ-large?

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.

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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 healthcare.gov 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 luck.

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.

DON BERWICK, FORMER ADMINISTRATOR CENTERS FOR MEDICARE AND MEDICAID 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 people.

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 hurt.

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 Coronavirus.

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 time.

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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