Category: Public Health

Coronavirus-infected Americans flown home against CDC’s advice

In the wee hours of a rainy Monday, more than a dozen buses sat on the tarmac at Tokyo’s Haneda Airport. Inside, 328 weary Americans wearing surgical masks and gloves waited anxiously to fly home after weeks in quarantine aboard the Diamond Princess, the luxury liner where the novel coronavirus had ­exploded into a shipwide epidemic.

But as the buses idled, U.S. officials wrestled with troubling news. New test results showed that 14 passengers were infected with the virus. The U.S. State Department had promised that no one with the infection would be allowed to board the planes.

A decision had to be made. Let them all fly? Or leave them behind in Japanese hospitals?

In Washington, where it was still Sunday afternoon, a fierce debate broke out: The State Department and a top Trump administration health official wanted to forge ahead. The infected passengers had no symptoms and could be segregated on the plane in a plastic-lined enclosure. But officials at the Centers for Disease Control and Prevention disagreed, contending they could still spread the virus. The CDC believed the 14 should not be flown back with uninfected passengers.

“It was like the worst nightmare,” said a senior U.S. official involved in the decision, speaking on the condition of anonymity to describe private conversations. “Quite frankly, the alternative could have been pulling grandma out in the pouring rain, and that would have been bad, too.”

The State Department won the argument. But unhappy CDC officials demanded to be left out of the news release that explained that infected people were being flown back to the United States — a move that would nearly double the number of known coronavirus cases in this country.

The tarmac decision was a pivotal moment for U.S. officials improvising their response to a crisis with few precedents and extraordinarily high stakes. Efforts to prevent the new pathogen from spreading have revealed the limits of the world’s readiness for an unprecedented public health emergency. In the worst-case scenario, covid-19, a flulike respiratory infection, could become a full-blown global pandemic.

Navigating the crisis has required delicate medical and political judgments. The decision to evacuate the Americans from the Diamond Princess came only after infections on the cruise ship spiked and passengers revealed their grim living conditions.

One lesson from that debacle is that cruise ships are like petri dishes.Thousands live in close quarters on a vessel never designed for quarantines. The crew continued to deliver food, and health workers moved throughout the ship. More than 600 of the 3,700 passengers and crew members have now tested positive for the virus and two older Japanese passengers have died.

With Japanese authorities isolating the passengers for weeks off the coast, the ship, operated by Princess Cruises, quickly developed the second-largest number of coronavirus cases on the planet outside of China — more than in Japan, Singapore, Thailand, the United States or all of Europe. Avoiding “another China” has been the goal of the World Health Organization for weeks, and then it happened anyway, in Yokohama harbor.

The treatment of the Diamond Princess passengers stands in stark contrast to what happened to those on another cruise ship, the Westerdam, who were greeted by the Cambodian prime minister with handshakes and flowers, and who later traveled widely. Only later did news come that one of the Westerdam passengers had tested positive for the virus.

That situation spurred fears that Westerdam passengers would spread the virus around the world. But no additional passengers have tested positive, and so far, no evidence has emerged they have widely seeded the virus.

The coronavirus (officially, SARS-CoV-2) is extremely contagious. Experts estimate that without protective measures, every infected person will spread it to an average of slightly more than two additional people. The disease has been fatal in roughly two out of 100 confirmed cases.

Travelers have already spread it to more than two dozen countries, where it has infected more than 75,000 people and killed more than 2,000.

[Washington Post]

Trump to roll back Michelle Obama’s school lunch rules on vegetables, fruits

The Trump administration on Friday announced plans to roll back school lunch standards on vegetables and fruits originally promoted by Michelle Obama, unveiling the proposal on the former first lady’s birthday.

The new standards will allow schools more flexibility “because they know their children best,” the Agriculture Department said in a press release.

“Schools and school districts continue to tell us that there is still too much food waste and that more common-sense flexibility is needed to provide students nutritious and appetizing meals. We listened and now we’re getting to work,” Agriculture Secretary Sonny Perdue said in a statement.

The proposed rules build on previous steps taken by the Trump administration to unwind the controversial school lunch rules championed by Obama as part of her “Let’s Move!” healthy living campaign. Those rules were implemented through an executive order signed by former President Obama.

Under the new rules, schools would be allowed to reduce the number of fruits and vegetables required at each meal. The latest change follows a 2019 rollback of restrictions on milk and sodium content in school lunches.

Critics said the change will pave the way for greasier, more unhealthy foods such as pizza, french fries and burgers.

“[It] would create a huge loophole in school nutrition guidelines, paving the way for children to choose pizza, burgers, french fries and other foods high in calories, saturated fat or sodium in place of balanced school meals every day,” Center for Science in the Public Interest’s deputy director of legislative affairs, Colin Schwartz, said in a statement Friday.

In a recent op-ed for The Hill, Dr. Rachel Borton, the director of the Family Nurse Practitioner online program at Bradley University, said healthy school meals are essential to both good physical and mental health, especially for low-income students who are more likely to receive their only healthy meal of the day while at school.

“If those students don’t have access to the nutritious options provided by the school, they may turn to low cost, processed foods that are high in calories but sparse in nutrients. Immediate effects of this type of diet include weight gain and poor physical health,” Borton wrote. “Long-term impacts range from increased risk of obesity, heart disease, diabetes, and a slew of other unfortunate health outcomes.”

The Obama administration’s school lunch plan increased the requirement for fruits and vegetables in meals, cut trans-fat and reduced sodium levels in food. It also required cafeterias to serve only skim or low-fat milk.

In 2019, the first comprehensive analysis of the Obama administration’s lunch plan by the Department of Agriculture found the updates “had a positive and significant influence on nutritional quality” as students ate more whole grains, greens, and beans, as well as fewer “empty calories.”

The report found evidence of food waste, but the levels were not substantially higher than food waste under previous lunch regulations.  

[The Hill]

Trump takes credit for decline in cancer deaths. The American Cancer Society says he’s wrong

President Donald Trump insinuated in a tweet on Thursday that his administration played a role in the US cancer death rate hitting a record low in 2017. The American Cancer Society says that’s not true.

Trump’s tweet appeared to be referring to the findings of an American Cancer Society report released on Wednesday, which said the rate of people dying from cancer in the United States declined in 2017 for the 26th year in a row. Trump took office in January 2017. The report, published in CA: A Cancer Journal for Clinicians, said that the cancer death rate had fallen “continuously” from 1991 through 2017.

The report also found that from 2016 to 2017, the United States saw its largest-ever single-year drop in overall cancer deaths, a 2.2% decline spurred in part by a sharp fall in lung cancer deaths.Trump’s tweet on Thursday said, “U.S. Cancer Death Rate Lowest In Recorded History! A lot of good news coming out of this Administration.”

[CNN]

Trump Admin Tells UN There Is ‘No International Right To An Abortion’

Health and Human Services Secretary Alex Azar railed against abortion rights on Monday during a speech at the United Nations General Assembly.

Azar presented a joint statement on behalf of the U.S. and 18 other nations, which expressed opposition to terms such as “sexual and reproductive health and rights” being used in U.N. documents because “they can undermine the critical role of the family and promote practices, like abortion, in circumstances that do not enjoy international consensus and which can be misinterpreted by U.N. agencies.”

Arguing that there is “no international right to an abortion,” the HHS secretary said that the aforementioned terms “should not be used to promote pro-abortion policies and measures.”

Azar also stated that the 19 countries, including the U.S., only support sex education that “appreciates the protective role of the family” and “does not condone harmful sexual risks for young people.”

“We therefore request that the U.N., including U.N. agencies, focus on concrete efforts that enjoy broad consensus among member states,” Azar said. “To that end, only documents that have been adopted by all member states should be cited in U.N. resolutions.”

Bahrain, Belarus, Brazil, Democratic Republic of the Congo, Egypt, Guatemala, Haiti, Hungary, Iraq, Libya, Mali, Nigeria, Poland, Russia, Saudi Arabia, Sudan, United Arab Emirates, and Yemen co-signed the statement.

[Talking Points Memo]

Trump Administration to Finalize Rollback of Clean Water Protections

The Trump administration on Thursday is expected to complete the legal repeal of a major Obama-era clean water regulation, which had placed limits on polluting chemicals that could be used near streams, wetlands and water bodies.

The rollback of the 2015 measure, known as the Waters of the United States rule, has been widely expected since the early days of the Trump administration, when President Trump signed an executive order directing federal agencies to begin the work of repealing and replacing it.

Weakening the Obama-era water rule had been a central campaign pledge for Mr. Trump, who characterized it as a federal land-grab that impinged on the rights of farmers, rural landowners and real estate developers to use their property as they see fit.

Environmentalists say Mr. Trump’s push to loosen rules on clean water regulations represents an assault on protecting the nation’s streams and wetlands at a moment when Mr. Trump has repeatedly declared his commitment to “crystal-clean water.”

The repeal of the water rule, which is scheduled to be announced at the headquarters of the National Association of Manufacturers, will take effect in a matter of weeks.

The Environmental Protection Agency and the Army Corps of Engineers, which had worked together to write the original Obama rule, are expected to issue a new, looser replacement rule by the end of this year.

The clean water rollback is the latest in a series of actions by the Trump administration to weaken or undo major environmental rules, including proposals to weaken regulations on planet-warming emissions from cars, power plants and oil and gas drilling rigs, a series of moves designed to push new drilling in the vast Arctic National Wildlife Refuge, and efforts to weaken protections under the Endangered Species Act.

Environmentalists assailed the move.

“With many of our cities and towns living with unsafe drinking water, now is not the time to cut back on clean water enforcement,” said Laura Rubin, director of the Healing Our Waters-Great Lakes Coalition. “We need more, not less, protection for clean water.”

But farming groups, a key political constituency for Mr. Trump, praised the repeal of a regulation that they said had severely restricted how farmers could use their land.

“The rule that was developed in 2015 was a significant overreach,” said Don Parrish, director of regulatory relations with the American Farm Bureau Federation, which has lobbied for the repeal and replacement of the rule. “It overstepped the limit of protecting clean water and tried to regulate land use. It created liabilities that can end up putting farmers in jail.” He was referring to actions like using pesticides, he said.

The Obama rule, developed under the authority of the 1972 Clean Water Act, was designed to limit pollution in about 60 percent of the nation’s bodies of water, protecting sources of drinking water for about a third of the United States. It extended existing federal authority to limit pollution in large bodies of water, like the Chesapeake Bay and Puget Sound, to smaller bodies that drain into them, such as tributaries, streams and wetlands.

Under the rule, farmers using land near streams and wetlands were restricted from doing certain kinds of plowing and planting certain crops and would have been required E.P.A. permits in order to use chemical pesticides and fertilizers that could have run off into those water bodies.

[The New York Times]

Trump Administration to Crack Down on Vaping with Plan to Ban Flavored E-Cigarettes

The Trump administration is planning to crack down on vaping, especially when it comes to its use among teens.

Health and Human Services Secretary Alex Azar announced the administration’s plan to completely remove flavored e-cigarettes from the market, save for tobacco-flavored products, on Wednesday from the Oval Office. He noted that about 8 million adults and 5 million children are currently vaping.

Before Azar announced the plan, President Donald Trump highlighted the fact that vaping poses a danger to children, saying that the popularity of e-cigarettes is a “very new and potentially very bad” problem.

The president and Azar were joined by First Lady Melania Trump and the Food and Drug Administration Acting Commissioner Norman Sharpless.

“We want to have parents understand that we’re studying it very carefully,” Trump said. “There have been deaths and there have been a lot of other problems. People think it’s an easy solution to cigarettes, but it’s turned out that it has its own difficulties.”

Azar then said that new data from the National Youth Tobacco survey shows “a continued surging” in e-cigarette use among teens and that young users are specifically drawn to the many flavors currently on the market, like mint and candy.

“With the president’s support, the Food and Drug Administration intends to finalize a guidance document that would commence enforcement to require that all flavors, other than tobacco flavor, would be removed from the market,” Azar said, adding that once the FDA finalizes the guidance, enforcement actions will begin.

Azar suggested that the ban on flavors could be the first step of many to keep children from vaping.

“If we find that children are being attracted to tobacco-flavored e-cigarettes, if we find that manufacturers are marketing the tobacco-flavored e-cigarettes to children, or placing them in settings where they get them, we will take enforcement action there also,” he added.

Trump’s announcement comes one day after Kansas health officials confirmed the sixth vaping-related death in the United States.

The Centers for Disease Control is investigating more than 450 reported cases of severe lung illness linked to vaping from U.S. residents of all ages, a number that the CDC said on Friday had more than doubled from the prior week.

The CDC is urging Americans to avoid vaping while investigations into the deaths and illnesses proceed.

“While this investigation is ongoing, people should consider not using e-cigarette products,” said Dr. Dana Meaney-Delman, incident manager of the CDC’s response to the vaping-related lung injuries. “People who do use e-cigarette products should monitor themselves for symptoms, for example, cough, shortness of breath, chest pain, nausea and vomiting — and promptly seek medical attention for any health concerns.”

On Wednesday, CDC Director Robert Redfield said the health organization “strongly supports” the FDA’s plan to “finalize an enforcement policy that will clear non-tobacco-flavored e-cigarettes from the market.”

“This is an important step in response to the epidemic of e-cigarette use among our Nation’s youth, and will help protect them from a lifetime of nicotine addiction and associated health risks. Clearing the market of non-tobacco-flavored products is important to reverse this alarming epidemic,” he continued in a statement obtained by PEOPLE.

“Any tobacco product use, including e-cigarettes, is unsafe for youth. Nicotine can harm the developing adolescent brain. We must do everything we can to reduce the use of e-cigarettes among middle and high school students.”

[People]

Reality

Donald Trump actually did a very good thing, and announced a ban on flavored e-cigarettes which are notoriously marketed to children.

Later we learned it was only after Melania was scared for her son, because the Trump’s only care about themselves.

Later Trump walked back his comments, saying not all e-cigarettes are bad… because he’s a shill for any industry who will donate to his campaign.

Trump backs Brazilian president as he rejects aid for fighting Amazon fires

President Donald Trump gave Brazil’s Jair Bolsonaro his full backing Tuesday as South America struggles to contain wildfires wreaking havoc in the Amazon rainforest and as Bolsonaro rejected a pot of international aid to fight the blazes.

“I have gotten to know President @jairbolsonaro well in our dealings with Brazil,” Trump tweeted. “He is working very hard on the Amazon fires and in all respects doing a great job for the people of Brazil – Not easy. He and his country have the full and complete support of the USA!”

Brazil on Tuesday said it would reject$20 million in aid money offered Monday by G-7 nations to battle the massive fires that have threatened one of the world’s greatest sources of biodiversity.

“The Amazon are the lungs of the planet, and the consequences are dire for the planet,” French President Emmanuel Macron said in announcing the aid fund earlier this week. The assistance was not intended solely for Brazil, but for the nearly dozen states that make up the Amazon region in South America, including French Guiana. Canada and Britain pledged an additional $11 million and $12 million in aid, respectively, during the G-7 summit.

Bolsonaro’s decision to spurn the aid money from France and other economic giants comes amid a public spat with Macron that resulted Monday in the French president openly wishing Brazil would soon have a new leader. Bolsonaro insisted Macron had called him a liar and insulted him by questioning his handling of the crisis. The Brazilian president said that once Macron retracted some of those comments, “then we can speak,” according to The Associated Press.

Critics have accused Bolsonaro, a right-wing populist dubbed the “Trump of the tropics,” of facilitating the fires and of taking a lax approach to preventing mass deforestation of the rainforest while also being too slow to respond to the fires. Macron last week threatened to upend a major trade deal between the European Union and the South American Mercosur trade bloc over the issue, claiming Bolsonaro was not living up to environmental commitments that had been made under the deal.

Brazil’s ambassador to France, Luís Fernando Serra, said on French TV on Tuesday that his country is rejecting the aid because the decision was made without involving his country and the “language is ambiguous.”

“We refuse because we see interference,” he said, calling the aid “help we didn’t ask for.”

Bolsonaro’s chief of staff went further, taking personal shots at Macron and suggesting the aid might be better spent reforesting his own backyard. And he knocked the massive blaze earlier this year at Paris’ historic Notre Dame Cathedral, adding, “Macron cannot even avoid a predictable fire in a church that is part of the world’s heritage, and he wants to give us lessons for our country?”

[Politico]

Trump’s EPA Just Made Its Final Decision Not to Ban a Pesticide That Hurts Kids’ Brains

On Wednesday, the United States Environmental Protection Agency doubled down on one of the most controversial environmental deregulation moves of the Trump presidency. Under pressure from a looming court-ordered deadline, the EPA reaffirmed its 2017 decision to reject a proposal from the agency’s own scientists to ban an insecticide called chlorpyrifos that farmers use on a wide variety of crops, including corn, soybeans, fruit and nut trees, Brussels sprouts, cranberries, broccoli, and cauliflower. 

Here’s background from my piece in 2017:

The pesticide in question, chlorpyrifos, is a nasty piece of work. It’s an organophosphate, a class of bug killers that work by “interrupting the electrochemical processes that nerves use to communicate with muscles and other nerves,” as the Pesticide Encyclopedia puts it. Chlorpyrifos is also an endocrine disrupter, meaning it can cause “adverse developmental, reproductive, neurological, and immune effects,” according to the National Institutes of Health.

Major studies from the Mount Sinai School of Medicine, the University of California-Davis, and Columbia University have found strong evidence that low doses of chlorpyrifos inhibits kids’ brain development, including when exposure occurs in the womb, with effects ranging from lower IQ to higher rates of autism. Several studies—examples here, here, and here—have found it in the urine of kids who live near treated fields. In 2000, the EPA banned most home uses of the chemical, citing risks to children.

And here’s the dirt on the relationship between President Donald Trump and the company that markets the chemical:

Dow AgroSciences’ parent company, Dow Chemical, has also been buttering up Trump. The company contributed $1 million to the president’s inaugural committee, the Center for Public Integrity notes. In December, Dow Chemical Chairman and CEO Andrew Liveris attended a post-election Trump rally in the company’s home state of Michigan, and used the occasion to announce plans to create 100 new jobs and bring back another 100 more from foreign subsidiaries. Around the same time, Trump named Liveris chair of the American Manufacturing Council, declaring the chemical exec would “find ways to bring industry back to America.” (Dow has another reason beside chlorpyrifos’ fate to get chummy with Trump: its pending mega-merger with erstwhile rival DuPont, which still has to clear Trump’s Department of Justice.)

Since the 2017 chlorpyrifos decision, the administration has approved the Dow-Dupont merger, and named several former Dow execs to high posts within the US Department of Agriculture.

Meanwhile, Hawaii, California, and New York have all announced plans to phase out use of chlorpyrifos in farm fields. 

Here’s information from the US Geological Survey on where chlorpyrifos is used:

pesticide use map

[Mother Jones]

Doctors Could Refuse to Treat People Based on Race and Age Under Trump’s New Rule

A new Trump administration proposal would change the civil rights rules dictating whether providers must care for patients who are transgender or have had an abortion. News stories have mainly focused on how the proposal might affect LGBTQ rights and abortion rights, but the sweeping proposal has implications for all Americans, because the Department of Health and Human Services seeks to change how far civil rights protections extend and how those protections are enforced.

Roger Severino, the director of the HHS Office for Civil Rights, has been candid about his intentions to overturn an Obama-era rule that prohibited discrimination based on gender identity and termination of a pregnancy. In 2016, while at the conservative Heritage Foundation, he co-authored a paper arguing the restrictions threaten the independence of physicians to follow their religious or moral beliefs. Supporters of the approach say it protects the freedom of conscience, but opponents say it encourages discrimination.

His office unveiled the proposed rule on May 24, when many people were focused on the start of the long Memorial Day holiday weekend.

The rule is the latest Trump administration proposal to strip protections for transgender Americans, coming the same week another directive was proposed by the Department of Housing and Urban Development that would allow homeless shelters to turn away people based on their gender identity.

The public was given 60 days to comment on the HHS proposal. Here’s a rundown of what you need to know about it.

What would this proposal do?

Fundamentally, the proposed rule would overturn a previous rule that forbids health care providers who receive federal funding from discriminating against patients on the basis of their gender identity or whether they have terminated a pregnancy.

The Trump administration proposal would eliminate those protections, enabling providers to deny these groups care or insurance coverage without having to pay a fine or suffer other federal consequences.

That may mean refusing a transgender patient mental health care or gender-confirming surgery. But it may also mean denying patients care that has nothing to do with gender identity, such as a regular office visit for a bad cold or ongoing treatment for chronic conditions like diabetes.

“What it does, from a very practical point of view, is that it empowers bad actors to be bad actors,” Mara Keisling, executive director of the National Center for Transgender Equality, told reporters.

The proposal would also eliminate protections based on sexual orientation and gender identity from several other health care regulations, like non-discrimination guidelines for the health care insurance marketplaces.

Does it affect only LGBTQ people?

The proposal goes beyond removing protections for the LGBTQ community and those who have had an abortion.

It appears to weaken other protections, such as those based on race or age, by limiting who must abide by the rules. The Trump proposal would scrap the Obama-era rule’s broad definition of which providers can be punished by federal health officials for discrimination, a complicated change critics have said could ease requirements for insurance companies, for instance, as well as the agency itself.

And the proposal erases many of the enforcement procedures outlined in the earlier rule, including its explicit ban on intimidation or retaliation. It also delegates to Severino, as the office’s director, full enforcement authority when it comes to things like opening investigations into complaints lodged under the non-discrimination rule.

Why did HHS decide to change the rule?

The Obama and Trump administrations have different opinions about whether a health care provider should be able to refuse service to patients because they are transgender or have had an abortion.

It all goes back to a section in the Affordable Care Act barring discrimination on the basis of race, color, national origin, age, disability or sex. President Barack Obama’s health officials said it is discrimination to treat someone differently based on gender identity or stereotypes.

It was the first time Americans who are transgender were protected from discrimination in health care.

But President Donald Trump’s health officials said that definition of sex discrimination misinterprets civil rights laws, particularly a religious freedom law used to shield providers who object to performing certain procedures, such as abortions, or treating certain patients because they conflict with their religious convictions.

“When Congress prohibited sex discrimination, it did so according to the plain meaning of the term, and we are making our regulations conform,” Severino said in a statement. “The American people want vigorous protection of civil rights and faithfulness to the text of the laws passed by their representatives.”

Much of what the Office for Civil Rights has done under Severino’s leadership is to emphasize and strengthen so-called conscience protections for health care providers, many of which existed well before Trump was sworn in. Last year, Severino unveiled a Conscience and Religious Freedom Division, and his office recently finalized another rule detailing those protections and their enforcement.

The office also said the proposed rule would save about $3.6 billion over five years. Most of that would come from eliminating requirements for providers to post notices about discrimination, as well as other measures that cater to those with disabilities and limited English proficiency.

The rule would also save providers money that might instead be spent handling grievances from those no longer protected.

The office “considers this a benefit of the rule,” said Katie Keith, co-founder of Out2Enroll, an organization that helps the LGBTQ community obtain health insurance. “Organizations will have lower labor costs and lower litigation costs because they will no longer have to process grievances or defend against lawsuits brought by transgender people.”

Why does this matter?

Research shows the LGBTQ community faces greater health challenges and higher rates of illness than other groups, making access to equitable treatment in health care all the more important.

Discrimination, from the misuse of pronouns to denials of care, is “commonplace” for transgender patients, according to a 2011 report by advocacy groups. The report found that 28 percent of the 6,450 transgender and gender non-conforming people interviewed said they had experienced verbal harassment in a health care setting, while 19 percent said they had been refused care due to their gender identity.

The report said 28 percent had postponed seeking medical attention when they were sick or injured because of discrimination.

Critics fear the rule would muddy the waters, giving patients less clarity on what is and is not permissible and how to get help when they have been the victims of discrimination.

Jocelyn Samuels, the Obama administration official who oversaw the implementation of the Obama-era rule, said that for now, even though the Trump administration’s HHS will not pursue complaints against those providers, Americans still have the right to challenge this treatment in court. Multiple courts have said the prohibition on sex discrimination includes gender identity.

“The administration should be in the business of expanding access to health care and health coverage,” Samuels told reporters on a conference call after the rule’s release. “And my fear is that this rule does just the opposite.”

[VICE]

Trump Takes Credit for Obama’s Gains for Vets

Boastful on the occasion of Memorial Day, President Donald Trump and his Veterans Affairs secretary are claiming full credit for health care improvements that were underway before they took office.

Trump said he passed a private-sector health care program, Veterans Choice, after failed attempts by past presidents for the last “45 years.” That’s not true. The Choice program, which allows veterans to see doctors outside the government-run VA system at taxpayer expense, was first passed in 2014 under President Barack Obama.

Trump’s VA secretary, Robert Wilkie, also is distorting the facts. Faulting previous “bad leadership” at VA, Wilkie suggested it was his own efforts that improved waiting times at VA medical centers and brought new offerings of same-day mental health service. The problem: The study cited by Wilkie on wait times covers the period from 2014 to 2017, before Wilkie took the helm as VA secretary. Same-day mental health services at VA were started during the Obama administration under Wilkie’s predecessor, David Shulkin.

The half-truths and exaggerations came in a week when selective accounting was a norm in Trump’s rhetoric, extending into his trip to Japan , where he inflated the drop in the U.S. unemployment rate for women.

A look at the claims, about the Russia investigation, the border, drug prices and more:

VETERANS

TRUMP: “We passed VA Choice and VA Accountability to give our veterans the care that they deserve and they have been trying to pass these things for 45 years.” — Montoursville, Pennsylvania, rally on May 20.

THE FACTS: Wrong. Trump is not the first president in 45 years to get Congress to pass Veterans Choice; Obama did it in the wake of a scandal at VA’s medical center in Phoenix, where some veterans died while waiting months for appointments. The program currently allows veterans to see doctors outside the VA system if they must wait more than 30 days for an appointment or drive more than 40 miles (65 kilometers) to a VA facility.

Trump did expand eligibility for the program. Now, starting June 6, veterans are to have that option for a private doctor if their VA wait is only 20 days (28 for specialty care) or their drive is only 30 minutes.

Still, VA’s top health official, Dr. Richard Stone, described the new program’s start to “almost be a non-event” in testimony to Congress. That’s in part because wait times in the private sector are typically longer than at VA. In 2018, 34 percent of all VA appointments were with outside physicians, down from 36 percent in 2017.

Also key to the Choice program’s success is an overhaul of VA’s electronic medical records to allow seamless sharing of them with private physicians, a process expected to take up to 10 years. Wilkie has said full implementation of the expanded Choice program is “years” away.

[Associated Press]

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