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How this bipartisan plan proposes scaling up contact tracing

As the U.S. grapples with the novel coronavirus, a bipartisan group is putting together an ambitious plan to scale capacity to track and contain the virus. Andy Slavitt, former director of the Centers for Medicare and Medicaid Services, joins Judy Woodruff to discuss the $46 billion proposal, which would expand contact tracing capabilities as well as provide income for people during isolation.

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  • Judy Woodruff:

    The COVID-19 testing plan announced at the White House this evening is one more step on a long road toward reopening much of the country.

    But many say it is still too small a step. A new bipartisan proposal calls for far more ambitious moves. This $46 billion plan would hire 180,000 workers to help trace and track those who were infected or exposed and the people they came in contact with, allocate money for housing where infected people could isolate themselves voluntarily, and provide income support while people are isolated.

    Andy Slavitt teamed up with former FDA Commissioner Scott Gottlieb and many others on this blueprint. He is the former head of Medicare and Medicaid under President Obama.

    Andy Slavitt, good to you have with us again.

    First of all, we have heard so much about testing. They're talking about it again at the White House today. The United States has a long way to go in that regard.

    But, in this proposal, you're not focusing on testing. Why not?

  • Andy Slavitt:

    Well, we have to improve our testing. We have to limit our case counts.

    But once we do that, once we have reduced our testing, and we begin to reopen, we have to give states the tools to prevent what we're — what we lived through the last month, Judy, I'd say, it's equivalent of a forest fire.

    What we have to do is to prevent forest fires from breaking out, so we can catch things when they're little campfires. And in order to do that, we have to have the ability to surround the outbreak as it happens, so it doesn't spread into community again.

    And what that will mean is, as you said, when we find someone who tests positive, we want to help them figure out, who are the people that they have been in contact with? And this is just the tried-and-true methods throughout the years for measles and other outbreaks, and then help support folks, so that the community can go on and people can feel safe.

  • Judy Woodruff:

    So, and the number are you are using, 180,000 people throughout the country, this is something organized by the states. How do you know people are going to cooperate with this?

  • Andy Slavitt:

    Well, I think the majority of people will, because people don't want to make other people unsafe.

    If someone were to tell you or me that I had COVID-19, I would want to know, who are all the people that I was in contact with, so that they could be alerted. And so if somebody was going to help me do that, and help me do it in a systemic way, it takes some resources.

    I would be appreciative. Of course it is going to be voluntary. And there may be people that don't want to do that. And I think we have to recognize that we're not talking about eliminating all of this or making COVID-19 disappear.

    But what we are talking about doing is limiting the damage as much as possible.

  • Judy Woodruff:

    So, that — I see you have about $12 billion in the plan set aside for what — again, what we call contact tracing.

    You have another $4 billion-plus set aside for hotel rooms for people. Explain why those would be needed.

  • Andy Slavitt:

    Well, for those of us who can isolate safely at home if we were to test positive and not infect our families, then there is — where there is a spare bedroom or a room to go, that is great.

    But that doesn't describe every American situation. And so, if someone is living in a multigenerational household, say, with a parent or a grandparent, and COVID-19 would be dangerous for them, what we want to do is, we want to have the many hotel and motel rooms available across the country made available on a voluntary basis, if people want to socially isolate for two weeks, have a couple of weeks of cable TV and "PBS NewsHour,' on their own, maybe get away from their families.

    And that way, they will be able to — be able to go back to their families and be safer. Of course, this would have to be voluntary. I think other countries have done this in a way, like China, where it hasn't been voluntary.

    But we live in a liberal democracy. And I don't think that is the right choice. Still, I think it's a comfortable choice for many.

  • Judy Woodruff:

    Yes, but, as you point out, people would have to agree to do that. And for many people, it would be an option they wouldn't have otherwise.

    And, Andy Slavitt, there is another $30 billion in here for what you call income support. What is that all about?

  • Andy Slavitt:

    Well, this is really important.

    We get asked to do our civic duty throughout our lives. We get asked to go sit on jury duty. And when we do that, we get some very small stipend. But it helps people who have a — who aren't getting reimbursed from their employer to be able to do that and do their civic duty without too much pain.

    So, what we are proposing here is that, for a period of time where people are going to be socially isolated, that they are eligible for this level of income replacement.

    Otherwise, I think it would be difficult for people to comply. If you told somebody who was living paycheck to paycheck to go without two paychecks in order to make all the rest of us safe, it may be hard for them to do that.

    So, we have a stipulation in this proposal that allows people who need that income to get it.

  • Judy Woodruff:

    And the $46 billion or so total, you think takes care of it for the whole country? For how long?

  • Andy Slavitt:

    We estimate that this needs to be done until we either have herd immunity or, more hopefully, a vaccine.

    So this is about 18 months of funding. The way we have structured it, to be fiscally prudent, is that states would apply for a block grant with the Department of Health and Human Services. They would estimate their number of cases. And, if, hopefully, they had fewer cases than they thought they did, the money would revert back to the federal treasury.

    So, we want to make sure that we are as prudent as possible in doing this. And, of course, if we get to a vaccine, and there's still money in the state coffers, it too would go back to the federal government.

  • Judy Woodruff:

    And just quickly, Andy Slavitt, you're saying this money would go to the states.

    As you know, there's been some criticism of testing, people saying it actually should have been coordinated more at the federal level. But you're saying these things should be run at the state level?

  • Andy Slavitt:

    Well, there's a role for the federal government in all of these things, and there's a role for the state government.

    So, in testing, the federal government is the most efficient person to make sure that the supply chain works, to make sure that we have all of the materials we need, to make sure that states aren't fighting and creating bidding wars. That can't be done by the states themselves.

    But when it comes to actually administering the tests, those are localized activities. Likewise, contact tracing can get done at a local level. And, remember, we're not going to be all going through the same thing at the same time.

    So, New York — what New York went through, they would need contact tracers after that point. Other cities, other states, they may need them at different times.

    So, we think that this could be much more easily coordinated at the state level.

  • Judy Woodruff:

    And, finally, what are the prospects that the White House, President Trump, the administration, and the Congress are going to go along with all this?

  • Andy Slavitt:

    So, sent it to the White House this morning. And we have had some preliminary conversations.

    I think that the — that — it was really important to get people on the political right and the political left to agree on this proposal. So, we hashed out many of the issues that are going to, I think, cause potential concern for either party.

    I think the political right is going to focus on issues of civil liberty and making sure that people's freedoms aren't being violated. And, of course, they're going to want to make sure it's fiscally responsible.

    I think people on the left are going to care — have those concerns as well. And the people on the left are going to want to make sure that tests are equitably distributed, that they don't just go — we don't just do the testing and contact tracing for the well-off, but that it's — that it's more evenly split.

    So, those are some minor, minor differences that I think can be well worked out. This feels like a very bipartisan, problem-solving approach that the White House should embrace.

  • Judy Woodruff:

    Andy Slavitt explaining this proposal that was just made public today, thank you so much. We appreciate it.

  • Andy Slavitt:

    Thank you.

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