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      What’s In (and Not In) the $1.7 Trillion Spending Bill

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      A big boost for the military, more aid for Ukraine, a preference for the lobster industry over whales and an overhaul of the Electoral Count Act are among the provisions in the 4,155-page bill lawmakers expect to pass this week.WASHINGTON — Billions of dollars in emergency aid to war-torn Ukraine and communities ravaged by natural disasters. A bipartisan proposal to overhaul the archaic law at the heart of former President Donald J. Trump’s effort to overturn the 2020 election. And a divisive oceanic policy that will change federal protections for whales in an effort to protect the lobster industry in Maine.In compiling the roughly $1.7 trillion catchall spending package that will keep the government open through September, lawmakers inserted several new funding and legislative proposals to ensure their priorities and policies become law before the end of the year.It includes funding that will guarantee the enactment of policies first authorized in bipartisan legislation approved earlier in this Congress, including money for innovation hubs established in the semiconductor manufacturing law and projects in the infrastructure law. The package also includes a round of earmarks, rebranded as community project funding, that allow lawmakers to redirect funds to specific projects in their states and districts.Here is a look at some of the provisions that would go into effect if enacted.Military spending is the big winner.The Defense Department would see an extraordinary surge in spending when adding its regular 2023 fiscal year budget together with additional funds being allocated to help respond to the war in Ukraine.All together, half of the $1.7 trillion in funding included in the package goes to defense, or a total of $858 billion. It comes after lawmakers bucked a request from President Biden and approved a substantial increase in the annual defense policy bill passed this month.The 2023 budget just for the Defense Department would total $797.6 billion in discretionary spending — a 10 percent increase over last year’s budget — representing an extra $69.3 billion in funds for the Pentagon, which is $36.1 billion above the president’s budget request.Sprinkled throughout the spending bill are hundreds of high-ticket add-ons that Congress wants to make to the president’s original Defense Department budget, such as an additional $17.2 billion for procurement that the Pentagon can largely distribute to military contractors to buy new ships, airplanes, missile systems and other equipment. The overall Pentagon procurement budget with these additional funds would be $162 billion.One of the biggest chunks of that extra money is for shipbuilding — an extra $4 billion that brings the Navy’s overall shipbuilding budget to $31.96 billion. That will allow it to buy 11 new ships, including three guided missile destroyers and two attack submarines.But that is just the start. There is $8.5 billion to buy 61 F-35 fighter jets made by Lockheed Martin and another $2.5 billion to buy 15 of Boeing’s new aerial refueling planes known as KC-46 tankers.There is also an extra $27.9 billion to help cover Defense Department costs associated with the war in Ukraine, as part of an emergency aid package to the country. That includes an extra $11.88 billion to replenish U.S. stocks of equipment sent to Ukraine — money that again will largely be used to purchase products from military contractors. That supplemental appropriation also includes $9 billion to assist Ukraine with training, equipment and weapons, as well as an extra $6.98 billion to cover U.S. military operations in Europe.— Eric Lipton and John IsmayMaking it easier (for some) to save for retirement.The package also includes a collection of new rules aimed at helping Americans save for retirement. The bill would require employers to automatically enroll eligible employees in their 401(k) and 403(b) plans, setting aside at least 3 percent, but no more than 10 percent, of their paychecks. Contributions would be increased by one percentage point each year thereafter, until it reaches at least 10 percent (but not more than 15 percent). But this applies only to new employer-provided plans that are started in 2025 and later — existing plans are exempt.Another provision would help lower- and middle-income earners saving for retirement by making changes to an existing tax credit, called the saver’s credit, now available only to those who owe taxes. In its new form, it would amount to a matching contribution, from the federal government, deposited into taxpayers’ retirement accounts.People struggling with student debt would also receive a new perk: Employees making student debt payments would qualify for employer matching contributions in their workplace retirement plan, even if they were not making plan contributions of their own.What to Know About Congress’s Lame-Duck SessionCard 1 of 5A productive stretch. More

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      Biden’s Honeymoon Is Over, and He Knows It

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      The first seven months of the Biden presidency have been easy compared with what’s coming down the pike.Key provisions of Covid relief legislation came to an end on Aug. 1, with more set to follow — including a cessation of moratoriums on evictions and mortgage foreclosures, termination of extended unemployment benefits (which carried $300-a-week supplemental payments) and a stop to enhanced food stamp subsidies and student loan forbearance.The prospect of millions of families forced from their homes as Covid variants infect growing numbers of people provoked frenzied attempts by the White House and congressional Democrats to take emergency steps to halt or ameliorate the potential chaos and a possible tragedy of national proportions.On Tuesday, the Centers for Disease Control and Prevention ordered a 60-day freeze on evictions — although the order faces possible rejection by the courts.“Any call for a moratorium, based on the Supreme Court’s recent decision, is likely to face obstacles,” Biden told reporters, adding that the “bulk of the constitutional scholarship says that it’s not likely to pass constitutional muster.”In a June report, the Census Bureau found that 1,401,801 people 18 and older living in rental housing were “very likely” to be evicted and 2,248,120 were “somewhat likely.” In addition, 345,556 people were “very likely” to lose their homes through mortgage foreclosure, and 746,030 were “somewhat likely” to face foreclosure and the loss of their homes. The combined total was 4.7 million adults.The eviction crisis has come at a time when an additional series of potentially damaging developments have come to the fore.The rate of inflation has been rising at its fastest pace in over a decade — to 5.4 percent in June, from 1.4 percent in January when Biden took office, with no end in sight. The number of homicides grew by 25 percent from 2019 to 2020, and the 2021 rate, 6.2 homicides per 100,000 residents, is on track to become, according to The Washington Post, “the highest recorded in the United States in more than 20 years.”The number of illegal border crossings has more than doubled during Biden’s seven months in office, raising the potential for immigration to become a central campaign issue once again, both next year and in 2024.U.S. Customs and Border Protection reported that in June of this year the enforcement agency “encountered 188,829 persons attempting entry along the Southwest Border,” a 142 percent increase from the 78,000 in January 2021 when Biden assumed the presidency.As the 2022 and 2024 elections get closer, Biden is in a race to keep public attention on policies and initiatives favorable to the Democratic Party and its candidates against the continuing threat that inflation, crime, urban disorder and illegal immigration — all issues that favor the Republican Party — take center stage.The danger for Biden if crime and immigration become a primary focus of public attention is clear in polling data. The RealClearPolitics average of the eight most recent polls shows Biden’s favorability at plus 7.5 points (51.1 positive and 43.6 negative) and that the public generally approves of his handling of the Covid pandemic, of jobs, of the economy and of the environment.Regarding Biden’s handling of crime and immigration, however, the numbers go negative. In the July 17-20 Economist/YouGov Poll, 38 percent of voters approved of his handling of crime, and 45 percent disapproved. In the Economist/YouGov poll taken a week later, Biden’s numbers on immigration were worse: 35 approving, 50 disapproving.The Biden administration has initiated a set of programs designed to “stem the flow of guns into the hands of those responsible for violence” — the centerpiece of its anti-crime program — but the Economist/YouGov poll found in its July 24-27 survey that 30 percent of voters approve of Biden’s handling of gun issues while 48 percent disapproveWhat does this all portend? Bruce Cain, a political scientist at Stanford, replied by email to my inquiry:The Biden administration has done a good job so far avoiding hard-to-defend, controversial positions on Republican hot button issues. That is really all they need to do. It is more likely that Covid and economic conditions will matter more in determining the Democratic Party’s fate in November.Cain argues thatthe best defense for the Democrats is to go on the offense in 2022 and remind voters about who Trump is and what the Republican Party has become. The resistance to supporting vaccination among Trumpist Republican officials could hurt the party’s national image substantially in 2022 if the unvaccinated are to blame for our inability to put this issue behind us.Sean Westwood, a political scientist at Dartmouth, has a very different take. In an email he wrote:The Democrats have lost a great deal of credibility when it comes to crime and policing by thoughtlessly adopting slogans like ‘defund the police’ without considering what the phrase means, how policies based on the idea might lead to surges in crime, or how the slogan might backfire in the face of rising crime and lawlessness.Biden, Westwood continued,was smart to distance himself from these factions, but many of those he needs in Congress and in state houses have been much less careful. Without a serious repositioning on criminal justice policies, the Democrats face the midterms with a gaping self-inflicted wound.Biden received a lift last week in keeping a bread-and-butter agenda front and center from an unexpected source, Mitch McConnell, the Senate minority leader. McConnell abandoned his Dr. No stance toward all things Democratic and joined 16 fellow Republicans in support of a key motion to take up a $1 trillion infrastructure spending bill. If enacted into law, the measure would legitimize Biden’s claim that he is capable of restoring a semblance of bipartisanship in the nation’s capital.McConnell has not fully explained his political reasoning, but his tactical shift suggests that he thinks the wind remains at Biden’s back, making the Republican strategy of destruction a much riskier proposition, at least for the moment.Early indicators suggest that in some ways Biden has yet to face the kind of voter opposition that characterized the administrations of his predecessors from both parties at this stage in their presidencies.Matt Grossmann, a political scientist at Michigan State, tweeted on Aug. 2:Still no sign of strong grassroots or conservative media opposition focused on Biden or congressional agenda At this point in Obama admin, it was clear August congressional recess would be full of boisterous town halls. Infrastructure doesn’t get base animated.Similarly, G. Elliott Morris, a data journalist for The Economist, wrote on Aug. 1 that there is a long-term “trend by which the people react in a thermostatic manner against the party in power,” with the public mood shifting to the right during Democratic presidencies and to the left during Republican presidencies.So far during the Biden presidency, Morris wrote, the expected tilt toward conservatism has not materialized:Where we go from here is a big question. As stated, the thermostatic model would predict a reversion in 2021 in the conservative direction. But the issue remains open; the public has not appeared very thermostatic on, say, immigration policy over the last year, and their demand for public spending is still very high.The trickiest issues facing the Biden administration are crime and urban disorder because these are issues that play to the advantage of conservatives, who have demonstrated expertise in weaponizing them.The June 29-July 6 USA Today/Ipsos poll found that “concerns about crime and gun violence have surged to the top of issues that worry Americans” and, in an ominous note for the Biden administration,Crime and public safety is the issue on which the Republican Party now holds its strongest advantage. By 32 percent to 24 percent, those polled said the G.O.P. was better at handling crime.There is considerable disagreement over the optimal strategy for Democrats to adopt when addressing crime — along with widespread concern over the party’s credibility on the issue itself.Rebecca Goldstein, a law professor at the University of California, Berkeley, emailed to say that she believes “the Biden Administration has correctly read the political winds by doubling the amount they are requesting for police hiring grants in 2022 compared to the 2021 appropriation, and also requesting eight-figure sums for police training and body-worn cameras.”These initiatives, Goldstein continued, are “not the outcome that any of last summer’s activists would have wanted. But the Biden Administration has realized that some of those proposals, particularly defunding or abolishing police agencies, were politically dead on arrival.”The crucial question, in Goldstein’s view, iswhether the administration will be able to convincingly advertise its support for police, and for police oversight and reform, while neither alienating some of the activists who mobilized to help Biden win in 2020 and might be put off from putting in the same sweat equity in 2022 or 2024, nor succumbing to the longstanding critique from the right that Democrats are “soft on crime.” This is a tightrope that even the most skilled politician might not be able to walk.Stanley Feldman, a political scientist at Stony Brook University, argued in an email that trying to engage voters on crime and other issues that have worked to the advantage of the Republican Party in the past is a fool’s errand:The Democratic Party has been losing voters who want economic benefits from the federal government but who are supporting Republican candidates because of their conservative positions on social and cultural issues. Biden can’t win back voters by engaging on these issues. Any positions he takes will raise the salience of these issues and that’s not helpful for him.Crime and policing, Feldman noted,are largely local concerns. Immigration is a potential minefield so the best he can do is to try to keep it from becoming a major media story. Given his limited options, any attempt to address these concerns would just give Republicans an opportunity to portray him in an unfavorable light. Providing concrete economic benefits to people while reducing the volume on social/cultural issues is the best way forward in 2022 and 2024.Aaron Chalfin, a professor of criminology at the University of Pennsylvania, agrees that engaging the debate over crime is inherently risky for Democrats:In my view, the political liabilities for the Democrats are probably fairly substantial. The surge in violence is rapid and has reversed 20 years of progress in just 18 short months. While I think the cause of the violence has little to do with Democratic political priorities at the national level, it seems likely that the Democrats will be held to account given the rhetoric around “Defund” that is associated with the left wing of the party.Lawrence Sherman, director of the Cambridge Center for Evidence-Based Policing at the University of Cambridge, agrees that “the greatest threat to Biden on policing and disorder comes from the left,” but he differs from some of his colleagues in arguing that Biden should take the issues of crime and urban dysfunction head on.Sherman contends that public anxieties over crime are just one part of a larger, more comprehensive “fear of chaos.” In that more expansive context, Sherman continued, Biden has strengthened his credentials as an adversary of disorder through his workon Covid and the economy, for which his competence grows more impressive daily in comparison to Trump’s. Climate change will also become a bigger issue (favoring Biden) for the swing vote, with smoke, heat and floods proving more scary than an unprecedented spike in murders. In a politics of fear, the targets of fear become identified with different candidates, and Biden’s fears now seem paramount: Covid, Climate and Chaos.Trump’s actions leading up to and during the Jan. 6 assault on the Capitol by Trump loyalists seeking to disrupt the vote count have opened the door for Biden to take the initiative on law and order and, in doing so, to counter the image of the Democratic Party as soft on crime, Sherman argued:“After what Trump did on Jan. 6, Biden has been able to stress his own historic support for the police as emblematic of his opposition to chaos,” Sherman wrote in an email:The “defund the police” movement probably did help to lose Dem seats in the House in 2020, and may increasingly be blamed for the huge spike in violent crime. But as long as Biden remains strong in his position that policing “works” to prevent crime, and that it is essential to saving Black lives, he will attract the suburban swing vote.Biden should take the initiative, Sherman argues, with “a major policing initiative,” and that initiative should stress “hot spots policing,” the focusing of police resources on small sections of urban areas, “under 5 percent of land in most cities,” while “pulling way back on stop and frisk everywhere else, especially suburban traffic stops, like the late Sandra Bland.”Biden goes into battle with one crucial advantage: He, his appointees and his advisers have more experience in the trenches of elections, legislative fights and bureaucratic maneuvering than the top personnel of any recent administration.On the other hand, if what his voters need is equality — that is, resource redistribution — experienced advisers may not be enough.Mart Trasberg and Hector Bahamonde, of Wake Forest University and the Universidad de O’Higgins in Chile, authors of “Inclusive institutions, unequal outcomes: Democracy, state capacity, and income inequality,” pointed out in an email that redistribution is exceptionally hard to achieve in an advanced democracy like the one in operation in the United States:The increase in inequality through market processes puts pressure on fiscal policy, making it difficult to increase redistribution via taxes and transfers. With increasing foreign investment flows and more developed financial sectors, domestic and international corporate and financial elites become stronger actors in domestic politics. Given that these changes are slow-moving and incremental, disorganized voters are not able to vote for a higher taxation of income-concentrating elites. Of course, other mechanisms are likely at play: political elites trick voters to vote on identity issues that do not concern socio-economic redistribution.In the end, much of the dynamism that powers today’s political competition comes back to — or down to — racial and cultural conflict. Can Biden find a redistributive workaround — and protect voting rights at the same time? The fate of the Democratic Party depends on it.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      The Trump Books Are Coming. Cue the War of the Excerpts.

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      As a handful of authors compete to recount President Donald J. Trump’s last year in office, Twitter is strewn with vividly reported snapshots of a monumental year in American history.WASHINGTON — The capital was just beginning to quiet down for the summer when the buzz over the books began: Several seeking to explain the final year of Donald J. Trump’s presidency are landing so closely together over the next month that publishers have hastily changed publication days to avoid mid-scoop collisions.It’s enough to give an author nightmares.“I literally just wake up every day waiting to find out that someone else has jumped in front of us, and some book that I had no idea was coming is going to be announced,” Michael C. Bender, the author of “Frankly, We Did Win This Election: The Inside Story of How Trump Lost,” said in an interview.Really, it is not the most unfounded fear. Mr. Bender is a reporter for The Wall Street Journal. “Frankly,” his first book, will be published on July 13. But he fast-tracked its publication, originally slated for August, after his publisher snooped on Amazon and uncovered the release dates of two other Trump-related books this summer: “Landslide: The Final Days of the Trump Presidency,” by Michael Wolff, and “I Alone Can Fix It: Donald J. Trump’s Catastrophic Final Year,” by Carol Leonnig and Philip Rucker, Pulitzer Prize-winning reporters at The Washington Post.What has ensued is a war of excerpts among writers who are realizing their juiciest material may not hold. Twitter is now strewn with the most unsettling moments from Mr. Trump’s last year in office. Vividly reported snapshots of a monumental year in American history are proliferating like cicada shells on city pavement.Mr. Bender’s book, in excerpts shared with CNN, Vanity Fair, Axios, The Daily Mail and others, lays bare the leadership failures of Mr. Trump and his team. “Frankly” is full of expletive-laden interactions, including one particularly colorful exchange between Gen. Mark A. Milley, the chairman of the Joint Chiefs of Staff, and Mr. Trump’s immigration adviser, Stephen Miller, over the protests that roiled the country last summer.The drip-drip of material is the extreme version of a commonplace promotion strategy, intended to get Mr. Bender, a lesser-known writer than some of his competitors, maximum publicity. But others seeking to claim their territory are aggressively following suit: Jonathan Karl of ABC News, whose book does not come out until later this year, published his own excerpt in recent days in The Atlantic.David Kuhn, a literary agent at Aevitas Creative Management, said the cascade of Trump books could end up “cannibalizing each other.”“There’s so many different planets that have to align for a book to truly break out,” he said.But the reporters are betting frequent promotion in a crowded market will improve their fortunes.An excerpt from Michael Wolff’s “Landslide,” which will be published on July 27, is the cover story for New York magazine, and outlines a scene in which Mr. Trump told his chief of staff, Mark Meadows, that he “didn’t mean it literally” that his supporters should march to the Capitol on Jan. 6.And more details of Mr. Trump’s illness from the coronavirus were shared before the publication on Tuesday of “Nightmare Scenario: Inside the Trump Administration’s Response to the Pandemic That Changed History,” by Damian Paletta and Yasmeen Abutaleb, journalists for The Post.Mr. Trump has invited some of the authors of books on his presidency to Mar-a-Lago, his estate in Palm Beach, Fla., more than once.T.J. Kirkpatrick for The New York TimesIn their book, Mr. Paletta and Ms. Abutaleb present gripping evidence that Mr. Trump received a strong cocktail of drugs — “Trump’s doctors threw everything they could at the virus all at once,” they write. Robert R. Redfield, then the director of the Centers for Disease Control and Prevention, had prayed that a serious bout with the coronavirus would change Mr. Trump’s response to the pandemic. It did not.“Nightmare Scenario” is focused on the federal government’s handling of the coronavirus — Ms. Abutaleb and Mr. Paletta do not examine the events of Jan. 6, for instance, and they did not interview Mr. Trump. Still, so many reporters covering the same material at the same time made for a crowded reporting process.“We definitely would hear from sources that they had gotten calls from other reporters,” Mr. Paletta said in an interview. “That was quite intimidating for us.”Some of the more decorated reporters in Washington’s press corps have chosen silence as a strategy as they complete books scheduled to be published this year.Little is known about when Bob Woodward and Robert Costa of The Washington Post may publish their book on Mr. Trump’s final days, but the best guess from agents and authors alike is that it will be in September. (Neither author replied to requests for comment.)The list of summer releases does not include titles coming next year from reporters for The New York Times. Peter Baker, the chief White House correspondent, is working on a definitive account of the Trump presidency with his wife, Susan Glasser of The New Yorker. Maggie Haberman, a former Trump White House reporter and current Washington correspondent for The Times, is also working on a book about Mr. Trump. Jonathan Martin and Alex Burns, national political correspondents, are writing a book on the presidential race between Mr. Trump and Joseph R. Biden Jr., and Jeremy Peters, who covers the Republican Party for The Times, is working on a book that assesses the G.O.P.’s attempts to wrangle Mr. Trump.Mark Leibovich, a political correspondent for The Times, is working on a sequel to “This Town,” a book on Washington culture, that will touch on the Trump era.At the center of the publishing frenzy is the subject himself. Aware of the barrage of books about his presidency and lacking a book deal that could give his grievances another formal platform, Mr. Trump has tried a charm offensive. He has invited some writers to Mar-a-Lago, his estate in Palm Beach, Fla., more than once, serving them steak and seating them in his estate’s great room, where the visiting journalists can be part of the political pageant that happens there each night.Mr. Trump, who keenly understands his own place in the news media ecosystem, has turned down only a few interview requests, including one from Mr. Woodward. Mr. Woodward’s 2020 book, “Rage,” included several interviews with Mr. Trump, who told Mr. Woodward he had downplayed the threat of the coronavirus pandemic.But Mr. Trump has quizzed other visiting journalists on the people they are talking to, the questions they are going to ask and the stories they plan to tell about his presidency.“We were really surprised by how much time he spent talking to us,” Mr. Rucker said. “And by, frankly, how interested he was in our book and the subjects we were covering. He very much wanted to be a part of trying to shape the historical narrative of his presidency.”(Given Mr. Trump’s history with reading books — he does not read them — Mr. Rucker does not expect that the former president will provide a full review.)As Mr. Bender readied another excerpt for publication — this time detailing the long-running animosity that existed between Kellyanne Conway, Mr. Trump’s counselor, and his son-in-law, Jared Kushner — he said Tuesday evening that the breakneck pace with which he has written and promoted his book mirrored the hectic nature of four years on the Trump beat.“When this is all done I want to ask my publisher how this is supposed to work,” Mr. Bender said. “Nothing about this has felt normal. Which is kind of the experience of covering Donald Trump in a nutshell.” More

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      White House Considers Lifting Rule That Blocked Migrants During Pandemic

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      Among the plans under consideration is whether to give migrant families a chance to apply for protections, and to possibly lifting the public health rule for single adults this summer.WASHINGTON — The Biden administration is in the later stages of planning how to phase out a Trump-era public health rule that has allowed border agents to rapidly turn away most migrants who have arrived at the southern border during the pandemic, according to two administration officials. It is possible that in the coming weeks, border officials could start allowing migrant families back into the country, with an eye toward lifting the rule for single adults this summer.The plan, while still not final, is sure to ​complicate an already thorny issue for President Biden and Vice President Kamala Harris, who is visiting the border on Friday as Republicans accuse the administration of being slow to address what they describe as an unrelenting surge of migrants trying to enter the country. Lifting the rule will only exacerbate that.Since the beginning of the pandemic, border agents have turned away migrants nearly 850,000 times under the public health rule, known as Title 42, which immigration and human rights advocates call unnecessary and cruel, particularly for those seeking asylum. Migrant families have been turned away more than 80,000 times since the rule was put in place in March 2020, according to government data.The White House has deflected questions about how much longer the rule will remain in place, saying it is up to the Centers for Disease Control and Prevention, which issued the policy. An agency spokeswoman referred questions about the rule to the White House.Mr. Biden, who has promised a more humane approach to immigration enforcement, decided not to continue the Trump administration’s policy of expelling children who arrived alone at the border. Single adults and many families, however, have continued to be turned away because of the public health rule, whose stated purpose is to prevent the coronavirus from spreading at points of entry or Border Patrol stations. Still, some migrant families have been allowed into the United States because Mexico or their home countries refuse to take them back.Despite the measured approach, lifting the rule — which many public health experts say has little point this late in the pandemic — is likely to sharply increase the flow of migrants, at least in the short term. That would force Mr. Biden to address the issue without compromising his pledge to take a more compassionate approach to enforcing immigration laws.Plans to lift the rule have been under discussion for weeks, but there appears to be a fresh sense of urgency; officials familiar with the evolving plan shared details with The New York Times on the condition of anonymity because they were not authorized to discuss it. Axios earlier reported some of the details.For migrant families, the officials said, one idea under consideration is to put those seeking asylum into one of Immigration and Customs Enforcement’s alternatives to detention. That includes having them wear ankle bracelets as their request makes its way through the immigration system, a process that can take years because of a chronic backlog of cases. The administration has already been doing this for other migrant families this year.The administration is considering placing families who do not make asylum claims in the queue for expedited removal, a process that allows immigration officers to deport people without a hearing, a lawyer or a right of appeal in some cases.One official familiar with the plans said that all the ideas under consideration included health and safety measures to avoid the spread of the virus.Lifting the public health rule for single adults is likely to come later, according to the most recent discussions, possibly by the end of the summer. Single adults have been barred from entering the country more than 262,000 times since the rule went into effect. The administration is still debating where these migrants would go once they enter the country, including whether to place them in expedited removal or in home detention so as to avoid a detention center, as Mr. Biden campaigned against mass incarceration of undocumented immigrants.Representative Henry Cuellar of Texas, a senior Democrat on the House Appropriations Subcommittee on Homeland Security, said border officials had been bracing for an end to the public health rule and other pandemic restrictions, including a ban on nonessential cross-border commercial traffic that was recently extended until July 21.President Biden has promised a more humane approach to immigration enforcement and started to allow children who arrived alone at the border to enter the country.Pete Marovich for The New York Times“That could be, according to them, ‘a perfect storm,’ because all of a sudden all those people will be coming into the U.S.,” Mr. Cuellar said.The Biden administration is trying to avoid just such a storm with a phased-in approach.Another challenge for the administration is that detention centers overseen by Immigration and Customs Enforcement are filling up, holding nearly 27,000 as of Thursday. That is a 90 percent jump compared with the average number of detainees in March, according to government data. If the administration lifts the health rule entirely, it would face the question of where to house the migrants, caught between significantly increasing the number of detained immigrants and releasing everyone to wait for court proceedings.Lifting the public health rule for families, though, will make it hard for the administration to defend keeping it in place for single adults.“This piecemeal approach doesn’t cut it,” said Denise Bell, a researcher for Amnesty International’s refugee and migrant rights program. “How many carve-outs until you have to admit there is no good public health rationale for Title 42?”Lifting the public health rule could lead to some bottlenecks along the border, but it could also ease pressure on the Department of Health and Human Services, which is overseeing the care of unaccompanied migrant children who have been arriving in record numbers.As of Thursday, about 14,500 such children were being held in government shelters, according to internal government data obtained by The Times, as officials try to place them with family members or other sponsors in the United States. Nearly half of the children are staying in emergency shelters where some conditions are far below government standards; the average stay is currently 37 days.“When families were pushed back, sometimes they’d make that extraordinarily difficult choice to send their child ahead, with the hope that as an unaccompanied child migrating alone, they’d have a better chance of being accepted and processed through,” said Wendy Young, the president of a nonprofit, Kids in Need of Defense. “It’s a horrible choice that families have to make, but we did see families doing exactly that.”Without the public health rule, families may again start trying to cross the border together — a better option, Ms. Young said, than being placed in the large emergency shelters overseen by the health and human services department.Ms. Harris, who will travel to El Paso on Friday with Alejandro N. Mayorkas, the homeland security secretary, is leading the administration’s efforts to help improve conditions in Central America, where many of the children are coming from, to deter migration.For weeks, Republicans have pressed Ms. Harris about why she traveled to Central America this month, but not to the American side of the border with Mexico. Her visit comes just days before Mr. Trump goes to the border with a group of Republicans, including Gov. Greg Abbott of Texas, who has pledged to finish Mr. Trump’s border wall in his state after Mr. Biden halted construction. Mr. Abbott has also threatened to kick thousands of migrant children out of shelters there. More

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      In Trump’s Final Chapter, a Failure to Rise to the Covid-19 Moment

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      #masthead-section-label, #masthead-bar-one { display: none }Covid-19 VaccinesVaccine QuestionsDoses Per StateAfter Your VaccineHow the Moderna Vaccine WorksWhy You’ll Still Need a MaskAdvertisementContinue reading the main storySupported byContinue reading the main story‘Covid, Covid, Covid’: In Trump’s Final Chapter, a Failure to Rise to the MomentAs the U.S. confronted a new wave of infection and death through the summer and fall, the president’s approach to the pandemic came down to a single question: What would it mean for him?President Trump not only ended up soundly defeated by Joseph R. Biden Jr., but missed his chance to show that he could meet the defining challenge of his tenure.Credit…Doug Mills/The New York TimesMichael D. Shear, Maggie Haberman, Noah Weiland, Sharon LaFraniere and Dec. 31, 2020Updated 9:57 p.m. ETWASHINGTON — It was a warm summer Wednesday, Election Day was looming and President Trump was even angrier than usual at the relentless focus on the coronavirus pandemic.“You’re killing me! This whole thing is! We’ve got all the damn cases,” Mr. Trump yelled at Jared Kushner, his son-in-law and senior adviser, during a gathering of top aides in the Oval Office on Aug. 19. “I want to do what Mexico does. They don’t give you a test till you get to the emergency room and you’re vomiting.”Mexico’s record in fighting the virus was hardly one for the United States to emulate. But the president had long seen testing not as a vital way to track and contain the pandemic but as a mechanism for making him look bad by driving up the number of known cases.And on that day he was especially furious after being informed by Dr. Francis S. Collins, the head of the National Institutes of Health, that it would be days before the government could give emergency approval to the use of convalescent plasma as a treatment, something Mr. Trump was eager to promote as a personal victory going into the Republican National Convention the following week.“They’re Democrats! They’re against me!” he said, convinced that the government’s top doctors and scientists were conspiring to undermine him. “They want to wait!”Throughout late summer and fall, in the heat of a re-election campaign that he would go on to lose, and in the face of mounting evidence of a surge in infections and deaths far worse than in the spring, Mr. Trump’s management of the crisis — unsteady, unscientific and colored by politics all year — was in effect reduced to a single question: What would it mean for him?The result, according to interviews with more than two dozen current and former administration officials and others in contact with the White House, was a lose-lose situation. Mr. Trump not only ended up soundly defeated by Joseph R. Biden Jr., but missed his chance to show that he could rise to the moment in the final chapter of his presidency and meet the defining challenge of his tenure.Efforts by his aides to persuade him to promote mask wearing, among the simplest and most effective ways to curb the spread of the disease, were derailed by his conviction that his political base would rebel against anything that would smack of limiting their personal freedom. Even his own campaign’s polling data to the contrary could not sway him.His explicit demand for a vaccine by Election Day — a push that came to a head in a contentious Oval Office meeting with top health aides in late September — became a misguided substitute for warning the nation that failure to adhere to social distancing and other mitigation efforts would contribute to a slow-rolling disaster this winter.His concern? That the man he called “Sleepy Joe” Biden, who was leading him in the polls, would get credit for a vaccine, not him.The government’s public health experts were all but silenced by the arrival in August of Dr. Scott W. Atlas, the Stanford professor of neuroradiology recruited after appearances on Fox News.With Dr. Deborah L. Birx, the coordinator of the White House virus task force, losing influence and often on the road, Dr. Atlas became the sole doctor Mr. Trump listened to. His theories, some of which scientists viewed as bordering on the crackpot, were exactly what the president wanted to hear: The virus is overblown, the number of deaths is exaggerated, testing is overrated, lockdowns do more harm than good.The president has long seen testing not as a vital way to track and contain the pandemic but as a mechanism for making him look bad by driving up the number of known cases.Credit…William DeShazer for The New York TimesAs the gap between politics and science grew, the infighting that Mr. Trump had allowed to plague the administration’s response from the beginning only intensified. Threats of firings worsened the leadership vacuum as key figures undercut each other and distanced themselves from responsibility.The administration had some positive stories to tell. Mr. Trump’s vaccine development program, Operation Warp Speed, had helped drive the pharmaceutical industry’s remarkably fast progress in developing several promising approaches. By the end of the year, two highly effective vaccines would be approved for emergency use, providing hope for 2021.The White House rejected any suggestions that the president’s response had fallen short, saying he had worked to provide adequate testing, protective equipment and hospital capacity and that the vaccine development program had succeeded in record time.“President Trump has led the largest mobilization of the public and private sectors since WWII to defeat Covid-19 and save lives,” said Brian Morgenstern, a White House spokesman.But Mr. Trump’s unwillingness to put aside his political self-centeredness as Americans died by the thousands each day or to embrace the steps necessary to deal with the crisis remains confounding even to some administration officials. “Making masks a culture war issue was the dumbest thing imaginable,” one former senior adviser said.His own bout with Covid-19 in early October left him extremely ill and dependent on care and drugs not available to most Americans, including a still-experimental monoclonal antibody treatment, and he saw firsthand how the disease coursed through the White House and some of his close allies.Yet his instinct was to treat that experience not as a learning moment or an opportunity for empathy, but as a chance to portray himself as a Superman who had vanquished the disease. His own experience to the contrary, he assured a crowd at the White House just a week after his hospitalization, “It’s going to disappear; it is disappearing.”Weeks after his own recovery, he would still complain about the nation’s preoccupation with the pandemic.“All you hear is Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid,” Mr. Trump said at one campaign stop, uttering the word 11 times.In the end he could not escape it.Supporters of Mr. Trump outside Walter Reed National Military Medical Center, where he was treated for the coronavirus, in October. He largely rejected aides’ efforts to use his bout with the illness to demonstrate a new compassion.Credit…Oliver Contreras for The New York Times‘The Base Will Revolt’By late July, new cases were at record highs, defying Mr. Trump’s predictions through the spring that the virus was under control, and deaths were spiking to alarming levels. Herman Cain, a 2012 Republican presidential candidate, died from the coronavirus; the previous month he had attended a Trump rally without a mask.With the pandemic defining the campaign despite Mr. Trump’s efforts to make it about law and order, Tony Fabrizio, the president’s main pollster, came to the Oval Office for a meeting in the middle of the summer prepared to make a surprising case: that mask wearing was acceptable even among Mr. Trump’s supporters.Arrayed in front of the Resolute Desk, Mr. Trump’s advisers listened as Mr. Fabrizio presented the numbers. According to his research, some of which was reported by The Washington Post, voters believed the pandemic was bad and getting worse, they were more concerned about getting sick than about the virus’s effects on their personal financial situation, the president’s approval rating on handling the pandemic had hit new lows and a little more than half the country did not think he was taking the situation seriously.But what set off debate that day was Mr. Fabrizio’s finding that more than 70 percent of voters in the states being targeted by the campaign supported mandatory mask wearing in public, at least indoors, including a majority of Republicans.Mr. Kushner, who along with Hope Hicks, another top adviser, had been trying for months to convince Mr. Trump that masks could be portrayed as the key to regaining freedom to go safely to a restaurant or a sporting event, called embracing mask-wearing a “no-brainer.”Mr. Kushner had some reason for optimism. Mr. Trump had agreed to wear one not long before for a visit to Walter Reed National Military Medical Center, after finding one he believed he looked good in: dark blue, with a presidential seal.But Mark Meadows, the White House chief of staff — backed up by other aides including Stephen Miller — said the politics for Mr. Trump would be devastating.“The base will revolt,” Mr. Meadows said, adding that he was not sure Mr. Trump could legally make it happen in any case.The president removed his mask upon arriving at the White House on Oct. 5, after being hospitalized with Covid-19. He was rarely seen wearing one again.Credit…Anna Moneymaker for The New York TimesThat was all Mr. Trump needed to hear. “I’m not doing a mask mandate,” he concluded.Aside from when he was sick, he was rarely seen in a mask again.The president had other opportunities to show leadership rather than put his political fortunes first..css-fk3g7a{font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:0.875rem;line-height:1.125rem;color:#121212 !important;}@media (min-width:740px){.css-fk3g7a{font-size:0.9375rem;line-height:1.25rem;}}.css-1sjr751{-webkit-text-decoration:none;text-decoration:none;}.css-1sjr751 a:hover{border-bottom:1px solid #dcdcdc;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-zs9392{margin:10px auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-zs9392{font-size:1.25rem;line-height:1.4375rem;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.75rem;margin-bottom:20px;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-size:1.5rem;line-height:1.875rem;}}.css-121grtr{margin:0 auto 10px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-qmg6q8{background-color:white;margin:1.5rem auto 1.9rem;max-width:600px;}#NYT_BELOW_MAIN_CONTENT_REGION .css-qmg6q8{padding:0;width:calc(100% – 40px);max-width:600px;margin-right:auto;margin-left:auto;}.css-qmg6q8 strong{font-weight:700;}.css-qmg6q8 em{font-style:italic;}@media (min-width:740px){.css-qmg6q8{margin:40px auto;}}.css-qmg6q8:focus{outline:1px solid #e2e2e2;}.css-qmg6q8 a{color:#326891;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ccd9e3;}.css-qmg6q8 a:visited{color:#333;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ddd;}.css-qmg6q8 a:hover{border-bottom:none;}.css-qmg6q8[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-qmg6q8[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-qmg6q8[data-truncated] .css-5gimkt:after{content:’See more’;}.css-qmg6q8[data-truncated] .css-6mllg9{opacity:1;}.css-11uwurf{border:1px solid #e2e2e2;padding:15px;border-radius:0;margin:0 auto;overflow:hidden;}@media (min-width:600px){.css-11uwurf{padding:20px;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-11uwurf{border-top:1px solid #121212;border-bottom:none;}Covid-19 Vaccines ›Answers to Your Vaccine QuestionsWith distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.After he recovered from his bout with the virus, some of his top aides, including Mr. Kushner and Jason Miller, a senior campaign strategist, thought the illness offered an opportunity to demonstrate the kind of compassion and resolve about the pandemic’s toll that Mr. Trump had so far failed to show.When Mr. Trump returned from the hospital, his communications aides, with the help of Ivanka Trump, his daughter, urged him to deliver a national address in which he would say: “I had it. It was tough, it kicked my ass, but we’re going to get through it.”He refused, choosing instead to address a boisterous campaign rally for himself from the balcony of the White House overlooking the South Lawn.Mr. Trump never came around to the idea that he had a responsibility to be a role model, much less that his leadership role might require him to publicly acknowledge hard truths about the virus — or even to stop insisting that the issue was not a rampaging pandemic but too much testing.Alex M. Azar II, the health and human services secretary, briefed the president this fall on a Japanese study documenting the effectiveness of face masks, telling him: “We have the proof. They work.” But the president resisted, criticizing Mr. Kushner for pushing them and again blaming too much testing — an area Mr. Kushner had been helping to oversee — for his problems.“I’m going to lose,” Mr. Trump told Mr. Kushner during debate preparations. “And it’s going to be your fault, because of the testing.”Mr. Morgenstern, the White House spokesman, said that exchange between the president and Mr. Kushner “never happened.”Mr. Azar, who was sometimes one of the few people wearing a mask at White House events, privately bemoaned what he called a political, anti-mask culture set by Mr. Trump. At White House Christmas parties, Mr. Azar asked maskless guests to back away from him.Dr. Stephen M. Hahn, center, the commissioner of the Food and Drug Administration, Dr. Deborah L. Birx, the coordinator of the White House virus task force, and Alex M. Azar II, the secretary of health and human services, in the Oval Office in May. Conflicts on the president’s team only intensified as the year went on.Credit…Erin Schaff/The New York TimesDivisions and DisagreementsThe decision to run the government’s response out of the West Wing was made in the early days of the pandemic. The idea was to break down barriers between disparate agencies, assemble public health expertise and encourage quick and coordinated decision-making.It did not work out like that, and by fall the consequences were clear.Mr. Trump had always tolerated if not encouraged clashes among subordinates, a tendency that in this case led only to policy paralysis, confusion about who was in charge and a lack of a clear, consistent message about how to reduce the risks from the pandemic.Keeping decision-making power close to him was another Trump trait, but in this case it also elevated the myriad choices facing the administration to the presidential level, bogging the process down in infighting, raising the political stakes and encouraging aides to jockey for favor with Mr. Trump.The result at times was a systemwide failure that extended well beyond the president.“What we needed was a coordinated response that involved contributions from multiple agencies,” said Dr. Scott Gottlieb, who was commissioner of the Food and Drug Administration for the first two years of the Trump administration.“Someone needed to pull that all together early,” he said. “It wasn’t the job of the White House, either. This needed to happen closer to the agencies. That didn’t happen on testing, or on a whole lot of other things.”The relationship between Mr. Azar and Dr. Stephen M. Hahn, the commissioner of the Food and Drug Administration, grew increasingly tense; by early November, they were communicating only by text and in meetings.Dr. Birx had lost the clout she enjoyed early on in the crisis and spent much of the summer and fall on the road counseling governors and state health officials.Mr. Meadows was at odds with almost everyone as he sought to impose the president’s will on scientists and public health professionals. In conversations with top health officials, Mr. Meadows would rail against regulatory “bureaucrats” he thought were more interested in process than outcome.Some of the doctors on the task force, including Dr. Anthony S. Fauci and Dr. Robert R. Redfield, were reluctant to show up in person at the White House, worried that the disdain there for mask wearing and social distancing would leave them at risk of infection.Vice President Mike Pence was nominally in charge of the task force but was so cautious about getting crosswise with Mr. Trump as they battled for re-election that, in public at least, he became nearly invisible.The debates inside the White House increasingly revolved around Dr. Atlas, who had no formal training in infectious diseases but whose views — which Mr. Trump saw him deliver on Fox News — appealed to the president’s belief that the crisis was overblown.Dr. Scott W. Atlas, the Stanford professor of neuroradiology recruited after appearances on Fox News, became the sole doctor Mr. Trump listened to.Credit…Anna Moneymaker for The New York TimesHis arrival at 1600 Pennsylvania Avenue was itself something of a mystery. Some aides said he was discovered by Kayleigh McEnany, the White House press secretary. Others said John McEntee, the president’s personnel chief, had been Googling for a Trump-friendly doctor who would be loyal.Marc Short, Mr. Pence’s chief of staff, opposed hiring Dr. Atlas. But once the president and his team brought him in, Mr. Short insisted that Dr. Atlas have a seat at the task force table, hoping to avoid having him become yet another internal — and destructive — critic.Once inside, Dr. Atlas used the perch of a West Wing office to shape the response. During a meeting in early fall, Dr. Atlas asserted that college students were at no risk from the virus. We should let them go back to school, he said. It’s not a problem.Dr. Birx exploded. What aspect of the fact that you can be asymptomatic and still spread it do you not understand? she demanded. You might not die, but you can give it to somebody who can die from it. She was livid.“Your strategy is literally going to cost us lives,” she yelled at Dr. Atlas. She attacked Dr. Atlas’s ideas in daily emails she sent to senior officials. And she was mindful of a pact she had made with Dr. Hahn, Dr. Fauci and Dr. Redfield even before Dr. Atlas came on board: They would stick together if one of them was fired for doing what they considered the right thing.Health officials often had a hard time finding an audience in the upper reaches of the West Wing. In a mid-November task force meeting, they issued a dire warning to Mr. Meadows about the looming surge in cases set to devastate the country. Mr. Meadows demanded data to back up their claim.One outcome of the meeting was a Nov. 19 news conference on the virus’s dire threat, the first in many weeks. But while Mr. Pence, who led the briefing, often urged Americans to “do their part” to slow the spread of the virus, he never directly challenged Mr. Trump’s hesitancy on masks and social distancing. At the briefing, he said that “decision making at the local level” was key, continuing a long pattern of the administration seeking to push responsibility to the states.Mr. Azar had been cut out of key decision-making as early as February, when Mr. Pence took over the task force. Mr. Azar would complain to his associates that Mr. Pence’s staff and task force members went around him to issue orders to his subordinates.On tenterhooks about his job status, Mr. Azar found an opening that offered a kind of redemption, steering his attention through the summer and fall to Operation Warp Speed, the government’s effort to support rapid development of a vaccine, lavishing praise on Mr. Trump and crediting him for nearly every advance.Behind the scenes, Mr. Azar portrayed Dr. Hahn to the White House as a flailing manager — a complaint he also voiced about Dr. Redfield. In late September, he told the White House he was willing to fire Dr. Hahn, according to officials familiar with the offer.For their part, Dr. Hahn, Dr. Redfield, Dr. Birx and other senior health officials saw Mr. Azar as crushing the morale of the agencies he oversaw as he sought to escape blame for a worsening crisis and to strengthen his own image publicly and with the White House.Health officials on the task force several times took their complaints about Mr. Azar to Mr. Pence’s office, hoping for an intervention.Caitlin B. Oakley, a spokeswoman for Mr. Azar, said he had “always stood up for balanced, scientific, public health information and insisted that science and data drive the decisions.”Once eager to visit the White House, Dr. Hahn became disillusioned with what he saw as its efforts to politicize the work of the Food and Drug Administration, and he eventually shied away from task force meetings, fearing his statements there would leak.If there was a bureaucratic winner in this West Wing cage match, it was Dr. Atlas.He told Mr. Trump that the right way to think about the virus was how much “excess mortality” there was above what would have been expected without a pandemic.Mr. Trump seized on the idea, often telling aides that the real number of dead was no more than 10,000 people.As of Thursday, 342,577 Americans had died from the pandemic.Two coronavirus vaccines arrived at sites across the country this month. Mr. Trump was furious that a successful vaccine was not announced until after the election.Credit…Bryan Anselm for The New York TimesTrump vs. Vaccine RegulatorsIn an Oval Office meeting with senior health officials on Sept. 24, the president made explicit what he had long implied: He wanted a vaccine before the election, according to three people who witnessed his demand.Pfizer’s chief executive had been encouraging the belief that the company could deliver initial results by late October. But Mr. Trump’s aides tried in vain to make clear that they could not completely control the timing.Dr. Fauci and Dr. Hahn reminded West Wing officials that a company’s vaccine trial results were a “black box,” impossible to see until an independent monitoring board revealed them. A vaccine that did not go through the usual, rigorous government approval process would be a “Pyrrhic victory,” Mr. Azar told them. It would be a shot no one would take.Dr. Moncef Slaoui, the scientific leader of Operation Warp Speed, said the president never asked him to deliver a vaccine on a specific timetable. But he said Mr. Trump sometimes complained in meetings that “it was not going to happen before the election and it will be ‘Sleepy Joe’” who would ultimately get credit.In late October, science and regulations worked against Mr. Trump’s waning hopes for pre-Election Day good news. At the F.D.A., scientists had refined the standards for authorizing a vaccine for emergency use. And at Pfizer, executives realized that the agency was unlikely to authorize its vaccine on the basis of so few Covid-19 cases among its clinical trial volunteers.They decided to wait for more data, a delay of up to a week.When Pfizer announced on Nov. 9 — two days after Mr. Biden clinched his victory — that its vaccine was a stunning success, Mr. Trump was furious. He lashed out at the company, Dr. Hahn and the F.D.A., accusing “deep state regulators” of conspiring with Pfizer to slow approval until after the election.The president’s frustration with the pace of regulatory action would continue into December, as the F.D.A. went through a time-consuming process of evaluating Pfizer’s data and then that of a second vaccine maker, Moderna.On Dec. 11, Mr. Meadows exploded during a morning call with Dr. Hahn and Dr. Peter Marks, the agency’s top vaccine regulator. He accused Dr. Hahn of mismanagement and suggested he resign, then slammed down the phone. That night, the F.D.A. authorized the Pfizer vaccine.In the weeks that followed, Mr. Pence, Mr. Azar, Dr. Fauci and other health officials rolled up their sleeves to be vaccinated for the cameras.Mr. Trump, who after contracting Covid-19 had declared himself immune, has not announced plans to be vaccinated.Michael D. Shear More

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      ‘Like a Hand Grasping’: Trump Appointees Describe the Crushing of the C.D.C.

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      #masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesThe Latest Vaccine InformationU.S. Deaths Surpass 300,000F.A.Q.AdvertisementContinue reading the main storySupported byContinue reading the main story‘Like a Hand Grasping’: Trump Appointees Describe the Crushing of the C.D.C.Kyle McGowan, a former chief of staff at the Centers for Disease Control and Prevention, and his deputy, Amanda Campbell, go public on the Trump administration’s manipulation of the agency.“Every time that the science clashed with the messaging, messaging won,” said Kyle McGowan, a former chief of staff of the Centers for Disease Control and Prevention.Credit…Audra Melton for The New York TimesDec. 16, 2020Updated 9:36 a.m. ETATLANTA — Kyle McGowan, a former chief of staff at the Centers for Disease Control and Prevention, and his deputy, Amanda Campbell, were installed in 2018 as two of the youngest political appointees in the history of the world’s premier public health agency, young Republicans returning to their native Georgia to dream jobs.But what they witnessed during the coronavirus pandemic this year in the C.D.C.’s leadership suite on the 12-floor headquarters here shook them: Washington’s dismissal of science, the White House’s slow suffocation of the agency’s voice, the meddling in its messages and the siphoning of its budget.In a series of interviews, the pair has decided to go public with their disillusionment: what went wrong, and what they believe needs to be done as the agency girds for what could be a yearslong project of rebuilding its credibility externally while easing ill feelings and self-doubt internally.“Everyone wants to describe the day that the light switch flipped and the C.D.C. was sidelined. It didn’t happen that way,” Mr. McGowan said. “It was more of like a hand grasping something, and it slowly closes, closes, closes, closes until you realize that, middle of the summer, it has a complete grasp on everything at the C.D.C.”Last week, the editor in chief of the C.D.C.’s flagship weekly disease outbreak reports — once considered untouchable — told House Democrats investigating political interference in the agency’s work that she was ordered to destroy an email showing Trump appointees attempting to meddle with their publication.The same day, the outlines of the C.D.C.’s future took more shape when President-elect Joseph R. Biden Jr. announced a slate of health nominees, including Dr. Rochelle Walensky, the chief of infectious diseases at Massachusetts General Hospital, as the agency’s new director, a move generally greeted with enthusiasm by public health experts.“We are ready to combat this virus with science and facts,” she wrote on Twitter.Mr. McGowan and Ms. Campbell — who joined the C.D.C. in their early 30s, then left together in August — said that mantra was what was most needed after a brutal year that left the agency’s authority crippled.In November, Mr. McGowan held conversations with Biden transition officials reviewing the agency’s response to the pandemic, where he said he was candid about its failures. Among the initiatives he encouraged the new administration to plan for: reviving regular — if not daily — news briefings featuring the agency’s scientists.Mr. McGowan and Ms. Campbell, both 34, say they tried to protect their colleagues against political meddling from the White House and Department of Health and Human Services. But an agency created to protect the nation against a public health catastrophe like the coronavirus was largely stifled by the Trump administration.The White House insisted on reviewing — and often softening — the C.D.C.’s closely guarded coronavirus guidance documents, the most prominent public expression of its latest research and scientific consensus on the spread of the virus. The documents were vetted not only by the White House’s coronavirus task force but by what felt to the agency’s employees like an endless loop of political appointees across Washington.Mr. McGowan recalled a White House fixated on the economic implications of public health. He and Dr. Robert R. Redfield, the C.D.C. director, negotiated with Russell T. Vought, the White House budget director, over social distancing guidelines for restaurants, as Mr. Vought argued that specific spacing recommendations would be too onerous for businesses to enforce.“It is not the C.D.C.’s role to determine the economic viability of a guidance document,” Mr. McGowan said.They compromised anyway, recommending social distancing without a reference to the typical six-foot measurement.One of Ms. Campbell’s responsibilities was helping secure approval for the agency’s Morbidity and Mortality Weekly Reports, a widely followed and otherwise apolitical guide on infectious disease renowned in the medical community. Over the summer, political appointees at the health department repeatedly asked C.D.C. officials to revise, delay and even scuttle drafts they thought could be viewed, by implication, as criticism of President Trump.“It wasn’t until something was in the M.M.W.R. that was in contradiction to what message the White House and H.H.S. were trying to put forward that they became scrutinized,” Ms. Campbell said.Dr. Tom Frieden, the C.D.C. director under President Barack Obama, said it was typical and “legitimate” to have interagency process for review.“What’s not legitimate is to overrule science,” he said.Often, Mr. McGowan and Ms. Campbell mediated between Dr. Redfield and agency scientists when the White House’s requests and dictates would arrive: edits from Mr. Vought and Kellyanne Conway, the former White House adviser, on choirs and communion in faith communities, or suggestions from Ivanka Trump, the president’s daughter and aide, on schools.“Every time that the science clashed with the messaging, messaging won,” Mr. McGowan said.Episodes of meddling sometimes turned absurd, they said. In the spring, the C.D.C. published an app that allowed Americans to screen themselves for symptoms of Covid-19. But the Trump administration decided to develop a similar tool with Apple. White House officials then demanded that the C.D.C. wipe its app off its website, Mr. McGowan said.Ms. Campbell said that at the pandemic’s outset, she was confident the agency had the best scientists in the world at its disposal, “just like we had in the past.”“What was so different, though, was the political involvement, not only from H.H.S. but then the White House, ultimately, that in so many ways hampered what our scientists were able to do,” she said.Top C.D.C. officials devised workarounds. Instead of posting new guidance for schools and election officials in the spring, they published “updates” to previous guidance that skipped formal review from Washington. That prompted officials in Washington to insist on reviewing updates.Brian Morgenstern, a White House spokesman, said that “all proposed guidelines and regulations with potentially sweeping effects on our economy, society and constitutional freedoms receive appropriate consultation from all stakeholders, including task force doctors, other experts and administration leaders.”A C.D.C. spokesman declined to comment.Mr. McGowan and Ms. Campbell both attended the University of Georgia and saw their C.D.C. positions as homecomings. Mr. McGowan said the two institutions he revered most during his Georgia childhood were the C.D.C. and Coca-Cola.He arrived with a résumé that made the agency’s senior ranks suspicious, he said. Like Ms. Campbell, he worked for former Representative Tom Price, first in his House office, then when he was health secretary under Mr. Trump. When he arrived at the C.D.C., Mr. McGowan told his new colleagues that he was there not to spy on or undermine them, but to support them.Mr. McGowan and Ms. Campbell, who have since opened a health policy consulting firm, said they saw themselves as keepers of the agency’s senior scientists, whose morale had been sapped. Dr. Redfield, whose leadership has been criticized roundly by public health experts and privately by his own scientists, was rarely in Atlanta, consumed by Washington responsibilities.The Coronavirus Outbreak More

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      After 4 Years of Trump, Medicare and Medicaid Badly Need Attention

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      President-elect Joe Biden has pledged to “marshal the forces of science” in his administration. Undoubtedly he needs to start by bolstering the credibility of the Food and Drug Administration and the Centers for Disease Control and Prevention.But a third health agency, central to the lives of older Americans, low-income families and the disabled, is sorely in need of his attention. Science has also been under assault at the Centers for Medicare & Medicaid Services, which provides federal health insurance to more than 130 million Americans at a cost of more than $1 trillion, nearly twice the Pentagon’s budget.C.M.S. does more than just write checks for medical care. Its scientists and analysts determine which treatments should be offered — I am the chairman of the committee that advises Medicare on those decisions — and how best to care for the patients it serves.Unfortunately, the Trump White House has steadily eviscerated the agency’s dispassionate approaches to making those determinations.Recently, for instance, the Trump administration set in motion a plan to strip C.M.S. of its ability to assess for itself whether new medical devices approved by the F.D.A. are appropriate for the older patients it covers. This is important because the benefits and risks of such devices and procedures, which range from implantable hips and cardiac stents to digital apps and laboratory tests, can vary widely based on patient age and disability.The proposed rule requires Medicare to pay for any new device so long as the F.D.A. labels it a “breakthrough.” And that word does not mean what you think it does.The F.D.A. calls a device a “breakthrough” when it is expected — though not yet proved — to be helpful to patients with serious conditions. The designation has nothing to do with how the device works in older patients, or even if it was studied in that population at all. The proposed rule would also require Medicare to cover any new drug or device if at least one commercial insurer covers it for its members, even if its members are young and healthy.Already, companies seldom generate enough data on their products for C.M.S. to assess their value for its patients. In 2019, for instance, data was insufficient in just under half of new F.D.A. drug approvals to assess benefits or side effects in older patients. The proposed rule would drain the last remaining motivation that companies have to study their treatments in the patients who are likely to ultimately receive them.C.M.S. scientists and analysts do more than evaluate new treatments. They also test alternative ways to organize and pay for patient care. The agency has found, for example, that enrolling people at risk of diabetes in gym sessions reduced how often they were hospitalized. But some seemingly obvious ways to improve health care don’t work: C.M.S. also found it could not reduce hospitalizations for cancer patients by paying their doctors to actively manage their patients’ care.The fact that so many promising ideas don’t work as expected is the reason C.M.S. needs to double down on evaluations of how medical care is delivered to its patients.This administration has gone in the other direction. Just before the election, the White House conjured up a plan to send older people a $200 prescription drug discount card in the mail. Research has already demonstrated that if you give people money to buy prescription drugs, they will buy more of them. The pharmaceutical industry knows this, too. That’s why it hands out coupons worth billions of dollars.These same studies also show that when people are indiscriminately given cash for medicines — instead of only those who need that money the most — it costs much more overall than it saves. No wonder the discount card giveaway would have cost around $8 billion. Fortunately, the president has yet to follow through with it.In another troubling development, the administration announced on Nov. 20 that it would run an experiment in which reimbursements to physicians will be cut for dozens of high-cost drugs they administer in the office, such as chemotherapies and treatments for inflammatory diseases.C.M.S. financial analysts warned that the cuts will lead many Medicare patients to lose access to these important treatments. Scientists should evaluate this prediction by including a comparison group of patients whose doctors would not receive a cut in payment. But the agency administrator made it clear that she didn’t believe the warning. No comparison group is planned. That is no way to evaluate whether our nation’s vulnerable would be helped or hurt by this significant policy change.Another example of a poorly designed experiment involved taking Medicaid coverage away from able-bodied people who are not working or going to school, under an ill-founded theory that doing so would inspire them to seek employment. Such a study is best done narrowly, so that any harms are minimized. Instead, the administration invited multiple states in 2018 to test the outcome.A Harvard study found that a work requirement in Arkansas led to a rise in the number of uninsured people and no significant changes in employment. Thousands of Medicaid beneficiaries in Michigan and New Hampshire were set to lose their coverage before work requirements in those states were ended. Given those results, the overall program should have been canceled. The administration broadened it.Through its reliance on scientific evaluation of what it should pay for, and how, C.M.S. has remained financially viable for more than half a century. As the new president plans to fix the damage done by the current president, this vital agency demands his attention.Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center. He served as a senior adviser to the administrator of the Centers for Medicare and Medicaid Services in 2005 and 2006.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More