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Comparing Trump and Biden on COVID-19

Jennifer Kates, Josh Michaud, Larry Levitt, Karen Pollitz, Tricia Neuman, Michelle Long, Robin Rudowitz, MaryBeth Musumeci, Meredith Freed, and Juliette Cubanski
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Federal Emergency Power

Trump Biden
The Trump Administration has declared three federal emergencies:

  • HHS declared a public health emergency (PHE), under Section 319 of the Public Health Service Act, on January 31 (renewed on April 21and July 23)
  • The President declared a national emergency under Section 501(b) of the Stafford Act, on March 13, and hasapproved major disaster declarations for all 50 states and 4 territories.
  • The President declared a national emergency under the National Emergencies Act, on March 13.

Travel Restrictions

Trump Biden
Travel restrictions and limitations put in place include the following:

  • Suspended entry of foreign nationals from:
    • China on January 31
    • Iran on February 29
    • The European Schengen Area on March 11
    • The UK and Ireland on March 14
    • Brazil on May 24
  • Suspended entry of those on immigrant visas on April 22 (extended on June 22), designed to protect the U.S. labor market
  • Limited non-essential travel by foreign nationals into the U.S. through ports of entry on the land borders with Canada and Mexico.
  • Suspended entry of individuals traveling from Canada or Mexico to the U.S. (regardless of country of origin) who would otherwise be held in a congregate setting (e.g., those seeking asylum); this has included unaccompanied minors, some of whom have been held in hotels vs authorized holding facilities.
  • ICE has implemented policies to reduce COVID-19 risk among detainees, but has continued certain enforcement actions and taken limited steps to release individuals from detention.
  • Established screening and quarantine requirements for all persons—including U.S. nationals, lawful permanent residents, and their immediate family members—arriving in the U.S. within 14 days after having been in mainland China.

Emergency Spending Bills

Trump Biden
Congress passed and the President signed four emergency spending bills:

  • The Coronavirus Preparedness and Response Supplemental Appropriations Act (L. 116-123), enacted March 6.
  • The Families First Coronavirus Response Act (Families First; L. 116-127), enacted March 18.
  • The Coronavirus Aid, Relief, and Economic Security Act (CARES Act; L. 116-136), enacted March 27.
  • The Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139), enacted April 24.

Coordinating a Federal Response

Trump Biden
Establish a White House COVID-19 Task Force on January 27. Biden has said that, as President, “the first step I will take will be to get control of the virus that’s ruined so many lives….We will never get our economy back on track, we will never get our kids safely back to school, we will never have our lives back, until we deal with this virus.” He would implement a national strategy on day one of his Presidency.

Federal Social Distancing and Reopening Guidelines

Trump Biden
The White House:

  • Issued federal social distancing guidelines on March 16 for a 15-day period, extended through the end of April.
  • Issued reopening guidelines on April 16.
 Biden:

  • Has said that “Social distancing is not a lightswitch. It is a dial” and that he would direct CDC to provide specific evidence-based guidance for “how to turn the dial up or down relative to the level of risk and degree of viral spread in a community, including when to open or close certain businesses, bars, restaurants, and other spaces; when to open or close schools, and what steps they need to take to make classrooms and facilities safe; appropriate restrictions on size of gatherings; when to issue stay-at-home restrictions.”
  • On April 12, issued a plan to re-open America safely, focused on controlling the virus.
  • On May 11, criticized the White House for presenting a “false choice” between health and the economy.
  • On August 21, said he would shut down the country again if scientists recommended it.

Reopening Schools

Trump Biden
  • President Trump began encouraging schools to re-open in person in July and has suggested he would tie emergency funding for schools to in-person schooling. As recently as mid-August, the President has focused on the importance of reopening schools.
  • CDC issued school re-opening guidance on July 23, emphasizing the importance of in-person schooling. It has since updated and modified that recommendation.
  • The CARES Act includes $13 billion for elementary and secondary schools.
  • The President has called for Congress to pass $105 billion – $70 billion of which is for K-12 schools – to provide financial assistance and incentives to help schools implement safety measures in their resumption of in-person classes.
  • The President has put forward eight recommendations to guide schools on reopening safely:
    1. Ensure all students, teachers, and staff understand the symptoms of COVID-19 and its risk factors.
    2. Require all students, teachers, and staff to self-assess their health every morning before coming to school; if they are symptomatic, they should consult their physician.
    3. Encourage frequent handwashing or hand sanitizing during the school day
    4. Minimize large indoor group gatherings; hold large gatherings outdoors whenever possible.
    5. Maintain high standards of hygiene and ventilation within all classrooms
    6. Require students, teachers, and staff to socially distance around high-risk individuals.
    7. Encourage the use of masks when social distancing is not possible.
    8. Liberally post instructions regarding hygiene and social distancing around the school.
  • On re-opening schools, Biden has said that “Creating the conditions to make it happen should be a top national priority” and that “the decision about when to reopen safely should be made by state, tribal, and local officials, based on science and in consultation with communities and tribal governments. It should be made with the safety of students and educators in mind. And, it should be made recognizing that if we do this wrong, we will put lives at risk and set our economy and our country back.”
  • He has issued a five-step roadmap for reopening schools:
    1. Getting the virus under control before reopening.
    2. Setting National Safety Guidelines with objective criteria for local decision-making. Decisions on re-opening should be tied to level of risk and spread and when schools have sufficient PPE, masks and other supplies.
    3. Providing emergency funding for public schools and child care providers, including through passage of the HEROES Act, which includes approximately $58 billion for local school districts; through renewable fund for state, tribal, and local governments; through a separate emergency package to provide $30 billion for child care providers and public schools and $4 billion to upgrade technology and broadband.
    4. Mobilizing a Department of Education effort to develop, adopt, and share the latest tools and best practices to ensure high-equality learning
    5. Close the COVID-19 Educational Equity Gap through a White House-led initiative to identify evidence-based policy solutions; launching a COVID-19 Educational Equity Gap Challenge Grant and other measures.

Scaling up COVID-19 Testing and Contact Tracing

Trump Biden
Under President Trump:

 Biden proposes to:

  • Ensure all who need a test can get one.
  • Provide daily public White House report on number of tests conducted.
  • Establish Pandemic Testing Board to scale up and oversee provision of diagnostic and antibody tests, including surge production of test kits and lab supplies; coordinate distribution to every state, tribe, and territory; identify testing sites and personnel; ensure adequate lab capacity and swift reporting of results; and provide clear guidance on who needs a test.
  • Double the number of drive-through facilities per state.
  • Build a National Contact Tracing Workforce by creating a U.S. Public Health Jobs Corps which would mobilize at least 100,000 people.

Addressing the Costs of COVID-19 Testing, Prevention, Treatment and an Eventual Vaccine

Trump Biden
Congress has passed and the President has signed emergency relief measures eliminating costs for testing, preventive services, and an eventual vaccine (but in most cases, not for treatment) as follows:

 Biden would work to eliminate cost-barriers (co-payments, deductibles, surprise billing) for all COVID-19 services and commodities, including testing, preventive services, treatment, and an eventual vaccine, for both those who are insured and uninsured, by:

  • Requiring all private plans (employer plans and individually purchased) to immediately cover all testing, treatment, and preventive services related to COVID-19, and for an eventual vaccine, and ensure that testing is free to everyone regardless of immigration status. On vaccine pricing, Biden would provide explicit authority for HHS Secretary to approve the commercial price of vaccines that are developed in conjunction with federally funded research.
  • Applying the same requirement to public plans including Medicare, Medicaid, the Children’s Health Insurance Program, Indian Health Service, Veterans Affairs, DoD’s TriCare program and the Federal Employees Health Benefits (FEHB) Program.
  • Fully funding and expanding authority for the National Disaster Medical System (NDMS) to reimburse health care providers for COVID-19-related treatment costs not directly covered by health insurance for the insured as well as uncompensated care incurred by uninsured and underinsured populations. 

Health Insurance Coverage During the Emergency Period

Trump Biden
In response to COVID-19, the Administration has:

  • Issued an emergency regulation extending COBRA election period (but has not provided subsidies).
  • Extended the time people have to sign up for marketplace coverage if they lose other coverage during the emergency period. However, declined to reopen ACA enrollment to all individuals during the emergency period.
  • Signed legislation increasing Medicaid FMAP by 6.2 percentage points from January 1 through the end of the quarter in which the public health emergency ends.
  • Approved Medicaid emergency authorities to help states address the COVID-19 emergency.
  • Immigrants remain subject to restrictions on eligibility for federal health and financial relief provided in response to COVID-19, as well as to health coverage more generally, that could leave them facing barriers to testing and treatment.
 In response to COVID-19 specifically, Biden proposes to:

  • Cover COBRA at 100% for those who lose their job due to COVID-19.
  • Reopen ACA enrollment during the emergency period.
  • Increase Medicaid FMAP by at least 10 percent for all states during the crisis, with upward adjustments for states that are facing particularly high unemployment rates.
  • Ensure that immigrants also have access to free testing and work to reverse the Trump Administration’s public charge rule, which has made immigrant families more fearful of accessing health programs and services.

Helping Workers/Workplaces

Trump Biden
Under President Trump:

  • Congress passed and the President signed legislation establishing emergency paid sick and family leave due to COVID-19, through the end of the year as follows:
    • Employers with fewer than 500 employees and all public employers are required to provide up to two weeks of fully-paid sick leave for eligible employees unable to work due to quarantine or isolation, or symptoms of coronavirus, and up to two-thirds pay for employees unable to work in order to care for someone in quarantine or whose child’s school or day care is closed.
    • Employers with fewer than 500 employees and all public employers are required to provide two-thirds pay for up to an additional 10 weeks for employees unable to work because their child’s school or day care is closed.
    • Employers receive refundable tax credits to cover costs of providing emergency paid leave.
    • Employees of private businesses with 500 or more employees are not eligible for emergency paid sick leave, totaling at least 69 million workers, including 8 million health care workers subsequently exempted by Department of Labor guidelines.
    • Employees of private businesses with 500 or more employees and most federal employees are not eligible for emergency paid family leave. Additionally, employers with fewer than 50 employees may be exempt from providing this benefit.
  • Congress passed and the President signed legislation creating new unemployment compensation programs for those affected by the pandemic, including a federally-financed $600/week supplement to state unemployment benefits that expired in late July. By executive order, the President temporarily extended a portion of the federal unemployment supplement in states that could share in the cost. No additional pay for frontline/essential workers, specifically, has been provided.
  • The CARES Act also provides a “recovery rebate” (a refundable tax credit) of up to $1,200 for eligible individuals ($2,400 for joint filers), and an additional $500 for each qualifying child. This benefit is limited to people filing taxes, leaving out some immigrant workers and their spouses.
  • The President has activated the DPA to direct domestic industry to expedite and expand supply of medical countermeasures, in the context of a national emergency. The DPA has been used to expand access to PPE, ventilators, and testing.
  • OSHA has issued standards and requirements to prevent occupational exposure to COVID-19.
 Biden would work to:

  • Expand emergency paid sick and family leave to include all workers regardless of industry, sector, or employer size.
  • Reimburse employers when employees use emergency paid leave benefits.
  • Include a refundable tax credit for employers’ extra costs of providing full health benefits to all workers during periods of work hour reductions due to COVID-19.
  • Ensure all essential workers have priority access to PPE, testing, childcare assistance, and other emergency COVID-19 support.
  • Ensure additional pay for frontline/essential workers.
  • Expand emergency unemployment compensation and ensure that workers receive payments quickly by issuing funds electronically or by prepaid debit cards.
  • Expand the use of the DPA to increase production of masks, face shields, and other PPE, and ensure equitable distribution in at-risk communities, particularly those with vulnerable populations.
  • Establish and enforce health and safety standards in workplaces including:
    • An Emergency Temporary Standard to give employers and frontline employees enforceable guidance.
    • Finalize permanent infectious disease standard to require health facilities and certain other high exposure workplaces to permanently. implement infection control programs to protect workers.
    • Double number of OSHA investigators.

Helping Hospitals/Health Care Facilities & Providers

Trump Biden
Under President Trump:

  • The Army Corps of Engineers and National Guard constructed temporary hospitals and medical centers, and the Navy’s two hospital ships, the USNS Mercy and USNS Comfort, were deployed.
  • Congress passed and the President signed the CARES Act and the Paycheck Protection Act which together provide $175 billion in grants to health care providers.
  • CMS accelerated $100 billion in Medicare payments to hospitals, physicians, and other entities that participate in Medicare to minimize the effects of revenue shortfalls due to COVID-19, and the CARES Act significantly expanded this authority. The CARES Act also increased Medicare payments to hospitals for the treatment of Medicare inpatients diagnosed with COVID-19 by 20%.
  • Based on new waiver authority included in the Coronavirus Preparedness and Response Supplemental Appropriations Act (and amended by the CARES Act), the Administration has temporarily broadened access to telehealth benefits under Medicare during the emergency period.
  • The Administration has waived or modified requirements under Section 1135 of the Social Security Act to allow, for example, out-of-state providers with equivalent licensing to practice in other states.
  • The Administration has issued numerous guidance to and recommendations for Medicare and Medicaid certified nursing facilities to address COVID-19 outbreaks, including: restricting visitors, except for compassionate care circumstances; guidance on screening all staff, residents, and visitors for symptoms and other risk factors; requiring nursing homes to report COVID-19 cases weekly; forming an independent commission to conduct a comprehensive assessment of facility response to COVID-19; providing a one-time procurement of rapid diagnostic tests to nursing homes in COVID-19 hotspots; and requiring LTC facilities to test all residents and staff.
  • CDC collected data from hospitals and maintained a dashboard, activities which have since been shifted to HHS
 Biden proposes to:

  • Prepare to stand up multi-hundred-bed temporary hospitals in any city on short notice by deploying existing Federal Medical Stations in the strategic national stockpile and preemptively defining potential locations for their use as needed.
  • Direct DoD to prepare for potential deployment of military resources, both the active and reserve components, and work with governors to prepare for potential deployment of National Guard resources, to provide medical facility capacity, logistical support, and additional medical personnel if necessary, including by activating the Medical Reserve Corps and deploying additional surge capacity, including U.S. Department of Veterans Affairs/DOD medical equipment and HHS Disaster Assistance Medical Teams.
  • Direct and assist hospitals to surge care for 20% more patients than current capacity through flexible staffing, use of telemedicine support, and delaying elective procedures.
  • Instruct CDC to establish real-time dashboards tracking (1) hospital admissions related to COVID-19 (2) supply chain information for essential equipment and PPE.
  • Expand CDC sentinel and other surveillance programs to offer tests broadly, especially to vulnerable populations like nursing home patients and people with underlying medical conditions.
  • Establish testing capacity so that long-term care residents could safely see at least one visitor every week.
  • Create “State and Local Emergency Fund” with resources to be allocated according to a formula: 45% to state governments; 45% to local governments; and 10% reserved for special assistance for “hot-spots” of community spread. Can use for medical supplies, critical health infrastructure, hiring of health care and other workers, and other services and supplies.

Building the Strategic National Stockpile & Critical Supplies

Trump Biden
Under President Trump:

  • The President activated the DPA to respond to COVID-19 which has been invoked for ventilators and respirators, to prevent hoarding and price gauging and in other select cases.
  • The White House launched “Project Airbridge,” an effort to procure and transport critical supplies and equipment from overseas to the U.S.  Millions of supplies, including N95 respirators, surgical masks, and gowns, arrived in the US through this effort, which was shut down at the end of June.
  • The White House announced a restructuring of the federal Strategic National Stockpile (SNS) to improve predictive analytics of supply and demand, ensuring a 90-day supply of critical items, and fostering more domestic production and less reliance on foreign suppliers. According to the Administration, the role of the SNS is to supplement state supplies during public health emergencies, a revision from how it had previously been described.
  • HHS has announced new partnerships, for example between the Biomedical Advanced Research and Development Authority (BARDA) and private sector companies, to ensure the supply of critical medicines and pharmaceutical ingredients.
 Biden proposes to:

  • Undertake a 100-day review upon taking office to identify critical national security risks across America’s international supply chains and ask Congress to enact a mandatory quadrennial Critical Supply Chain Review to institute this process permanently.
  • Sign an Executive Order to inventory U.S. supply chain vulnerabilities.
  • Appoint Supply Commander to oversee national supply chain of essential. equipment, medications, protective gear.
  • Increase federal stockpiles of medical supplies and other critical goods through regulation and other measures.
  • Direct distribution of critical equipment as cases peak at different times in different states or territories.
  • Use the DPA to manufacture critical products, including those immediately needed to respond to the COVID-19 pandemic in near term and create process to determine the best way forward over the mid- and long-term.
  • Work with businesses to expand production of critical supplies and incentivize greater supplier production, including committing, if necessary, to large scale volume purchasing and removing all relevant trade barriers to their acquisition.
  • Task the Department of Justice with combating price gouging for critical supplies.
  • Use BARDA to spur medical production to ensure adequate production of vaccines and other medical countermeasures to address COVID-19.
  • Leverage federal purchasing power to encourage pharmaceutical companies to make key drugs, drug inputs, and medical devices in the U.S. while ensuring fair and transparent pricing.
  • Ensure the U.S. tax code encourages on-shoring of pharmaceutical supply chains.

Research & Development/ Treatment and Vaccine Distribution

Trump Biden
Under President Trump:

  • Congress passed and the President signed emergency legislation providing additional funding for vaccines, therapies and diagnostics totaling an estimated $9 billion.
  • In June, the White House announced “Operation Warp Speed” with the goal of delivering “300 million doses of a safe, effective vaccine for COVID-19 by January 2021” through “investing in and coordinating countermeasure development.”
  • HHS announceda task order to advance domestic manufacturing capabilities for vaccines and therapeutics.
  • DoD and HHS announceda $138 million contract for more than 100 million syringes for future vaccines.
  • HHS and DoD announced a joint effort to increase domestic manufacturing capacity for vials.
  • As part of Operation Warp Speed, US agencies, including CDC and DoD, developing portfolio of distribution options for eventual COVID vaccines.
  • The White House decided not to participate in the WHO-led international R&D collaborative that was launched in April.
 Biden proposes to:

  • Establish a New Emerging Infectious Disease Clinical Trial Network.
  • Scale-up National Institutes of Health-funded COVID-19 pediatric research partnerships to help address gaps in understanding of how the virus affects children and generate evidence-based guidance.
  • Invest $25 billion in a vaccine manufacturing and distribution plan, and plan for the effective, equitable distribution of treatments and vaccines.
  • Be part of coordinated global approach to develop a safe, effective vaccine and the manufacturing capacity for the doses and related materials like syringes that we will need at home and around the world.
  • The following 3 principles should guide vaccine development:
    • Put scientists in charge of all decisions on safety and efficacy.
    • Publicly release clinical data for any vaccine the FDA approves.
    • Authorize career staff to write a written report for public review and permit them to appear before Congress.

International Cooperation and Global Health Security

Trump Biden
Under President Trump:

  • An “America First” approach has guided foreign policy.
  • The National Security Council’s Directorate for Global Health Security and Biodefense (charged with overseeing pandemic response) was dissolved in 2018.
  • The first National Biodefense Strategy was released in 2018, and first U.S. Global Health Security Strategy was released in 2019, both required by Congress.
  • Supported the extension of The Global Health Security Agenda (GHSA) for another five-year period (2019-2024).
  • The President signed legislation providing $3.2 billion for global COVID-19 response efforts, to assist governments, international efforts and non-governmental organizations.
  • The U.S. announced it would not participate in the WHO-led global research and development initiative for drugs and vaccines.
  • The White House suspended funding for the World Health Organization (WHO) and announced its intention to withdraw the U.S. from WHO membership.
 Biden proposes to:

  • Re-embrace international engagement and alliances.
  • Restore the National Security Council’s Directorate for Global Health Security and Biodefense, created under the Obama Administration.
  • Empower the State Department to ensure the U.S. plays a major role in all global decisions about COVID-19.
  • Direct USAID, in coordination with State, DOD, HHS, and CDC, to mobilize an international response to assist vulnerable nations.
  • Help create a Global Health Emergency Board to harmonize crisis response for vulnerable communities, including to offset the cost of an eventual vaccine, with leadership from the U.S., G7 partners, and other countries in support of WHO.
  • Bolster CDC and DOD’s disease detection and protection programs overseas.
  • Re-launch and strengthen USAID’s “PREDICT” program.
  • Revitalize, elevate, expand Global Health Security Agenda GHSA including by fully staffing all federal agencies and advisory groups focused on global health security, establishing an Assistant Secretary at the State Department to oversee an office of Global Health Security and Diplomacy, and prioritizing sustained funding for global health security.
  • Call for creation of a Permanent Facilitator within the Office of the United Nations Secretary-General for Response to High Consequence Biological Events.
  • Fully resource WHO and reverse Trump Administration decision to withdraw from WHO membership.
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