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A doctor is opening up about working at one of the first hospitals in the country dedicated solely to treating people with severe cases of COVID-19.“Hope gave way to frustration as heartwarming images of mutual sacrifice were replaced by images of protest about the sanctity of dining out and getting haircuts,” said Dr. Ben Trappey at Bethesda Hospital in St. Paul, Minnesota. “Now, even frustration has given way to bone deep sense of weariness and resignation. I’m running on fumes.”Trappey spent nearly three months away from his wife, quarantining at a hotel while caring for patients at Bethesda Hospital near Minneapolis.He destresses through reflective writing and teaches it to other residents and physicians.His essay “Running on Fumes” was recently published in the Journal of the American Medical Association (JAMA). It reflects how he feels still being on the front lines of COVID-19, but not feeling like the rest of the world is behind him.“The thing that made me feel most supported early on was just that everybody was making these sacrifices together and now when there are so many people who refuse to acknowledge that a sacrifice even needs to be made is really frustrating,” said Trappey.He says one of his challenges is not knowing which COVID-19 patients will get better.Many hospitals have provided support like counseling and buddy systems.Trappey is now on parental leave at home with his wife and newborn son.“It’s hard to think about what things will be like as we get further into the fall and we have other respiratory viruses in place as well. It’s pretty worrisome, so I’m just trying not to let myself think too much about that,” said Trappey.The doctor says he hopes people realize they're not alone in the pandemic. 1758

A federal judge in Texas said on Friday that the Affordable Care Act's individual coverage mandate is unconstitutional and that the rest of the law must also fall."The Court ... declares the Individual Mandate ... unconstitutional," District Judge Reed O'Connor wrote in his decision. "Further, the Court declares the remaining provisions of the ACA ... are inseverable and therefore invalid."The case against the ACA, also known as Obamacare, brought by 20 Republican state attorneys general and governors, as well as two individuals. It revolves around Congress effectively eliminating the individual mandate penalty by reducing it to A cadre of former FDA commissioners under Republican and Democratic presidents say that President Donald Trump has undermined the credibility of the FDA.Robert Califf, Scott Gottlieb, Margaret Hamburg, Jane Henney, David Kessler, Mark McClellan and Andy von Eschenbach pinned a joint op-ed in the Washington Post on Tuesday.Among the group who signed the letter, Gottlieb was Trump’s longest service FDA commissioner, heading the agency for nearly two years until April 5, 2019.The former commissioners said Trump has inserted himself into the vaccine approval process.“But a safe and effective vaccine will not be enough; people will also have to choose to take it,” the former commissioners wrote. “This depends on widespread confidence that the vaccine approval was based on sound science and not politics. If the White House takes the unprecedented step of trying to tip the scales on how safety and benefits will be judged, the impact on public trust will render an effective vaccine much less so.”Last week, Trump said it’s possible he would overrule the FDA if the agency uses stricter guidelines to give an emergency use authorization for a coronavirus vaccine candidate.The group of former commissioners blasted Trump for his comments.“The implications of the recent shift are potentially dire,” they wrote. “When the FDA warns about a risk from contaminated food, will people heed it? When a new drug for cancer or heart disease is approved, will clinicians and families trust it to work? And most urgent for today: When the FDA approves a COVID-19 vaccine, will Americans accept it?”Trump has been at odds with many government public health experts on the timing of when a vaccine would be available to the public.There are several vaccines in Phase 3 testing. Even though a vaccine could be approved by year’s end, trials will be expected to continue for over a year to monitor for possible side effects.According to the FDA, a typical Phase 3 trial would take one to three years. 2000 as part of the 2017 tax cut bill.The Republican coalition is arguing that the change rendered the mandate itself unconstitutional. They say that the voiding of the penalty, which takes effect next year, removes the legal underpinning the Supreme Court relied upon when it upheld the law in 2012 under Congress' tax power. The mandate requires nearly all Americans to get health insurance or pay a penalty.The Trump administration said in June that it would not defend several important provisions of Obamacare in court. It agreed that the zeroing out the penalty renders the individual mandate unconstitutional but argued that that invalidates only the law's protections of those with pre-existing conditions. These include banning insurers from denying people policies or charging them more based on their medical histories, as well as limiting coverage of the treatment they need.But the administration maintained those parts of the law were severable and the rest of the Affordable Care Act could remain in place.Because the administration would not defend the law, California, joined by 16 other Democratic states, stepped in. They argued that the mandate remains constitutional and that the rest of the law, in any event, can stand without it. Also, they said that eliminating Obamacare or the protections for those with pre-existing conditions would harm millions of Americans.In oral arguments in September, a lawyer for California said that the harm from striking down the law would be "devastating" and that more than 20 million Americans were able to gain health insurance under it.The lawsuit entered the spotlight during the midterm elections, helping propel many Democratic candidates to victory. Protecting those with pre-existing conditions became a central focus of the races. Some 58% of Americans said they trust Democrats more to continue the law's provisions, compared to 26% who chose Republicans, according to a Kaiser Family Foundation election tracking poll released in mid-October.The consumer protections targeted by the administration are central to Obamacare and transformed the health insurance landscape. Their popularity is one of the main reasons GOP lawmakers had such difficulty repealing Obamacare last year."Guaranteed issue" requires insurers to offer coverage to everyone regardless of their medical history. Prior to the Affordable Care Act, insurers often rejected applicants who are or had been ill or offered them only limited coverage with high rates.Under the law's community rating provision, insurers are not allowed to set premiums based on a person's health history. And the ban on excluding pre-existing conditions from coverage meant that insurers cannot refuse to pay for treatments because of a policyholder's medical background.All these provisions meant millions of people with less-than-perfect health records could get comprehensive coverage. But they also have pushed up premiums for those who are young and healthy. This group would have likely been able to get less expensive policies that offered fewer benefits prior to Obamacare. That has put the measures in the crosshairs of Republicans seeking to repeal the law and lower premiums.It's no wonder that politicians on both sides of the aisle promised to protect those with pre-existing conditions during the election. Three-quarters of Americans say that it is "very important" for the law to continue prohibiting health insurers from denying coverage because of medical histories, according to the Kaiser Family Foundation's September tracking poll -- 58% of Republicans feel the same way. And about the same share of Americans say it's "very important" that insurers continue to be barred from charging sick people more. 4383

A CNN analysis has found that embattled Environmental Protection Agency Administrator Scott Pruitt paid himself nearly ,000 in reimbursements from his two campaigns for Oklahoma attorney general, a move at least one election watchdog has sharply criticized as being recorded so vaguely that there was no way to tell if such payments were lawful.The reimbursement method, which Pruitt used in his 2010 and 2014 campaigns, effectively scuttled two key pillars of campaign finance: transparency about how campaign funds are spent and ensuring campaign funds are not used for personal purchases, according to a former top elections attorney and a CNN review of the documents.Some of the reporting may also violate Oklahoma campaign finance rules, according to research done by the Campaign Legal Center, a nonprofit and nonpartisan group.At EPA, Pruitt is under scrutiny for questionable spending and ethical decisions that have landed him in hot water with investigators and on Capitol Hill. Ethics watchdogs, federal auditors and congressional committees are conducting nearly a dozen inquiries into Pruitt's actions at the agency.During his attorney general bids, records show Pruitt made purchases and then received reimbursement from his campaign -- sometimes thousands of dollars apiece -- rather than having the campaign pay directly for expenses like renting a vehicle or purchasing a meal. When purchases are made directly, the campaign filings would show more details about who received the payments.Instead, dozens of entries on Pruitt's 2010 and 2014 campaign finance filings show payments to him but don't have the same level of detail, making it difficult to tell if the purchases were legitimate.The reimbursements are vaguely stated as being for meals, travel, office supplies, phone service, internet access and office decorations, and in some cases do not list the the vendors.A spokesman for Pruitt, Jahan Wilcox, described the payments to CNN as "standard reimbursements.""This is useless reporting," said Larry Noble, the former general counsel at the Federal Election Commission. He is now at the Campaign Legal Center and is a CNN contributor. "There's no way of telling if this is a personal expense. ... You couldn't do this on the federal (level) -- it's illegal."Noble said Oklahoma rules require campaigns to "show the ultimate vendor and an adequate description so you know what the item was for." Because some of the payments to Pruitt do not do that, "It was not at all clear that these were all lawful," Noble said.Noble noted that the campaigns, however, still made direct payments of more than .6 million."So he's not running the campaign through his credit card," Noble said.All of the payments were made when Pruitt was a candidate for attorney general or after he had been first elected to the office in 2010. The records do not show any payments since Pruitt became administrator of the EPA last year.As EPA chief, Pruitt has faced allegations he took advantage of increased security and made travel arrangements for his own benefit -- demanding to fly Delta in order to get frequent-flyer points and staying at posh hotels more expensive than government limits for reimbursement (which also placed an undue burden on his staff who have to pay out of pocket). He's also been accused of excessive spending on his office, like an ornate restored desk and a soundproof booth. In some cases, he blamed the expenditures on his staff.The reimbursements to Pruitt when he was AG totaled ,204.87 from the 2010 campaign account and ,665.73 from his 2014 re-election account, according to the filings.The filings show Pruitt was frequently reimbursed for dining expenses at The Beacon Club, which was described by a local newspaper as "Oklahoma City's oldest private downtown dining" establishment when it closed last year. "The Beacon Club was where deals got done," The Oklahoman newspaper reported.Some of Pruitt's reimbursements were for "officeholder expenses" -- meaning items needed for his role as attorney general -- after he was elected in 2010 and re-elected in 2014.More than ,000 is for items that appear to be office supplies and decorations. Around ,600 is described as "Artwork/Decorations" from retailers like Pier 1 Imports, an Oklahoma florist and a local picture framing shop. Records also show Pruitt purchased a ,400 Apple computer.Because of the limited information and lack of transparency, it's impossible to determine whether the purchases were appropriate and for official purposes, Noble said."Do we know how the campaign spent its money? No," Noble said. "How do you enforce a personal use prohibition unless you know how the money is being used? ... This is not any way you want to have a campaign finance log."The office purchases were made a mere 10 days after the Bank of America skyscraper in downtown Tulsa agreed to lease office space to the attorney general's office, headed by Pruitt. The move expanded the Tulsa AG's offices and placed them in the same building as Pruitt's campaign offices, raising the rent from about ,000 per month to ,000 per month.The office of current Attorney General Mike Hunter told CNN that around the same time, the AG's office was required to expand and hire more staff.One Republican source said Pruitt would sometimes leave the AG's office to work from the campaign office in the same building.His move to Tulsa was seen publicly as a convenience, since he lived in Tulsa and not Oklahoma City, where the AG is headquartered.Wilcox, the Pruitt spokesman, did not address detailed questions from CNN about the expenditures and decision to relocate his government offices to the same building as his campaign office.This week, Democratic lawmakers requested more information about a similar request Pruitt made of the EPA. A letter from three members of the House alleged that Pruitt, through his chief of staff, asked the agency to find a secure facility in Tulsa, where Pruitt lives when not in Washington, where he could work and make phone calls. The EPA says that didn't end up happening.  6121

A day after General Motors announced plant closures and job cuts, President Donald Trump has taken to Twitter saying his administration is looking into cutting the automaker's subsidies.Trump tweeted the following Tuesday afternoon: 240

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