Even in this extraordinary year, this has been an extraordinary week.  Last Tuesday we had what many believe to have been the most important Presidential election in recent times, maybe ever.  The week also found the coronavirus pandemic reaching new heights.  That was the week that was.

What struck me, though, is how both our election systems and our healthcare system rely on “ordinary” people to keep them going.  They’ve never been more extraordinary than this year.

The pandemic first impacted voting earlier in the year, during primary season.  Going to the polls suddenly seemed like potentially a life-threatening choice, and working at them practically suicidal.  Dates of primaries were moved, many polling stations were closed, new voting procedures were put into place, and absentee ballots found a new popularity.  And yet people turned out in droves to vote, often standing in line for hours.

President Trump upped the ante by constantly railing against absentee ballots and warning about voter fraud.  Despite this, or perhaps because of it, record numbers of people voted early, in person or by mail.  Several states had surpassed 2016 numbers of voters before Election Day.   Tens of millions more showed up on Election Day.  And, amazingly, Election Day passed with relatively few incidents.

Then the counting started. 

We’re a week in and races in several states have yet to be called, and have lack of agreement from most Republicans about some of the ones that have been called.  We have an apparent President-elect but no concession from the current President or other Republican “leaders.”  Instead, they utter the bromide that we should count the legal votes, not count the illegal votes, and let the judicial process play out.

As is always true, but especially during the pandemic, the election would not have been possible without poll workers.  With older people both being more at risk for COVID-19 and being the majority of the election workforce, it wasn’t initially clear there would be enough workers. 

Calls went out for young people to become poll workers – and they responded.  Organizations like Power the Polls and Poll Hero Project recruited over 650,000 new workers, most of them under 65 and many of them students.

“I just felt that I had to do something,” one student worker told The New York Times.   Another told The Christian Science Monitor:

There are a lot of stereotypes about my generation: We’re lazier, not connecting to the real world. We’re zombies to social media and our phones and stuff.  But this has truly shown me that is just not at all true. There are so many people my age who are just looking for any opportunity to get involved.”

Election Assistance Commission chairman Ben Hovland told Time: “Poll workers are really the unsung heroes of our democracy.” He’s right.

But, of course, once all those votes are cast they have to get counted, and that leads to a second group of unsung heroes of democracy.  Those are the people sitting in those drab offices and warehouse deciding which ballots are valid and ensuring they get properly counted.  They’re set up as bipartisan teams, usually with election observers watching the process. 

In 2020, unfortunately, they’re the ones also risking catching CIVID-19 in the close quarters and getting threats of physical violence, even death threats.  The President and his allies are constantly questioning their motives, challenging their tallies and gathering outside counting spots to protest. They’re demeaning the hard work and long hours the workers have been putting in. 

One nonpartisan poll watcher saw partisan observers harassing election workers, telling WaPo:

That was the most heartbreaking part.  I felt for those workers. I could only imagine what it would feel like, trying to do your job, having these people hover and sneer at you and yell at you and make something so simple, something that’s supposed to be so patriotic, so hard.

Despite all that, the Registrar in Clark County (NV) spoke for all his compatriots, insisting to WaPo: “We’re going to be okay.  We’re going to continue to count. We will not allow anyone to stop us from doing what our duty is.”

“It’s a risky thing to do, but it’s essential work,” one such worker proudly told NYT. 

Meanwhile, the U.S. is nearing 10 million COVID-19 cases and a quarter of a million deaths, setting new daily records for cases and hospitalizations, both nationally and in a majority of states.  ICU beds are in short supply, as is PPE.  As bad as the spring was in the northeast, the fall is proving to be just as frightening, and the winter threatens to be even worse.

Speaking of unsung heroes, the last count – well over a month ago — for health care worker deaths from COVID-19 topped 1,700 in the U.S. alone. 

Health systems are again resorting to recruiting contract health care workers, often from other states USA Today reports: “Hospitals in nearly every state are recruiting contract nurses to fill shifts,” often paying “crisis rates.”  One emergency room physician added: “Pretty much every nurse who wants a job right now in the United States has a job.”

These are the workers whom President Trump accused of falsely inflating COVID-19 counts in order to get paid more.  It’s not clear if he was including the Walter Reed staff who saved his life when he contracted COVID-19.   

“Trump has insulted our integrity and allowed for more than seven months of chaos and excessive deaths (due) to COVID,” one ER physician told CNBC.  Another lamented that so many still voted for President Trump: “I really thought that our experiences in the trenches would impact people’s voting decisions.” 

The poll workers showed up to work.  The ballot counters showed up to work.  The nurses, medical technicians, aides, doctors, pharmacists, and other healthcare workers showed up for work.  It isn’t always, or even usually, glamorous, and, for most of them, it’s not even particularly well paid. But they do it anyway, despite the risk of COVID, despite the criticisms, despite even the threats,

The least we could do is to be grateful, and not make their jobs even harder.  Let’s make them unsung no more. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

One of the most important responsibilities of the American government is to protect its citizens from harmful industry practices, from lead poisoning to dangerous pharmaceuticals to financial meltdowns. Its record is far from perfect, but government regulators usually act in good faith and in turn earn the trust of those they protect. As we head into Tuesday’s election, it’s important to shine a spotlight on the fact that the Trump administration has betrayed that trust yet again. They have allowed low-quality, unregulated forms of insurance called Short-Term Limited Duration Insurance (STLDI) to prey upon those who lost their jobs during this pandemic. Also known as “junk” insurance, this issue has gotten far less attention than the need to protect people with pre-existing conditions. But the consequences of its inadequate coverage can be just as devastating.

Only 57% of STLDI plans cover mental health care, only 29% cover prescription drugs, and virtually none cover pregnancy. These plans are also allowed to discriminate against the sick, which most do in order to save money. STLDI managed to penetrate the market through a combination of cheap prices, lucrative broker incentives, and deceptive marketing.

Consumers get very little back for their money with these plans. Plans on the Affordable Care Act’s exchanges must spend 80 cents out of every premium dollar collected on care. In 2018, the top five STLDI insurers spent only 43 cents.

Originally envisioned as short-term solutions to gaps caused by unexpected coverage loss, the Trump administration extended their maximum length from three to 12 months and allowed renewals that can essentially extend them to three years, thus drawing consumers away from the individual markets established under Obamacare. This was essentially a kick in the gut for the law, after the current administration was unable to win any legislative or court battles against it.

These last few years, the shortcomings of these plans have been blindsiding consumers, leaving some with hefty bills for $200,000 heart surgeries and $800,000 cancer treatments. But the current pandemic has exposed just how vulnerable consumers are and just how little foresight the Trump administration displayed in allowing these plans to operate freely.

An investigative report by the Economic Studies department at Brookings and the University of Southern California called STLDI brokers, agents and other salespeople posing as consumers. They found that these entities were greatly exaggerating the extent of coverage: only one out of nine provide an accurate description of the plan’s COVID-19 treatment coverage, and half of the others provided information that was demonstrably false. This is extremely concerning. With hospital bills for COVID treatment often reaching into the tens of thousands of dollars, unaware patients will be caught with devastating surprises.

States have a number of effective options to protect consumers from this junk insurance, and many have already taken action. They can limit their duration, require a minimum Medical Loss Ratio, require disclosures, prohibit pre-existing condition discrimination, and outright ban the plans, among other options. But in the absence of federal oversight, residents of many states are left unprotected.

14 million Americans are expected to lose their health coverage during this pandemic and will be unable to switch to a family member’s plan or be eligible for Medicaid. These Americans are vulnerable to these predatory plans. With the election right around the corner, it’s time for all states to protect consumers from being taken advantage of. And it’s time for the people to hold our state and federal governments accountable for our safety and consumer rights.

Rosemarie Day (@Rosemarie_Day1) is the Founder & CEO of Day Health Strategies and author of “Marching Toward Coverage:  How Women Can Lead the Fight for Universal Healthcare” (Beacon Press, 2020). 

Niko Lehman-White is a Consultant with Day Health Strategies.

Episode 30 of “The THCB Gang” was live-streamed on Thursday, October 29th! Watch it below!

Matthew Holt (@boltyboy) was joined by some regulars and this episode was a spooky be a COSTUME PARTY! On this episode were data privacy expert Deven McGraw (@healthprivacy), writer Kim Bellard (@kimbbellard), health economist Jane Sarasohn-Kahn (@healthythinker), CTO of Carium Health Lygeia Ricciardi (@Lygeia), MD & hospital system exec Rajesh Aggarwal (@docaggarwal), policy & tech expert Vince Kuraitis (@VinceKuraitis), and me, THCB’s Editor-in-Chief (@zoykskhan). The conversation had a more spooked tone to it as many of us are worried about the safe transition of power, the safety of voters, the misinformation about herd-immunity, the rising COVID-19 cases, and everything happening in the Senate. What will the results of November 3rd bring for this country?

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan, producer