March Recess

Intro: ACA At 10 

March 23 is the 10 year anniversary of the passage of the Affordable Care Act. Since this landmark anniversary falls during March recess, it’s the perfect opportunity to remind Americans of the positive impact that the ACA has had on the lives of millions of Americans and of the existential threat to Americans’ health care posed by the Trump administration and their Republican allies. 

To mark the anniversary, Protect Our Care is putting on a multi state tour in key 2020 battleground states kicking off Sunday, March 15 and traveling to Minnesota, Iowa, Wisconsin, Michigan, Pennsylvania, North Carolina and Washington, DC. Protect Our Care will also be marking the anniversary with 10 days of action highlighting the specific ways the Affordable Care Act has helped communities and making clear what’s at stake because of the Trump administration’s sabotage agenda and their effort to overturn the law in the courts. 

We recommend a four part message for the recess:

  • Monday the 23rd is the 10th anniversary of the ACA. The ACA has dramatically improved health care in America.
  • Republicans led by President Trump are trying to take away your care, and we must keep up the fight. 
  • The ACA makes America more safe as we battle the coronavirus.
  • Democrats in Congress are passing bills to lower costs and improve care and doing everything they can to stop Republican sabotage and efforts to turn back the progress we have made.

Texas Lawsuit Threatens the Future of the Affordable Care Act: 

Just this month, the Supreme Court announced it would hear the Trump-Republican lawsuit to overturn the ACA in its upcoming term, with briefs from the Administration expected during the summer putting the case firmly into the fall campaign. There has never been a more important time to remind constituents just what’s at stake if the law is overturned — coverage ripped away from 20 million Americans, protections for 135 million people with pre-existing conditions eliminated and our health care system thrown into chaos. 

The ACA is Vital for a Successful Coronavirus Response: 

The GOP’s assault on Americans health care comes as Americans are responding to the threat of coronavirus. Imagine what would happen if 20 million Americans lost their coverage and could no longer afford care. Or if insurance companies could deny people with the coronavirus virus coverage because of a pre-existing condition.

Even worse, President Trump refuses to commit to both an affordable vaccine and affordable care for the uninsured, the number of whom has increased by millions as a result of his disastrous policies. In fact, President Trump’s push for short-term junk plans that do not include ACA protections, have already left patients seeking coronavirus treatment with thousands of dollars in medical bills. 

This packet provides fact sheets and message guidance on all these issues. If you’d like to work with Protect Our Care in your district, contact Anne Shoup at [email protected].

 

 

ACA At 10: Expanded Access To Affordable Care

Ten years ago, the Affordable Care Act (ACA) became the law of the land and millions of Americans gained coverage and critical protections as a result. Today, the ACA is more popular than ever and Americans are benefitting every day from the health care law. Meanwhile, the Trump administration and its Republican allies are trying to take those benefits away by fighting the law in Congress and in the courts. It’s no surprise that Democrats are trusted far more than Republicans to continue to protect people’s care and lower costs. While Democrats continue to put forth measures to strengthen the ACA, Republicans want to rip away coverage and raise costs across the board.

Here is how the Affordable Care Act is working across the country:

  • More than 20 million Americans gained health coverage. Because of the ACA, more than 20 million Americans gained health coverage.

  • 13 million people have coverage through the individual market. Last year, 13.3 million people were covered by marketplace or non-marketplace plans subject to ACA consumer protections. 82 percent of those enrolled through the marketplace were satisfied with their plans.

  • Insurers can no longer deny or drop coverage because of a pre-existing condition. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge you more because of a pre-existing condition. More than 135 million Americans have a pre-existing health condition.

  • Women no longer charged more than men. Because of the ACA, insurers can no longer charge women more than men for the same care, and insurers are now required to cover important health benefits like maternity care. Before the ACA, 75 percent of non-group plans refused to cover maternity care.

  • Ended annual and lifetime limits. Because of the ACA, insurers can no longer put annual or lifetime limits on the care you receive.

  • Young adults can stay on their parents plan until age 26. Because of the ACA, roughly 2.3 million young adults have coverage because they can stay on their parents coverage until age 26.

  • Allowed states to expand Medicaid. Because of the ACA, states can get additional federal money to expand Medicaid. More than 17 million Americans have coverage through Medicaid expansion.

  • Free preventive care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes nearly 137 million Americans, most of whom have employer coverage.

  • Comprehensive Coverage. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and substance and mental health.

  • Tax credits are available to help people afford coverage. Because of the ACA, most people getting coverage on the marketplace qualify for tax credits to help pay for coverage. 8.9 million of the ACA’s 11.4 million marketplace enrollees receive premium tax credits.

  • Improved access to care and financial security. Between 2010 and 2018, the share of non-elderly adults with a problem paying a medical bill fell by 17 percent, the share who didn’t fill a prescription fell by 27 percent, the share who skipped a test or treatment fell by 24 percent, and the share who didn’t visit a provider when needing care fell by 19 percent.

  • Helping seniors afford prescription drugs. Because of the ACA, the Medicare prescription drug donut hole is closed. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

  • Helping increase access to employer-sponsored coverage. The Affordable Care Act’s individual and employer mandates are credited with helping increase rates of employer-sponsored health insurance. The Kaiser Family Foundation estimates that between 2013 and 2017, seven million more people gained employer coverage, nearly as many as gained coverage through the ACA marketplaces.

Supreme Court Will Decide Fate Of Trump-Texas Lawsuit In Upcoming Term

Earlier this month, the Supreme Court announced it would grant cert in the Trump-Republican lawsuit to overturn the Affordable Care Act. This means arguments will likely be held next fall–just as voters prepare to cast their 2020 ballots. If President Trump and his allies are successful, 135 million Americans with pre-existing conditions will lose protections and 20 million Americans will lose coverage. Every serious legal scholar agrees that this Trump-Republican lawsuit is entirely without merit. Every Republican who claims to care about health care should tell the president to drop this lawsuit.

 

Fact Sheet On Trump Lawsuit To Overturn ACA

President Trump is trying to rip apart our health care by going to court to eliminate the Affordable Care Act in its entirety. If the Trump lawsuit is successful, it will strip coverage from millions of Americans, raise premiums, end protections for people with pre-existing conditions, put insurance companies back in charge, and force seniors to pay more for prescription drugs. The result will be to — as the Trump Administration itself admitted in Court — unleash “chaos” in our entire health care system. 

If the Affordable Care Act is struck down:

  • GONE: Protections for 135 million Americans with pre-existing conditions. The uninsured rate will increase by 65 percent. 
  • GONE: Medicaid expansion, which covers 17 million people. 
  • GONE: Nearly 12 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
  • GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
  • GONE: Insurance companies will be able to charge women 50 percent more than men.
  • GONE: Financial assistance that helps 9 million people purchase health care in the marketplace.
  • GONE: Key support for rural hospitals. As Americans lose coverage, already struggling hospitals will be hit even harder as their costs increase.
  • GONE: Ban on insurance companies having lifetime caps on coverage.
  • GONE: Requirements that insurance companies cover prescription drugs and maternity care.

Thanks To The Republican Lawsuit, 20 Million People Could Lose Their Coverage

  • According to the Urban Institute, 19.9 million people could lose coverage by repealing the Affordable Care Act, meaning the number of uninsured Americans would increase from 30.4 million to 50.3 million, representing a leading to a 65 percent increase in the uninsured rate. As the uninsured rate swells, so will the amount of uncompensated care, which Urban predicts will grow by at least 82 percent.
  • States would lose important federal health care funding — an estimated reduction of $135 billion in the first year. The Urban Institute estimates that a full repeal of the ACA would reduce federal spending on Medicaid/CHIP care and Marketplace subsidies by $135 billion, or 34.6 percent in the first year.
  • Millions of children could lose their coverage. Almost three million children nationwide gained coverage thanks to the ACA. If the law is overturned, many of these children will lose their insurance.
  • The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if the lawsuit succeeds in overturning the ACA. 

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 135 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders

Republicans Want To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies have license to do this again.

 

  • A 2009 congressional report found that the of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five year period

  • An analysis by Avalere finds that “102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs” if the Trump-GOP lawsuit is successful.

Republicans Want To Give Insurance Companies The Power To Charge You More, While Their Profits Soar

  • 138 Million Americans Could Once Again Have To Pay For Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes nearly 138 million Americans, most of whom have employer coverage.

  • Women Can Be Charged More Than Men For The Same Coverage. Prior to the ACA, women, for example, were often charged premiums on the nongroup market of up to 50 percent higher than they charged men for the same coverage. 

  • People Over The Age of 50 Can Face A $4,000 “Age Tax.” Thanks to the Republican lawsuit, insurance companies can charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to the AARP.

  • Nine Million People In The Marketplaces Will Pay More For Coverage. Thanks to the Republican lawsuit, consumers no longer have access to tax credits that help them pay their marketplace premiums, meaning roughly nine million people who receive these tax credits to pay for coverage will have to pay more.

  • Seniors Will Have To Pay More For Prescription Drugs. Thanks to the Republican lawsuit, seniors will have to pay more for prescription drugs because the Medicare “donut” hole got reopened. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

Republicans Want To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

  • Reinstate Lifetime and Annual Limits On 109 Million Privately Insured Americans. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage for those insured through their employer or on the individual market.

  • Insurance Companies Do Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.

  • Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB) in even some states, states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.

Republicans Want To End Medicaid Expansion

  • Seventeen Million People Enrolled Through Medicaid Expansion Could Lose Coverage.

  • Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in ten, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.

  • Key Support For Rural Hospitals Would Disappear, leaving hospitals with $9.6 billion more in uncompensated care. 

Trump’s Health Care Sabotage Left The U.S. Unprepared For Coronavirus

The Trump administration’s sabotage of health care does not stop at increasing costs and reducing coverage. It also includes failing to adequately protect Americans from infectious disease outbreaks. From budget cuts to leaving key positions unfilled to making it harder for people to access health care, the administration has worked the last three years to undermine and dismantle our pandemic response apparatus, leaving Americans more vulnerable to the coronavirus outbreak

Trump Once Again Sought Cuts To Key Programs For Global Disease Response In His 2021 Budget. In his 2021 budget, Trump proposed steep cuts to the two agencies in charge of the coronavirus response, seeking to reduce NIH funding by $3.7 billion and CDC funding by $1.29 billion. He previously proposed cutting global health funding in his 2020 budget from more than $10 billion to $8 billion, its lowest level since 2008. Per Foreign Policy, other Trump-backed efforts included “reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS.” 

Trump Dismantled The NSC’s Entire Global Health Security Unit And Failed To Fill Other Key Public Health Vacancies, Leaving The Country “Ill-Prepared” For A Global Pandemic. In 2018, the Trump administration dismantled the entire global health security unit at the National Security Council, reassigning its leader, Rear Adm. Timothy Ziemer, a long-time public health official who had served under both the Bush and Obama administrations. Additionally, Tom Bossert, another key official for infectious disease preparedness and biodefense strategy, left that same year. No one has since filled these positions. Moreover, Trump has pursued cuts to the global health section of the CDC so severe that the number of countries it was working in decreased from 49 to 10. In 2017, the Washington Post reported that Trump had “failed to fill crucial public health positions across the government, leaving the nation ill-prepared” for a global pandemic.”

Trump’s Recent Proposal To Block Grant Medicaid Threatens The Ability to Respond to Outbreaks. Under the Trump administration’s proposed block grant, federal funding would no longer necessarily increase in response to a public health emergency. This could lead to people losing coverage and access to care, undermining prevention and treatment of diseases nationwide. 

Trump’s Texas Lawsuit And Other Efforts To Repeal The ACA Would Cut Key Funding From The CDC. GOP repeal bills would have eliminated the Affordable Care Act’s Prevention and Public Health Fund. In 2017, the Washington Post reported that this fund “provides almost $1 billion annually to CDC, now about 12 percent of CDC’s budget. It includes prevention of bioterrorism and disease outbreaks, as well as money to provide immunizations and heart-disease screenings.” The Trump administration is currently supporting a lawsuit that could repeal the ACA in its entirety, and there is no plan to maintain this funding if the courts overturn the health care law. 

Trump Is Spreading Misinformation About The Outbreak. On January 30, 2020, Trump tweeted: “Working closely with China and others on Coronavirus outbreak. Only 5 people in U.S., all in good recovery.” But as Time noted, “a sixth case of the virus had already been confirmed, and public health experts said it was not yet clear that those infected were ‘all in good recovery.”’ A few days later, without evidence, Trump claimed “we’ve pretty much shut it down.”

Talking Points: Coronavirus 

The Trump administration’s response to the growing threat of coronavirus makes America less safe.

  • The president and his allies need to take the partisanship and politics out of this conversation and focus on his job of protecting the American people.
  • Trump continues to focus more on his own reelection and holding rallies than taking responsibility and doing the work necessary to keep Americans safe. Calling the virus a hoax when lives are at stake is unconscionable.
  • President Trump already has a credibility problem, and what Americans need during a public health crisis is a leader who tells the truth, respects the experts, and doesn’t make it about himself or his political interests. People need information they can trust to protect their families and business people must have confidence in the information they need to make decisions.
  • The president needs to stop muzzling the scientists and experts at CDC and NIH so that they can do their job and Americans have information they can trust. 

America is paying the price now for Trump’s earlier decisions to cut budgets for preparedness and dismantle proven programs to stop pandemics from reaching our shores. His efforts to repeal the Affordable Care Act would leave millions at even greater risk.

  • Last month, Trump proposed billions of dollars in cuts to HHS and CDC’s budgets, including programs specifically designed to protect us from possible pandemics like coronavirus. 
  • Trump dismantled two critical initiatives established after the Ebola outbreak that were keeping us safe — one within the White House National Security Council and another within the Department of Homeland Security. 
  • The president is in court trying to take health insurance away from 20 million Americans, which would make it harder for them to get health care if they get sick and increase the chance of transmitting the disease to others. The Affordable Care Act also guarantees free vaccinations for especially dangerous diseases.

The administration’s effort is simply not what it should be to deal with a serious outbreak. 

  • Local governments, businesses and families don’t have the trusted information they need to make the best decisions.
  • Hospitals are worried about not having enough face masks and protective clothing.
  • Front line health care workers and first responders are not getting the training they need.
  • We still don’t have the testing capacity we need. 
  • We still don’t know who is truly in charge of the administration’s response. Is it the president who calls it a hoax? The vice president who is spending his days at fundraisers and campaign events? The HHS Secretary who has said we have to protect drug company profits even if that means people won’t be able to afford a life saving vaccine?

The vice president is not the right person to lead our response efforts. 

  • Mike Pence’s anti-science views and record on public health make him the last person who should lead this response effort. 
  • Mike Pence has a terrible record of dealing with public health crises: as Governor of Indiana he was widely criticized for his handling of an HIV outbreak in the state and defended the tobacco companies by saying smoking doesn’t kill people. 
  • Does anyone really believe the vice president would choose the truth over the president’s reelection messaging?
  • Pence’s first public acts as our new coronavirus czar were to give a speech at the hyperpartisan CPAC conference followed by a high-dollar fundraiser in Florida. That alone shows you the lack of seriousness by which this administration is preparing for this threat. 

Ebola response contrast: During the Ebola outbreak, President Obama believed the science, let the experts speak and left the politics out of his response. 

  • Unlike President Trump, President Obama was deeply and personally engaged in his administration’s response to the Ebola outbreak in 2014. 
  • President Obama regularly presided over Cabinet meetings, understood and followed the science and respected the experts. 
  • President Obama instilled trust in the response effort and Americans understood he wasn’t playing politics with people’s health.
  • The Obama administration invested in global health and established a team at the NSC to be sure America was working every day to prevent and prepare for the next possible pandemic. President Trump dismantled that team, ended effective preventative programs that helped keep infectious diseases that begin outside of America from reaching our shores and repeatedly tried to cut billions from the budgets on HHS and CDC.

Here is what we should be doing:

  • The American people need to trust the president to follow the science and put the health of Americans first. State and local leaders, families and the business community need information they can trust to make the right decisions. They need to know and trust the people in charge.
  • The president should take the politics and partisanship out of the response effort, unmuzzle the experts and stop calling it a life threatening outbreak that has already taken American lives a hoax.
  • He should focus more on safeguarding the American people and less on trying to prop up the stock market.
  • We need to get our hospitals and health care workers trained and protected. We need to be sure they have the drugs, masks and protective clothing they need.
  • We need to help our hospitals be ready so when cases grow we can treat everyone who needs care and do it safely.
  • We need to be able to help local governments, hospitals and people address the economic costs that a serious outbreak will cause.
  • We need to guarantee that any vaccines or treatments developed for coronavirus are available and affordable to all Americans whether they have health insurance or not. We need to put peoples’ health over Big Pharma’s profits.
  • And the president needs to stop trying gut Medicaid and destroy the ACA. Imagine if we had 20 million more people uninsured and unable to get treatment when they need it.

Poll: Americans Think Coronavirus Threat Is Very Real; Unhappy With Trump

From: Tom Jensen, Public Policy Polling

To: Interested Parties

Subject: Americans Think Coronavirus Threat Is Very Real; Unhappy With Trump

Date: March 5, 2020

A new national Public Policy Polling survey finds that voters are very concerned about the coronavirus and strongly disapprove of the administration’s response. 

72% of voters say they’re concerned about the impact the virus will have on the economy, including 36% who say they’re ‘very concerned.’

57% of voters say they’re concerned that they or someone in their family will get sick from the virus, including 24% who say they’re ‘very concerned.’

Voters take the virus a lot more seriously than the president does. Only 8% of voters agree with Trump’s claim that the virus is a Democratic hoax, while 82% think the virus is real. Only 16% of Trump’s own voters agree with him that the virus is a hoax.

Trump’s handling of the coronavirus could threaten his reelection. By a 20-point margin, voters say his administration’s handling of the virus makes them less likely to vote for him this fall. Independents say they’re less likely to vote for Trump by 32 points because of how he’s dealt with this issue. Only 37% of voters agree with Trump’s assessment that his administration is doing a “great job” dealing with the coronavirus, while 53% disagree.

Voters are also concerned about the administration’s failure to commit to an affordable coronavirus vaccine – 67% of voters have serious concerns about the administration’s statement that “they can’t control that price.” 61% of voters also have serious concerns with the administration’s advice –“tell people to turn their televisions off for 24 hours” — in response to the historic decline in the stock market.

Public Policy Polling surveyed 866 registered voters on March 2nd and 3rd on behalf of Protect Our Care. The survey’s margin of error is +/-3.3%.

Read the full polling results here.

On Coronavirus Affordability, Trump Fails the Test

As worries about the spread of coronavirus rise, President Trump and his administration have failed to address concerns over the affordability of a future vaccine, treatment and testing. The lip service they have paid to the issue is belied by a health care record which includes a spike in the uninsured and a relentless war on coverage and protections afforded to millions through the health care law. 

BACKGROUND:

The Trump administration has not committed to making the vaccine affordable. The Trump administration has failed to commit to making a potential coronavirus vaccine affordable. While the spending package passed in Congress includes some affordability language, Trump has made no plans to address access to treatment for the uninsured. 

Trump is pushing short-term junk plans that would not need to cover coronavirus treatment. Junk plans do not need to comply with the consumer protections established by the Affordable Care Act, including coverage of essential health benefits. The expansion of junk plans under Trump has already led to reports of patients receiving thousands of dollars in unexpected medical bills. 

The uninsured rate is rising under Trump. Uninsured individuals are far less likely to seek medical treatment when they are sick. Amid growing concern about what would be done for uninsured patients seeking coronavirus tests, the Trump administration has so far deflected the problem. While Trump said the White House would “see if we can help them out,” Pence refused to answer questions on this subject altogether. At least 7 million people have already lost coverage under Trump, and experts warn that recent enactment of anti-immigration policies will only serve to deter more people from gaining coverage and seeking medical treatment.

Making matters worse, Trump is backing a lawsuit that would rip away coverage from 20 million people. The Trump administration is currently backing a lawsuit that overturn the Affordable Care Act and, if they are successful, 20 million people would lose insurance overnight. 

The administration’s promise to make coronavirus treatment an “essential health benefit” rings hollow and does not solve the problem of affordability. Any reliance on essential health benefits leaves millions of Americans out in the cold. EHBs only apply to ACA-compliant plans, which the administration is trying to eliminate through their lawsuit. EHBs are also subject to cost-sharing and deductibles, making treatment out of reach for many families. Per the New York Times’ Margot Sanger-Katz, “a change to EHB would require some sort of regulatory change. HHS has issued no new rule or guidance on this matter so far.” 

Americans have already received steep bills for seeking coronavirus treatment. One man in Florida who had traveled to China sought treatment for coronavirus symptoms and ended up with thousands of dollars in medical bills. A Pennsylvania man who had been quarantined with his daughter after returning from China received nearly $4,000 in medical bills. There has been no response from the administration on how to address existing medical bills from coronavirus. 

Republicans continue to reject guaranteed paid sick leave. Many experts have pointed out that American workers face serious barriers to taking time off when they are sick, which could contribute to the spread of the virus. As it stands, about 33.6 million workers do not have access to paid sick leave, and Republicans continue to block the passage of paid sick-leave legislation. During his appearance on Sean Hannity’s program on Fox News, Trump implied that it was all right for people to continue to go to work while sick. 

State-By-State Facts Sheets