Federal and State Responses to COVID-19

Duck and cover!

by James C. Sherlock

The federal government’s relationships with state and local governments is defined by the U.S. Constitution. Presidential management of internal national crises is constrained by lack of command authority over the states. No governor works for the President. He cannot order them to do anything, even in wartime. He can take control of industries, but not state governments. If the President nationalizes the National Guard, the Guard loses its ability to enforce state laws or respond to the Governor. And no, I don’t think we need to change our constitution.

The most complete restructuring of the federal government in my lifetime was the creation of the Department of Homeland Security after 9/11 and a complete rewrite of the National Response Plan. Giving birth to that full-grown mastodon was as noisy and bloody as you can imagine. After its birth, it was very awkward for a time. FEMA, now an element of DHS, existed at 9/11 exclusively as an agency that wrote checks upon the Presidential implementation of the Stafford Act. Although all of the plans and programs were restructured in 2002 and 2003, FEMA had that same role when Katrina happened in 2005.

After Katrina, the National Response Plan (NRP) was re-written again. The lessons learned from that tragedy resulted in a major restructuring of FEMA to support a national emergency command center and greatly improve its logistics capabilities, but those logistics capabilities still largely lie with check writing to implement contracts negotiated both before and during crises. Virtually every other major federal agency has a role in federal response coordinated by FEMA with participation of other federal agencies defined in plans specific to the type of emergency. The White House has its own staff to support the president and direct the federal agencies.

State Annexes to the NRP- and the HSS-funded Hospital Preparedness Program (HPP) are written by the states on templates provided by the federal government, and the effort to create and refine them is funded by the federal government. The federal templates ensure that state response and federal responses have the same playbook, use the same terminology and have parallel structures to enable real-time coordination. The federal government supplies the materials and funds state training and exercises. But participation by a state in those training and exercise programs is voluntary. Some do more, some do less. Some officially participate but the key leaders do not.

Over 10 years of working within this system before my retirement, it was my professional observation that states have been led to water by federal efforts and funding. Some of them drink, some don’t. Most of that pertains to training and exercises. Others are about equipment and state emergency supplies. I related my story about Louisiana Gov. Blanco’s failure to accept the Department of Defense’s offer of free emergency systems upgrades in 2004 that would have made a huge difference during Katrina. I did not mention that she was never present during the demonstrations of that technology in her Emergency operations center.

So, the fact that the President’s task force reports supply and logistics data that seem to be refuted by local reports of shortages makes perfect sense to me based on my experience with the system. Federal logistics is not a “last mile” system by design. If you think about it, the federal government really cannot be expected to perform that role in 50 states simultaneously. Under the existing system, it delivers supplies and equipment to state-designated supply centers. It is the responsibility of the state to get them to hospitals and other care providers on a prioritized basis — each state because of the federal templates has plans in place to do that. Not every state has rigorously exercised those plans pre-crisis. So, what we get is what we see happening. The President yesterday recommended that governors who are not doing so should use the National Guard to distribute federally-provided supplies and equipment. They should have been way ahead of him.

Remember, all of this in future years when you choose your Governor. Ask each candidate how they will lead the Commonwealth in an emergency and inspect their records to see if such leadership can be reasonably expected. The General Assembly will have to assert oversight of state emergency training and exercise programs with new law. I expect that Governor Northam will be eager to sign such a law.

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10 responses to “Federal and State Responses to COVID-19

  1. Thank you, Jim, This column makes it crystal clear that there is a division of labor in disaster preparedness — mandated by the constitution, federal law, the structure of the federal bureaucracy, and by federal and state preparedness plans — between the federal and state government. Uncle Sam has certain responsibilities, the states have certain responsibilities.

    The United States has a national press corps devoted to tracking federal-level issues, in particular the actions of the Trump administration. The Commonwealth of Virginia has a shriveled media contingent to monitor and critique the actions of the Northam administration. Given this blog’s focus on state/local government, our focus is on the Northam administration’s disaster preparedness and response to COVID-19, not President Trump’s.

    So, if you’re one of those who say, but, but, but… what about Trump… why aren’t you criticizing Trump? That’s why.

    Here at Bacon’s Rebellion, we will do the best we can with the limited resources we have available to hold the Northam administration accountable. That’s not because Northam is a Democrat, or because we don’t like his policies, it’s because that’s our job as local publication to point out both what the Governor of Virginia is doing right, what he’s doing wrong, and what he should do but hasn’t done yet.

  2. “Over 10 years of working within this system before my retirement, it was my professional observation that states have been led to water by federal efforts and funding. Some of them drink, some don’t. Most of that pertains to training and exercises. Others are about equipment and state emergency supplies …

    Federal logistics is not a “last mile” system by design. If you think about it, the federal government really cannot be expected perform that role in 50 states simultaneously. Under the existing system, it delivers supplies and equipment to state-designated supply centers. It is the responsibility of the state to get them to hospitals and other care providers on a prioritized basis — each state because of the federal templates has plans in place to do that. Not every state has rigorously exercised those plans pre-crisis. So, what we get is what we see happening …” End Sherlock quote.

    So what has happened on these issues in the past in Virginia by Virginia state officials and Virginia health care industry?

    And what in this regard has not happened in Virginia? And if so, why not?

    As I recall Trump today is in Virginia on these issues. In Farmville, at a Walmart as I recall.

  3. Nice article James – It is nice to have this perspective.

    My one question is that, shouldn’t the Federal government be the one to step in to lead the procurement of supplies? It seems that most of the states have to compete amongst one another (as well as the Federal government itself) for needed supplies, ventilators, and testing materials. Should it be the role of the Federal government to acquire these materials and then divvy these up to states based on need and deliver them to state designated supply centers as you stated?

    • At this point, yes, and the federal government has centralized procurement. But the states each had a responsibility to stockpile needed equipment and supplies for pandemic virus response for their own health systems before the crisis. Some did, some did not. Same with exercising the last mile logistics systems for delivery of federal equipment and supplies. Some did, some didn’t.

  4. Bureaucracy, red tape and inefficiency grows with the size of government. The federal government is good at moving money (collecting and distributing), national defense, federal courts, foreign relations and some other things that need to be done once. Local governments, which can be strapped, are better at focusing on specific needs that often change quickly. State governments, which are sovereign, are in the middle. I think states, often with federal money and federal statutory or regulatory power, are the best entities to manage crises in their states. A state can probably respond to the need for purchasing supplies needed within itself.

    If the feds purchase and distribute supplies, there will be fights over who got what, who has the biggest needs, etc. Witness the City of Washington, D.C. whining because its not treated as state for purposes of one of the aid bills. Why should Washington be given more money than Baltimore or Milwaukee?

    I like the idea that Jeff McKay and the other Fairfax County supervisors are focused on the needs of the county’s residents. While they need financial help, they will do a helluva lot better job at identifying and satisfying those needs than the feds. Similarly, Northam has a better feel for what’s needed and where it’s needed in Virginia than the feds. The Commonwealth needs money but can be a lot more responsive to the needs of Virginia.

  5. “Northam has a better feel for what’s needed and where it’s needed in Virginia than the feds. The Commonwealth needs money but can be a lot more responsive to the needs of Virginia.” Indeed! He may have a better feel for what’s needed, but what’s he doing about it? To NoVa, Richmond has been a black box! In this situation, opaque leadership is no leadership at all.

  6. Add together the number of sworn officers in Fairfax, Loudoun and Arlington Counties and it’s considerably more than the number of Virginia state policemen and special agents. Localities have the manpower necessary to get things done at scale. The state does not. Unless localities decide to enforce Northam’s anti-congregating edict it will not be enforced. Ditto for immigration and gun control.

    While the Fairfax County BoS has its share of problems I have vastly more confidence in that organization than the Virginia General Assembly, governor, etc.

  7. False and corrupt walls are falling round the nation.

    For example, this from “Florida’s Pioneering Medical Reforms. (other states should repeal rules they’ve temporarily relaxed to deal with to corona virus.)” …

    The Covid-19 epidemic is putting new strains on the U.S. health-care system. Many states are struggling with shortages of ventilators and personal protective equipment. But the shortfalls aren’t limited to hardware. According to the Association of American Medical Colleges, the U.S. will face a shortage of as many as 122,000 physicians by 2032.

    We recently published a study outlining state-level reforms to address the shortage, many of which one state—Florida—has already adopted. Other states are beginning to recognize the benefits of these reforms and are adopting measures to implement them temporarily.

    Thirty-five states and the District of Columbia have certificate-of-need laws, which require clinics and hospitals to complete a lengthy and burdensome approval process before adding new facilities and services. Florida repealed most of its certificate-of-need requirements last year. Within weeks, three hospitals that had previously had their expansion plans stymied announced immediate plans for new transplant services. Two other hospitals indicated that they would also expand in the near future. North Carolina and others are suspending laws that prevent hospitals from expanding their number of beds. …

    Even if states repeal certificate-of-need laws, medical facilities are likely to be overwhelmed by the surge of Covid-19 patients. Telemedicine can alleviate some of this strain by allowing for remote treatment. As infections approach their peak, technology will be essential to providing care for at-risk populations—like the elderly and immunocompromised—while keeping health-care workers safe. …

    Last year, Florida enacted substantial reforms to facilitate the adoption of telemedicine. These included a registration process allowing professionals in other states to provide telemedicine services without obtaining an additional license to practice in Florida …” End Quotes by Mr. Sal Nuzzo, vice president of policy at the James Madison Institute. Mr. Victtorio Nastasi is a policy analyst at the Reason Foundation.

    For more of editorial in today’s Wall Street Journal see:
    https://www.wsj.com/articles/floridas-pioneering-medical-reforms-11585694842

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