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This story first appeared at ProPublica. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

Emergency room doctors and nurses many of whom are dealing with an onslaught of coronavirus patients and shortages of protective equipment — are now finding out that their compensation is getting cut.

Most ER providers in the U.S. work for staffing companies that have contracts with hospitals. Those staffing companies are losing revenue as hospitals postpone elective procedures and non-coronavirus patients avoid emergency rooms. Health insurers are processing claims more slowly as they adapt to a remote workforce.

“Despite the risks our providers are facing, and the great work being done by our teams, the economic challenges brought forth by COVID-19 have not spared our industry,” Steve Holtzclaw, the CEO of Alteon Health, one of the largest staffing companies, wrote in a memo to employees on Monday.

The memo announced that the company would be reducing hours for clinicians, cutting pay for administrative employees by 20%, and suspending 401(k) matches, bonuses and paid time off. Holtzclaw indicated that the measures were temporary but didn’t know how long they would last.

In a follow-up memo sent to salaried physicians on Tuesday night, Alteon said it would convert them to an hourly rate, implying that they would start earning less money since the company had already said it would reduce their hours. The memo asked employees to accept the change or else contact the human resources department within five days “to discuss alternatives,” without saying what those might be. The memo said Alteon was trying to avoid laying anyone off.

“It’s completely demoralizing,” said an Alteon clinician who spoke on the condition of anonymity. “At this time, of all times, we’re putting ourselves at risk but also putting our families at risk.”

Some co-workers are already taking on extra burdens such as living apart from their families to avoid the risk of infecting them, the clinician said. “A lot of sacrifices are being made on the front line that the administration is not seeing because they’re not stepping foot in a hospital,” she said. “I’ve completely lost trust with this company.”

Other employers will soon follow suit, Holtzclaw said, citing conversations with his counterparts across the industry. “You can be assured that similar measures are being contemplated within these organizations and will likely be implemented in the coming weeks,” he wrote.

However, another major staffing company for emergency rooms, TeamHealth, said its employees would not be affected. “We are not instituting any reduction in pay or benefits,” TeamHealth said in a statement to ProPublica. “This is despite incurring significant cost for staffing in anticipation of surging volumes, costs related to quarantined and sick physicians, and costs for PPE as we work hard to protect our clinicians from the virus.”

Alteon and its private-equity backer, Frazier Healthcare Partners, didn’t immediately respond to requests for comment.

Private equity investors have increasingly acquired doctors’ practices in recent years, according to a study published in February in JAMA. TeamHealth was bought by Blackstone Group in 2016; another top staffing firm, Envision Healthcare, is owned by KKR. (The staffing companies have also been implicated in the controversy over “surprise billing.”)

Hospital operators have also announced cuts. Tenet Healthcare, a Dallas-based publicly traded company that runs 65 hospitals, said it would postpone 401(k) matches and tighten spending on contractors and vendors. Emergency room doctors at Boston’s Beth Israel Deaconess Medical Center have been told some of their accrued pay is being held back, according to The Boston Globe. More than 1,100 staffers at Atrius Health in Massachusetts are facing reduced paychecks or unpaid furloughs, and raises for medical staff at South Shore Health, another health system in Massachusetts, are being delayed. Several other hospitals have also announced furloughs.

“We all feel pretty crestfallen,” another ER doctor employed by Alteon said in a text message. “I did expect support from our administrators, and this certainly doesn’t feel like that.”

At Alteon, Holtzclaw wrote that the measures were necessary despite relief available from the $2 trillion stimulus that Congress passed last week. Those provisions include deferring payroll taxes, suspending reimbursement cuts and receiving advance Medicare payments.

Alteon’s pay cut doesn’t affect hourly rates for clinicians, but some of the people characterized as administrative employees are practicing doctors such as medical directors, according to one who spoke on the condition of anonymity. In his case, he said the cut amounts to about $20,000 a year.

“Every day I’m in county and federal emergency meetings. This is besides seeing patients. I’m doing more hands-on work right now than ever before,” he said. “I’m getting calls 24/7 from the hospital administration, the county management team. I have not had a day off in over two weeks. And I’m working all this for 20% less.”

The medical director said he understood the company has to cope with lost income, but he wished the leadership had let employees choose among a range of sacrifices that would best suit their individual circumstances.

“This decision is being made not by physicians but by people who are not on the front lines, who do not have to worry about whether I’m infecting my family or myself,” he said. “If a company cannot support physicians during the toughest times, to me there’s a significant question of integrity.”

Another Alteon physician said he had been planning to ask for time off to go help out in New York, where the coronavirus outbreak is the worst in the nation. Now he has no paid time off, and he thinks his employer won’t support him if he gets sick. He said if his pay drops he’ll have to look for a new job.

“I have a huge loan payment. I have rent. I have groceries. I’m not going to sacrifice my life for when I get sick and they’re going to say, ‘You were replaceable,’” the physician said. “I cannot believe they did that to us.”

Claire Perlman and Maryam Jameel contributed reporting.

Update, April 1, 2020: This article was updated to add details from a follow-up memo that was sent to Alteon employees after publication.

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NEW YORK (AP) — Deaths from the coronavirus topped 1,000 in New York City as officials warned that the worst of the virus’ toll is yet to come.

The city’s Health Department reported late Tuesday that nearly 1,100 people have died of the virus in the city. More than 1,500 deaths from COVID-19 have been recorded across New York state.

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The following is the first installment in a TPM series, Not Safe At Home. The series takes a look at fixes the next Congress and President should consider to how our democracy works. This essay is part of TPM Cafe, TPM’s home for opinion and news analysis. 


Throughout our nation’s history, black Americans have faced systematic disenfranchisement when it comes to the vote. Despite constitutional amendments that sought to protect voting rights, it is clear that the Constitution does not go far enough to ensuring that all Americans have access to the polls.

It is time to amend the Constitution to fix this problem. This amendment must guarantee to every American the right to vote. It should also resurrect an old idea, embodied in the 14th Amendment, and reduce the number of members of Congress apportioned to states that keep citizens from the polls.

A 28th Amendment to the U.S. Constitution should provide: “All citizens the age of 18 and over are guaranteed the right to vote. Each state shall guarantee the right to vote.” This language incorporates the spirit of prior amendments that aimed to open the door to black American voters and then goes further. It bars future voter suppression schemes. A new 28th Amendment would make the states responsible for ensuring the right to vote, turning access to the ballot box into the presumed right of every adult American.

Across a century, between 1870 and 1971, four amendments have addressed access to the ballot, but none have gone far enough. Each was intended to expand the body politic and limit the states’ capacity to suppress votes. These amendments defined what states may not do, but did not expressly guarantee any citizen the vote. The 15th amendment prohibited the states from relying upon “race, color, or previous condition of servitude” when determining who can vote but did not bar other forms of disenfranchisement. No state can consider “sex” when legislating access to the ballot pursuant to 1920’s 19th amendment. But women are not guaranteed access to the ballot box. In 1964, the 24th Amendment prohibited states from using poll taxes to keep citizens from voting. Since 1971, age for those “eighteen years of age or older,” may not be a basis for denying the vote, by the 26th amendment. Still many millions of Americans — including non-whites, women, and those who are 18 and older — cannot vote.

Voting rights in America have been persistently shaped by racism. Much of U.S. history can be told as one long struggle over the right to vote. Though the term “voter suppression” was not in use in past centuries, it was as much a part of our political culture in the 18th century as it is in the 21st.

Very early in the history of the new republic, free black Americans faced the loss of voting rights. In the wake of the American Revolution, former slaves voted in many states. In Maryland, for example, they went to the polls until 1802, when the state for the first time made “white” a pre-requisite for voting. In New York, it was 1821 when lawmakers increased the property qualification when it came to black voters, while white men were subject to no such limitation. In 1838, Pennsylvania’s constitutional convention limited the vote to “white freemen.” The African-American “appeal of 40,000 citizens threatened with disenfranchisement” failed to change white lawmakers’ minds.

In the Reconstruction era that followed the Civil War, black Americans, millions of them formerly enslaved, joined the body politic as voting citizens of the United States. Still, after a brief period of significant black political power, white officials conspired to keep them from the polls. Grandfather clauses made voting dependent upon the status of one’s forebears. Literacy and understanding requirements let local officials administer tests unevenly and with ill-intent. All-white primaries kept black voters out of party deliberations over who would appear on the ballot. Poll taxes ensured that even those who could surmount other hurdles would miss the chance to vote because of dollars and cents. Add to these obstacles intimidation and violence. The result was a 75-year long era during which the votes of black Americans in the southern states, where the vast majority had long lived, were brutally suppressed.

Consider the difference between an amendment that prohibits the states from barring people from voting because of race and one that guarantees the vote to all adult Americans. "

The 1965 Voting Rights Act was signed into law after years of sustained and risky direct action by black Americans in places like Selma, Alabama, where the state had long kept them from the polls. The decades that followed were an unprecedented era of democracy in the U.S. It did not, however, last. In the early 21st century, Republican state officials initiated a new generation of voter suppression techniques: voter ID, purging of rolls, shuttering of polling places, and the disregard of absentee ballots. In its 2014 decision in Shelby County v. Holder, the U.S. Supreme Court annulled the Voting Rights Act requirement that states with a history of suppressing non-white voters get prior Justice Department approval before changing their voting rules.

It is time to amend the Constitution’s voting rights provisions and transform limits on the states into positive guarantees to citizens. It is time to amend phrasing that falls short of making promises to members of the body politic.

Consider the difference between an amendment that prohibits the states from barring people from voting because of race and one that guarantees the vote to all adult Americans. The former leaves states at liberty to shut black voters out using ostensibly non-racial qualifications, while the latter demands that they be included. Similarly, rather than barring states from relying upon sex when determining who can vote, it would guarantee to all women the vote. What if all Americans 18 and older were promised access to the polls? These changes would initiate a powerful shift, one that transforms voting from a privilege meted out by the states into a guarantee to all American citizens.

There is, of course, reason to suspect that some states, even in the face of a Constitution that guaranteed the vote, would curtail that exercise of political power. This prospect suggests that it is also time to use a little considered provision in section 2 of the 14th Amendment. It provides that when any state deprives its citizens of voting rights, it will be penalized, automatically, by the proportional loss of that state’s members of Congress. While this section was originally limited to male citizens over twenty-one, these details have been abrogated by subsequent constitutional amendments.

This penalty is a harsh one that would reduce the political power of any state that engages in voter suppression. Take the example of Georgia where, in 2017 alone, the secretary of state cancelled the registration of 670,000 voters. What sort of penalty should the state pay for depriving those individuals — who total nearly 6.5% of the state’s overall population and an even higher percentage of eligible voters — access to the polls? The 14th Amendment provides that the cost to be paid for voter suppression must be proportional — the percentage of citizens disenfranchised determines the reduction of representation. That formula demands that Georgia should lose at a minimum 6.5% of its 14 members of Congress, the rough equivalent of one representative. Texas might lose more.

The persistence of voter suppression today suggests that the Constitution is not up to the task of guaranteeing the right to vote. On the horizon is an opportunity to adopt an amendment that would guarantee the vote to all adult Americans. This may be a far-off remedy, but imposing the terms of section 2 of the 14th Amendment need not be. Though never enforced, the language says the penalty is supposed to be automatic — “shall be reduced.” Already at our disposal is the authority to penalize those states that suppress voting rights. Until today, states have paid too small a price for keeping Americans from polls. It is time to turn up the heat. Let’s take what we know about the numbers and demand that states pay for keeping citizens from the polls with their power in Congress, and by extension the electoral college, since the number of electors there is simply the state’s number of senators and representatives. It was a good idea, one added to the Constitution in 1868, whose time has come.


Martha S. Jones is the Society of Black Alumni Presidential Professor and Professor of History at The Johns Hopkins University. She is the author of Birthright Citizens: A History of Race and Rights in Antebellum America and All Bound Up Together: The Woman Question in African American Public Culture 1830-1900.

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The following is the first installment in a TPM series, Not Safe At Home. The series takes a look at fixes the next Congress and President should consider to how our democracy works. This essay is part of TPM Cafe, TPM’s home for opinion and news analysis. 


The 2016 election of Donald J. Trump and the subsequent rightward turn of the Supreme Court are both a disaster and an opportunity for Democrats. The disaster is visible everywhere around us; the opportunity, understandably, is harder to discern. But the political system’s failure to prevent the election of a minority-backed, outrageously unqualified candidate, or to restrain him sufficiently once elected, demands that Democrats ask not just how to defeat Trump but how to fix the political system that seems prepared to ratify many of his party’s actions.

But asking questions about changing the way political power is allocated seems risky. The response is predictable: that isn’t the way the United States does things. In the popular imagination — especially among the political press — the United States’ past is a story of political stability, of battles fought sharply but within defined and persistent boundaries. The nation’s people and its policies have changed; its procedures — the argument goes — have not and therefore should not.

While this preference for stability may be justified as strategy, it is vacuous as history. The United States has survived not by keeping the same system but by transforming its rules at crucial moments.

Our historical amnesia about the reworking of our political system has significant consequences for the way we think about politics today. "

Our historical amnesia about the reworking of our political system has significant consequences for the way we think about politics today. More so than in the past, U.S. politicians — even purportedly radical ones — have deeply constrained views about changing the rules of the political game: how the president is selected, how seats are allocated in Congress, how many states exist, how voting rights are defined, how much power the Supreme Court wields. Many of these contemporary constraints developed after World War II, in a broad liberal faith that a well-functioning Supreme Court can help fix the country without dirtying politicians’ hands.

But past U.S. politicians lacked that faith. In his Second Annual Message to Congress in December 1862, Abraham Lincoln dismissed some restraints of tradition as he and Congress waged the Civil War and prepared for the impending Emancipation Proclamation. “The dogmas of the quiet past are inadequate to the stormy present,” he wrote. “The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew.” So, Lincoln continued, “We must disenthrall ourselves, and then we shall save our country.”

This article is the first in a series on this topic of thinking and acting anew. TPM has asked historians and constitutional scholars to use their understanding of the historic changes in the U.S. political and constitutional systems to help us disenthrall ourselves today from the passivity or alienation that emerges when a people face problems that the political system seems unable to solve, and when leaders retreat from the challenge of devising solutions as vast as the challenges. Of course passing laws within the incumbent system matters. So too does seeking broader cultural change. But at crucial moments it is important to fix the political system, to go beyond playing within the rules and instead to improve the rules of the game.

At crucial moments it is important to fix the political system, to go beyond playing within the rules and instead to improve the rules of the game. "

The essays differ in their solutions but they share two common premises. First, that a Democratic victory alone will not be sufficient to fix the political system. Second, that the history of the United States provides useful models of politicians seeking to change the very political and constitutional system they worked within.

A Democratic victory in 2020 undoubtedly would restore some sense of decency in the country’s operation and brake the extremist positions of the current administration, but still the nation would not be safe at home. The conditions that prompted a Trump victory would remain intact, along with the probability of revanchist neo-Trumpite movements, perhaps led by his children. So, too, would Democratic victory only marginally stave off Republican state efforts to roll back voting rights, to attack necessary congressional delegation of regulation, to assault the rights of women to control their own bodies, to transform the nature of the Census in order to disadvantage Democratic states. The hope that the Supreme Court might save the country from an extreme right-wing agenda has died. The lifetime installation of Neil Gorsuch and Brett Kavanagh suggests that there are no referees who will save us. The best-case scenario for Democrats appears to be the survival of Democratic-appointed justices until 2021, a Democratic capture of both the presidency and the Senate in fall 2020, and a chance to sustain today’s moderate minority on the Court. This is better than losing even more seats on the Supreme Court, but is clearly insufficient to meet the actual challenges we face.

U.S. history provides a different, riskier, but in some ways more promising alternative. In my recent book The Second American Revolution: The Civil War-Era Struggle over Cuba and the Rebirth of the American Republic, I argue that Civil War and Reconstruction-Era Republicans permanently transformed the political system by methods that would appear shocking today. When Republicans needed more states to balance the Senate, they created them. When the Supreme Court threatened Republicans’ Reconstruction policies, Congress restricted the Supreme Court’s jurisdiction, added and then subtracted justices, and threatened to dismantle the court altogether. When the Constitution did not defend the civil and voting rights Republicans prized, they transformed the nation’s founding document through three sweeping constitutional amendments, the last two passed in the face of bitter opposition not only from white Southerners but from many white Northerners. Between 1860 and 1870, Congress considered many other constitutional amendments, including some to eliminate the Electoral College or to enfranchise women. In 1888, as Heather Cox Richardson has written, Republicans faced a Democratic Party that sought to build a permanent congressional majority by disfranchising black Southern voters; Republicans responded by creating six new western states between November 1889 and July 1890, though they tragically (and narrowly) failed to pass a voting rights bill. The new political map that Senate Republicans fashioned still shapes our world

Where did that sense of boldness go? In 2009 the Democrats possessed for a time a 60-seat bloc in the Senate, yet barely considered the obvious (in retrospect) move of adding Washington D.C. as a state, much less investigating the addition of Puerto Rico or the creation of multiple states out of California or New York. Of course Democrats look timid today next to Abraham Lincoln; what’s astonishing is how timid they look compared to Benjamin Harrison.

Our history of norm-busting politics suggests that Republicans today are less anomalous than Democrats might like to think.  "

There is something fearful about facing the nation’s history. Our history of norm-busting politics suggests that Republicans today are less anomalous than Democrats might like to think. We forget the nation’s bloody and confounding political history because there is pleasure in amnesia.

But there is power in recognition. The Democratic Party has become adept at defining problems for which the party offers no realistic solution. Against the assault on voting rights and the outrages of partisan gerrymandering, Democrats passed — to their credit — a significant bill in the House of Representatives that will never pass the Senate; now the party seems prepared to wait for courts that seem unlikely to intervene. Against the overweighting of rural votes or the problems of the Electoral College, Democrats complain about unfairness, instead of proposing a fairer system. Even the most-radical major candidate to run in 2020, Bernie Sanders, inexplicably declined to support the timid act of undoing a non-constitutional filibuster rule in in the Senate, ensuring that even a 2020 Senate victory will mean that moderate Democratic bills are doomed to defeat at the hands of Mitch McConnell. Other Democratic candidates were often even more timid. The Democratic Party’s unilateral disarming not only makes the Democrats look weak; it also makes them look helpless, as if they are the party that tells people what cannot be changed.

If the United States does not face an existential crisis, if this is just another blip in the political road, then of course Democratic caution makes sense; so too does defense of the status quo. But if Democrats see this as a nearly unprecedented challenge to the nation’s ideals and images, then they must propose solutions as grave as the crisis. Perhaps it is time for us, too, to disenthrall ourselves from a hope that the United States will naturally right itself and to get about the work of saving our country.

The essays that follow argue, in different ways, that the past can provide some guidance as we do the painful but necessary work of expanding our sense of the possible, of assessing the problems in our political system, and of devising solutions sufficient to address them.

The “Not Safe At Home” series will be published over the next two weeks. Read the next article, here.


Gregory P. Downs is a professor of history at the University of California, Davis, and author of After Appomattox: Military Occupation and the Ends of War and The Second American Revolution: The Civil War-Era Struggle over Cuba and the Rebirth of the American Republic.

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NEW YORK (AP) — The U.S. death toll from the coronavirus climbed past 3,500 Tuesday, eclipsing China’s official count, as hard-hit New York City rushed to bring in more medical professionals and ambulances and parked refrigerated morgue trucks on the streets to collect the dead.

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MIAMI (AP) — Passengers from an ill-fated South American cruise are anxious to disembark once they reach Florida, but Gov. Ron DeSantis said the state’s health care resources are already stretched too thin to take on another ship’s coronavirus caseload. The U.S. Coast Guard said Tuesday that the decision would be punted to Washington if authorities can’t agree.

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BOSTON (AP) — At school, Rose Hayes, 8, works with a team of teachers and therapists trained to help with her genetic condition. They set goals for her reading, give her physical therapy to improve her balance and make sure she stays on track. But for the last two weeks, her only connection to school has been through a computer screen.

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