When U.S. officials feared an outbreak of the Zika virus last year, the Department of Health and Human Services and state officials kicked into high gear.

They tested mosquitoes neighborhood by neighborhood in Miami and other hot Gulf Coast communities where the virus was likely to flourish. They launched outreach campaigns to encourage people to use bug spray. And they pushed the development of a vaccine.

“The response was swift,” says former Surgeon General Vivek Murthy, and was even faster during the Ebola outbreak a year earlier.

But last month when 50 people died and more than 400 were injured in Las Vegas, and weeks later another 26 died in Texas of the same cause, public health officials have had almost no role.

That’s because the victims in Las Vegas and Texas were killed with guns. And over the last three decades, Congress has made it clear that they don’t want the public health community looking too hard into the causes of the violence.

“If you look at the number of people who have died or been injured from gun violence, that dwarfs the number of people who have been affected by Zika or Ebola. There’s absolutely no comparison,” Murthy says.

More than 30,000 people are killed with guns in the U.S. every year. That’s more than die of AIDS, and about the same number as die in car crashes or from liver disease. But unlike AIDS or car crashes, the government doesn’t treat gun injuries or deaths as a public health threat.

Murthy and other public health experts say it should.

Funding For Research On Gun Violence Compared To Other Leading Causes Of Death

Funding represents the total funding awarded over the years 2004 to 2015. Dollar amounts have not been corrected for the year in which they were reported. (Note: Funding and mortality rate values are plotted on a logarithmic scale.)

Source: JAMA

“It should be no different than the approach we take to cancer, heart disease or diabetes,” he says.

But such an approach would have to start essentially from scratch. The government spends only about $22 million a year on research into gun violence — a tiny fraction of what it spends on other major health threats.

That’s because of Congress. Back in 1997, lawmakers added a provision in the bill that funds the Centers for Disease Control and Prevention barring the agency from doing anything that would “advocate or promote gun control.” At the same time, they cut CDC’s budget by the exact amount it had been spending in gun violence research up until then.

So government research into the causes of gun deaths virtually stopped.

The issue comes up routinely after mass shootings. Two years ago, after a young man killed nine people in a church in South Carolina, a reporter asked former Republican House Speaker John Boehner about the CDC restrictions.

“The CDC is there to look at diseases that need to be dealt with to protect the public health. I’m sorry but a gun is not a disease,” he said at the time.

After the most recent shootings, Democrats in Congress have called for more restrictions on guns while Republicans, including President Trump, say the problem is mental health.

But neither conclusion is backed by research, says Dr. Georges Benjamin, the executive director of the American Public Health Association.

“When a new disease, particularly an infectious disease, enters the community … we have a mechanism to anticipate it, track it, get our arms around it,” he says. “We do that when he have measles, mumps, chicken pox, zika. But firearm-related death and disability, we don’t.”

That kind of prior knowledge could lead to policies that reduce the toll of gun injuries without cutting off access to them.

“Firearms are a tool, and … a consumer product. And unlike other consumer products, we’re not working hard to make that consumer product safer,” he says.

Take cars for example. Benjamin points to the combination of safety features — airbags and seat belts — and safety policies like requiring licensing and banning drunk driving — that have made cars less lethal, while ensuring they’re still available.

A similar strategy with guns could lead to some laws or regulations that make them safer.

That could involve barring large ammunition clips to limit the number of shots a person could take, or requiring trigger locks that open by fingerprint, allowing only the gun owner to fire a weapon.

“We could think about where firearms ought not to be,” he says. “Alcohol and firearms and people who might get a little rowdy probably are not a good combination. There are solutions to that.”

Creating more shooting ranges may be a good idea so gun owners have a safe place to use their weapons, he says.

Today, Benjamin says, there is no data to show whether people are safer in communities with more or fewer guns.

Something has to change, because up until now, “We have done everything we can to ensure that this epidemic of death and disability from firearms is only going to get worse,” he says.

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Updated 5:56 p.m. ET

Senate Republicans now plan to try to repeal the Affordable Care Act’s individual mandate as part of a tax overhaul bill.

Several Senate Republicans said Tuesday that including the repeal in tax legislation, currently making its way through a key Senate committee, would allow them to further reduce tax rates for individuals without adding more to the deficit.

The decision was a rapid change of direction for Republicans, who previously believed it would be politically dangerous to add any health care measure to the tax legislation.

Senate Majority Leader Mitch McConnell told reporters Tuesday that members of the Senate Finance Committee believe tacking on the repeal will ensure the bill has sufficient votes to pass when it comes up for a vote in the Senate.

“We’re optimistic that inserting the individual mandate repeal would be helpful,” McConnell said, “and that’s obviously the view of the Senate Finance Committee Republicans as well.”

The Congressional Budget Office said last week that such a repeal would reduce federal deficits by $338 billion over the next 10 years, which would help the GOP avoid exceeding a $1.5 trillion cap on how much the tax bill can add to the deficit over the same time period. The repeal would also increase the number of uninsured by 13 million by 2027, according to the CBO.

Sen. John Thune, R-S.D., a top McConnell deputy, said the savings from the repeal would give Republicans more room to cut taxes for the middle class.

“It will be distributed in the form of middle-income tax relief,” Thune said. “It will probably mean adjusting the rate structure as we have today. We’ll probably still have seven brackets, but they would be at different rates.”

Asked if he was confident such a bill could pass, Thune said yes, adding that leaders had already “whipped” the bill, meaning they already know how their colleagues will vote.

Not all Republicans agree with the decision. Moderate Sen. Susan Collins, R-Maine, said she had not decided how she will vote on the tax bill, but she worries that ending the individual mandate could increase health care premiums.

“I personally think it complicates tax reform to put the repeal of the individual mandate in there,” Collins said. “I’m going to wait and see what the bill says.”

But adding it in could appeal to other skeptics of the legislation, including Sen. Rand Paul, R-Ky., who supports the individual mandate repeal.

The Senate Finance Committee is expected to release an updated version of the legislation Tuesday evening. The committee plans to approve the bill later this week in hopes of holding a vote in the full Senate before Thanksgiving.

Republicans on the Finance Committee worked around the clock in recent days to try to bring down the long-term cost of their tax bill. Republicans want to take advantage of complicated Senate budget rules, known as reconciliation, that would allow them to pass the tax bill with 51 votes rather than the 60 needed for most other legislation. That would allow the 52 Senate Republicans to pass the bill without the help of any Democrats.

But those same budget rules require that the tax overhaul not add to the deficit after 10 years. The Senate bill appeared to violate those regulations as recently as Tuesday morning. Repealing the individual mandate could help ease the fiscal pressure.

Democrats, enraged over McConnell’s announcement, said adding the individual mandate to the legislation effectively ended any chance for bipartisan agreement on taxes. Sen. Ron Wyden, D-Ore., the top Democrat on the Finance Committee, said repealing the mandate would hurt the middle class.

“In their desperation to secure an ideological trophy, no matter the consequences,” Wyden said, “Republicans are choosing to pay for corporate tax cuts by raising premiums for middle class families and ripping away health care altogether from millions more.

“This is a con job on the American people.”

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A California judge could decide Tuesday if Gloria Single will be reunited with her husband, Bill. She’s 83 years old. He’s 93. The two have been married for 30 years. They lived in the same nursing home until last March, when Gloria Single was evicted without warning.

Her situation isn’t unique. Nationwide, eviction is the leading complaint about nursing homes. In California last year, more than 1,500 nursing home residents complained that they were discharged involuntarily. That’s an increase of 73 percent since 2011.

Gloria Single has a number of ailments. One of them is Alzheimer’s disease. So when her son Aubrey Jones comes to visit her in her new nursing home, he brings old photos to show her. She can still recognize faces from long ago — one picture shows her three sons when they were just little kids.

Jones says the photograph makes him and his brothers look like real troublemakers. “You are troublemakers,” his mom teases.

Jones also shows his mother a more recent photo. It was taken at Pioneer House, the nursing home where Gloria Single and her husband Bill lived together before her eviction. They’re gazing into each other’s eyes and smiling.

When Jones tells her he loves that photo, Gloria Single slyly replies that’s “because [Bill’s] got his hand on my knee.”

In court documents, Pioneer House paints a more troubling picture of Gloria Single. They say that she became aggressive with staff and threw some plastic tableware. So Pioneer House called an ambulance and sent her to a hospital for a psychological evaluation. The hospital found nothing wrong with her, but the nursing home wouldn’t take her back. They said they couldn’t care for someone with her needs.

Jones protested his mother’s eviction to the California Department of Health Care Services. The department held a hearing. Jones won.

“I expected action — definitely expected action,” says Jones.

Instead, he got an email explaining that the department that holds the hearings has no authority to enforce its own rulings. Enforcement is handled by a different state agency. He could start over with them.

This Catch-22 situation attracted the interest of the legal wing of the AARP Foundation. Last year, attorneys there asked the federal government to open a civil rights investigation into the way California deals with nursing home evictions. Now, they’re suing Pioneer House and its parent company on Gloria Single’s behalf. It’s the first time the AARP has taken a legal case dealing with nursing home eviction.

“We certainly hope we can get Mrs. Single some relief,” says William Alvarado Rivera, the foundation’s senior vice president for litigation. “But we also hope that there is a lesson to be learned by facilities — that there will be accountability for their failure to respect the due process rights of their residents.”

Nursing home residents have a lot of rights guaranteed in state and federal law. For example, they have to be given 30 days’ notice before they’re moved involuntarily. And the nursing home has to hold their bed for a week if they’re in the hospital.

Rivera says Gloria Single didn’t get any of that. As a result, she was stuck in the hospital for four and a half months before being accepted by another facility. During that time Single received none of the services and activities she would have had in a nursing home. She lost her ability to walk and now relies on a wheelchair.

Rivera says that “in the absence of state enforcement, it will depend on individuals like Mrs. Single having to advocate for themselves to get their rights respected and enforced.”

Fourteen years of public records obtained by NPR show that nursing homes rarely pay a price for illegally evicting residents. Just 7 percent of nursing homes that were found to have violated the law in California were fined by the state. With just a couple of exceptions, the highest fines assessed were $2,000. The majority were $1,000 or less — and most fines were never paid in full.

Diana Dooley, California’s secretary of health and human services, declined NPR’s request for an interview, citing pending litigation against the state on a similar issue.

Frustration with the lack of state enforcement led the California Long-Term Care Ombudsman Association to join the Single lawsuit as a co-plaintiff. The organization represents long-term-care ombudsmen. Those are the public officials who track complaints about nursing homes and advocate for residents. But Leza Coleman, the group’s executive director, says the spike in complaints about evictions is so overwhelming, that it’s “impacting our ability to handle other complaints.”

Coleman believes another reason that eviction complaints are going up, is that the number of nursing homes is going down. State records show there are about 2,300 fewer beds in California than there were six years ago.

“Those residents that are more challenging — those that have to be repositioned often, those that don’t want to sit quietly and watch television — … they’re more expensive,” she says. “They can be very taxing on the staff of a facility, and if a facility has one bed and two people looking at it, they’re going to take the person that’s easier to care for.”

But eviction complaints need to be seen in a different context, says Jim Gomez, CEO of the California Association of Health Facilities. “We have a very low rate of complaints regarding discharge,” he says, adding that roughly 1,500 complaints is “less than a half of 1 percent of some 300,000 discharges” a year.

And when residents are involuntarily discharged, Gomez says, “it’s for the safety of staff and other residents.

“We’ve had many attacks on residents and staff,” he says. “Are you going to allow that person back to the facility?”

Pioneer House and its parent corporation, the Retirement Housing Foundation, declined to be interviewed for this story. They sent a written statement which says, in part, “We intend to vigorously defend the allegation set forth in the lawsuit.”

Meanwhile, Aubrey Jones says the lawsuit is not just about his mother any more.

“If anything,” he says, “I want the dial to be turned a little bit so this thing doesn’t happen again —[so] it’s less likely to happen to someone else.”

Most of all, Jones says, he wants to see his mother and stepfather reunited, so they can be together for the little bit of time they have left.

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