• Desmond Molloy

The role of Medicaid in the Zika virus epidemics


The Zika virus seized international headlines early this year. For the first time, Brazilian

health officials connected the tropical mosquito-borne disease to an uptick in cases of

microcephaly (an abnormally small head) and other developmental disorders. Concern over the

virus dampened attendance at the 2016 Summer Olympics in Rio de Janeiro. But while dozens

of athletes and thousands of would-be spectators avoided the country, they are not necessarily

out of the woods, as the virus continues to spread northward. Health officials estimate that 50

people per day contract Zika in Puerto Rico. In the contiguous United States, mosquitoes in

South Florida have begun to transmit the virus to humans, rendering several neighborhoods in

Miami unsafe for pregnant women and prompting travel warning from local officials. At least one

baby born in Miami has complications from exposure to Zika. Cases have also been reported in

Georgia, and other humid southern states, such as Texas and Alabama, may also be at risk.

State governments need to take precautions to ensure that Zika does not blossom into an

epidemic.

However, southern state legislatures’ decision to overwhelmingly reject the Affordable

Care Act’s Medicaid expansion is impeding efforts to slow the spread of Zika. The Kaiser Family

Foundation estimates that doing so left 2.6 million low-income adults in southern states like

Texas and Florida without coverage, making too much money to qualify for Medicaid but too

little to afford health insurance. This population is highly susceptible to Zika. Peter Hotez of Rice

University’s Baker Institute has warned that in sprawling Houston, for instance, “Houses with no

window screens, discarded tires filled with water, especially now after a lot of rain, [and] plastic

containers[,]” all of which are more common in impoverished neighborhoods, provide a prime

launching pad for the mosquitoes that spread Zika. The warm weather, insects and poverty that

gave rise to the disease in Brazil are not foreign to the United States. Consequently,

impoverished Americans are highly vulnerable to Zika.

Because it covers many of the services and treatments needed to prevent or mitigate

Zika, Medicaid could make a substantial difference. Both preventive and long-term measures

are covered by the program. While mosquito repellent is usually associated with camping trips

and summer weather, Hannah Katch of the Center on Budget and Policy Priorities wrote earlier

this year that it is considered medically necessary. Repellent can therefore be prescribed by

doctors and paid for with Medicaid funds. Birth control and contraception are also important.

Health officials in Brazil and El Salvador have advised women that delaying pregnancy may be

the best option for preventing microcephaly. Women enrolled in Medicaid can use their benefits

to purchase contraceptives and schedule pregnancy accordingly. But those who would have

benefitted from Medicaid expansion have a hard time accessing contraceptives. Medicaid can

also help those born with complications from Zika. Children with microcephaly need an

extensive package of social services, from physical therapy to long-term care. Many

Southerners affected by Zika will be eligible for such assistance. But such help will be

unavailable for the millions of at-risk Americans who fall into the Medicaid gap.

Even if next year’s hoped-for rollout of the Zika vaccine is successful, the need for better

preventive care in the South will not dissipate. As other tropical mosquito-borne diseases like

West Nile virus and Chikungunya gradually spread northward, the threat of infectious disease

continues to grow. Humid parts of the southern United States are already experiencing

resurgences of tropical diseases. This problem is expected to grow in the coming years as

America’s climate warms up, disproportionately affecting the poor. Neglecting a critical tool like

Medicaid will make it difficult for health officials, in Washington and the state capitals alike, to

address Zika and its relatives. Such neglect is hardly a foregone conclusion. Conservative

Louisiana recently accepted Medicaid expansion. As a result, Georgia state legislators are

exerting pressure on Governor Nathan Deal to reconsider his opposition to the Affordable Care

Act. Their counterparts in Florida, Alabama and other states at risk of Zika may follow suit. But

expansion may not come in time to help combat the aftereffects of mosquito-borne tropical

diseases like Zika.

#Zika #Medicaid #PuertoRico #uspolitics

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