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.