This month, the first wave of locally-transmitted Zika virus infections in the continental United States in Florida could signal the escalation of a public health crisis with lasting consequences. Early action by the Obama administration improved access to Zika preventives, such as mosquito repellant, for Medicaid beneficiaries. Yet Medicaid’s effectiveness to fight against Zika is hobbled by the refusal of many state governments to close the Medicaid coverage gap. Tens of thousands of those most at risk for Zika in states like Florida, Texas, and Georgia are uninsured because they’re stuck in that gap.
State health advocates have keenly noted the hypocrisy: at the same time that state officials are calling on the federal government to address Zika with emergency aid, these same states cite opposition to federal support as a key reason to resist closing the Medicaid coverage gap—which would make health care accessible for hundreds of thousands of people in need. The result is billions of federal dollars left on the table in non-expansion states – money that would ensure a more comprehensive approach to fighting Zika than relying solely on emergency funds after the situation worsens.
Florida health advocates bristled at the governor’s suggestion that women thinking of becoming pregnant should consult their health care providers about the risk of Zika. Florida CHAIN released a statement emphasizing the absurdity of this advice for the more than 280,000 uninsured Florida women caught in the coverage gap. The Florida Health Alliance created a Zika fact sheet and this week called on members to contact their legislators about Zika.
Puerto Ricans migrating to the mainland United States are also highly at risk. Puerto Rico recently declared a state of emergency on the island due to Zika. The lack of health care in migrant and immigrant communities has concerning implications for health equity in Florida. This disturbing disparity could be alleviated if Governor Scott and other Florida policymakers took swift action to close the coverage gap this year.
As Texas braces itself to be the next state with local transmissions of Zika, advocates are already calling on state policymakers to close the coverage gap as part of the equation to address Zika. They believe waiting until Zika becomes an emergency to take action is the wrong choice for the roughly 800,000 uninsured Texans in the coverage gap. Increased access to Medicaid among low-income individuals is critical to efforts to detect and prevent the spread of Zika and associated health problems such as microcephaly, which will have long-term effects. Although pregnant women typically have more generous eligibility for Medicaid, women who might not know they are pregnant yet, and the partners of pregnant women – who can spread Zika through sexual transmission – often fall into the coverage gap.
Meanwhile, Louisiana’s newly expanded Medicaid program, Healthy Louisiana, took swift action to prevent Zika by covering mosquito repellant and other preventive services. Louisiana’s decision to close the coverage gap effective July 1, 2016 means that 375,000 Louisianans are newly eligible for Medicaid coverage as Zika heats up in the region. What a contrast!