Climate Change: An Urgent Reason for Medicaid Expansion in Florida

November, 2018

The changing global climate is already creating far-reaching impacts on population health in Florida that, paired with barriers to affordable healthcare access, will impact Florida’s most vulnerable populations. One particular concern is the increased threat of vector-borne diseases. Thanks to South Florida’s unique environment and status as an international gateway, Florida is particularly vulnerable to vector-borne diseases. The public health impacts of this threat are compounded by the fact that many cannot access affordable health coverage, including over 20% of adult Floridians. This brief explains the increasing threat of vector-borne disease in Florida as a result of the changing climate and the available public-sector responses, including expanding Florida’s Medicaid program under the Affordable Care Act (ACA).

Vector-Borne Disease

Vector-borne diseases are transmitted through a vector species, such as a mosquito, usually through a bite. Several biological and environmental factors control the transmission and spread of vector-borne diseases. While some factors are capable of human control, Florida also faces major environmental factors, including temperature and rainfall, which impact pathogen infectivity and survival as well vector species breeding. Hurricanes also provide an opportunity for vector-borne diseases to spread—heavy rains, storm surge, and damage create breeding opportunities for disease-carrying mosquitoes.

There is an obvious need to mitigate the immediate and long-term health impacts of these diseases. It is well documented that vector-borne diseases can be mitigated by reducing their breeding and reproductive opportunities. A less well documented but equally critical mitigation strategy is ensuring inexpensive and simple access to healthcare.

In 2016 and 2017, Florida experienced an outbreak of the Zika virus. Zika is known to occur in tropical and subtropical regions around the world and is associated with health problems in babies exposed to it in the womb. According to the Centers for Disease Control and Prevention (CDC), about 14% of babies exposed to Zika in U.S. territories were born with, or later developed health problems including microcephaly and nervous system issues. Florida’s outbreak resulted in over 1,500 cases spread mostly by mosquitos, and some occurring after sexual intercourse. The negative effects of the virus are still being discovered, with health problems in some babies exposed to Zika expected to become apparent only as the child reaches developmental milestones. Florida’s response to zika was limited by the state’s access to funding for prevention and testing kits, as well as the high uninsured rate among adults.

While the Zika virus harms children (most of who are covered under the state’s Medicaid program), other vector-borne diseases threaten adult Floridians who currently have no path to affordable health coverage. For example, West Nile Virus, Dengue, and Chikungunya are also transmitted by mosquitoes and can cause both acute and chronic health impacts. As the climate changes, Florida is likely to see more frequent heavy rainstorms and hurricanes as well as longer periods of warm temperatures. These conditions improve breeding opportunities for vector species and increase the likelihood that other vector-borne diseases will spread.

Recommended Responses

Thus, it is important that the state prepare now by limiting the impacts of vector-borne diseases through both disease prevention/mitigation and by eliminating barriers to accessing healthcare for those exposed to disease. Hundreds of thousands of Floridians fall in the “coverage gap,” meaning that they are ineligible for both Medicaid and health insurance subsidies under the Affordable Care Act (ACA). In a vector-borne disease outbreak like Florida’s Zika experience, those in the coverage gap are at risk of serious health problems. Many in the coverage gap, including adult men who may not have experienced obvious health issues from Zika infection, can still pass the virus via mosquito or sexual intercourse.

Expansion could also give more Floridians access to benefits focused on prevention, detection, and treatment of future vector-borne disease outbreaks. While Medicaid does not generally cover over-the-counter mosquito repellents, state programs may choose to cover repellents when prescribed by health professionals. Where the disease is sexually-transmitted or able to be transmitted in-utero, state Medicaid programs may also cover family planning counseling and contraceptive devices. After diagnosis, treatment of conditions resulting from vector-borne diseases is covered through Medicaid.

In sum, Florida is America’s “ground zero” for vector disease threats due to climate change. Expanding Medicaid will allow Florida to more effectively prevent and treat vector-borne diseases by increasing access to affordable healthcare and giving Florida greater flexibility to use its limited emergency resources while ensuring its residents remain healthy.

By Brett Brumund, J.D

References:
1) https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf
2) The ACA encourages states to expand their Medicaid programs to include residents with income up to 133% of the poverty level with the federal government covering up to 90% of expansion costs after 2020. See Patient Protection and Affordable Care Act, 42 U.S.C. § 2001(a).
3) http://floridaclimateinstitute.org/docs/climatebook/Ch04-Liang.pdf
4) https://www.sciencedirect.com/science/article/pii/S1477893916302113
5) https://www.cdc.gov/vitalsigns/pdf/vs-0818-zika-territories-H.pdf
6) https://www.miamiherald.com/news/health-care/article216181565.html
7)https://19january2017snapshot.epa.gov/sites/production/files/2016-09/documents/climate-change-fl.pdf
8) In June 2018, the Kaiser Family Foundation reported that 384,000 Floridians fell within the coverage gap https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/
9) Following worldwide Zika outbreaks in 2016, the Center for Medicaid and CHIP services (CMCS) released this informational bulletin describing how Medicaid can aid in the prevention, diagnosis, and treatment of Zika-related conditions https://www.medicaid.gov/federal-policy-guidance/downloads/cib060116.pdf

Climate Change: An Urgent Reason for Medicaid Expansion in Florida

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