Tag Archives: cdc

The GOP Health Bill Would Make Zika the Newest Preexisting Condition

Mother Jones

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The controversial GOP health care bill that narrowly passed the House of Representatives this month could have devastating consequences for mothers and children infected with Zika, experts say. The mosquito-borne virus is just one on a nearly endless list of preexisting medical conditions—cancer, asthma, pregnancy—for which insurers could potentially charge higher premiums if Republicans get their way.

One of the most popular features of Obamacare is a provision known as “community rating,” which bars insurance from charging more for people with preexisting conditions. This was a common practice before Obamacare was enacted in 2010; stories of sick people being unable to find affordable coverage were one of the main arguments used by the legislation’s supporters. Of course, the public health crisis surrounding Zika—and the birth defects it can cause—wasn’t an issue at the time; no one in the United States had yet contracted the virus. But if the House’s Obamacare repeal bill becomes law, people with Zika could end up paying far more for their health care—and could even end up priced out of insurance entirely.

Multiple health care experts told Mother Jones that the GOP bill would almost certainly mean a host of insurance problems for both pregnant women who have had Zika and infants born with microcephaly, a condition where a child has a smaller brain and other health defects. Zika can cause a host of other birth defects and in rare cases has been linked to Guillain-Barré syndrome, which can cause temporary paralysis in adults. What’s more, the GOP bill cuts funding to the Centers for Disease Control and Prevention, the agency on the front lines of the battle against the disease.

The Republican bill includes an amendment that allows states to opt out of the Obamacare community rating protection. Under the GOP plan, if a person’s health coverage were to lapse longer than 63 days in a state that opts out, that person could be charged a prohibitive cost on the private market. Short lapses in coverage are incredibly common. The Kaiser Family Foundation estimates that 27.4 million nonelderly adults had a several-month gap in coverage in 2015. For the 6.3 million of these adults who have preexisting conditions, the costs could be significant. The liberal Center for American Progress estimated that under the GOP bill, people with even mild preexisting conditions would pay thousands more per year—a 40-year-old, for example, would likely be charged an extra $4,340 in premiums if she had asthma, or $17,320 extra if she were pregnant.

Zika was first identified in 1947 in Uganda. It didn’t emerge in Brazil until 2015, when researchers began to notice the link to a spike in birth defects. Since then, mosquitoes carrying the Zika virus have been found in almost every country in the Western Hemisphere. Zika is particularly prevalent in Latin American, but it has also appeared in the United States. There have been more than 30,000 cases confirmed in Puerto Rico, including 3,300 pregnant woman, and more than 1,000 cases in Florida. The spread of Zika has varied wildly from year to year, with cases this year down sharply from 2016.

Yet our understanding of the Zika virus and its related health problems is still evolving. In most people, the virus shows no visible symptoms or just mild problems such as aches and a fever. But it does raise the risk of microcephaly, a rare brain defect in which a child develops with an abnormally small head and brain. Microcephaly is incredibly rare in a normal pregnancy, but a Zika infection in the first trimester raises the risk to 1 to 13 percent.

Zika is linked to various health problems in infants, but microcephaly itself is an expensive medical condition. The CDC estimates it would cost an additional $1 million to $10 million in medical care over the child’s lifetime. Zika-associated microcephaly would probably cost somewhere in the tens or hundreds of thousands of dollars per year in premium surcharges, according to the Center for American Progress health policy team.

Experts say that, under the Republican plan, insurers would almost certainly treat Zika as a reason to charge higher premiums.

“If it’s documented in your medical records that you had this infection and you have it now, they might well act on it,” Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told Mother Jones. And if an infant was born with microcephaly, Pollitz added, “you’d have to be very careful as the parent of a child to never have a break in coverage.” Pollitz also added that the total number of Zika cases is small, but the issue could come up in medical records and be cause for insurers to “jump on that and possibly charge you a higher premium.”

In other words, insurers would be tempted to charge more based on the expensive medical costs sometimes associated with Zika, and there would be nothing preventing them from doing it. “There’s no rule about what can or cannot qualify” as a preexisting condition, New York University health care expert Sherry Glied said in an email, “and Zika will certainly raise later costs, so would count.”

David Anderson, a Duke University health policy researcher who has worked in the health insurance industry, added that another part of the GOP’s health bill—massive cuts to Medicaid spending—would add more strain to state budgets in the case of a Zika outbreak. The bill reduces Medicaid expenditures by $834 billion over the next decade, according to an analysis by the nonpartisan Congressional Budget Office. Trump’s 2018 budget released Tuesday proposes even deeper cuts than the GOP bill. If passed, the budget would reduce Medicaid spending by $1.4 trillion over 10 years.

Anything affecting babies is a big deal for Medicaid, which covers nearly half of all births in the United States. That would cause a significant problem if Zika leads to an unexpected spike in microcephaly. “If it’s not that common, states can handle one or two isolated events,” Anderson says. “If it’s very common and there are hundreds of babies born with microcephaly under high-cost conditions, then states can’t handle it.”

The House bill would have other impacts on Zika prevention efforts. It cuts nearly $1 billion from the CDC’s budget. The CDC funds testing and research and deploys emergency teams to provide extra medical assistance and to control the spread of Zika-infected mosquitoes. The CDC fights Zika by monitoring mosquitoes that transmit the virus, and it collects data about how Zika affects pregnancies. Trump’s budget doesn’t help the situation either. Although it sets up a CDC emergency response fund to deal with outbreaks like Zika, the budget weakens prevention efforts by seeking a 17 percent cut to the CDC and an 18 percent cut to the National Institutes of Health.

The confluence of Zika and the GOP health care bill could have political consequences in places like Florida, where the virus has already proved to be a potent electoral issue. Two South Florida congressmen—GOP Reps. Carlos Curbelo and Mario Diaz-Balart—championed a bill last year that sent $1.1 billion to the CDC and the NIH to combat Zika. Both also voted for the Obamacare repeal bill. Neither of their offices responded to requests for comment.

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The GOP Health Bill Would Make Zika the Newest Preexisting Condition

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Use Your Seat Belt!

Mother Jones

And now, from the Department of Random Stuff, we have seat belt use in the 50 states. Christopher Ingraham writes about this today over at Wonkblog, and his map showed shockingly low seat belt use. There were quite a few areas with seat belt use around 50 percent, and more than half the country was under 70 percent. Can that be true?

To find out, I headed over to the Owellian-named Behavioral Risk Factor Surveillance System at the CDC and created my own map. Here it is:

This doesn’t look so bad. The Dakotas are laggards at 70 percent, but most of the country is between 75-90 percent, with 11 states over 90 percent. The national average is 86.4 percent. I sort of assumed that after all these years, seat belt use was pretty much automatic for nearly everyone, but I guess not. Especially in the Dakotas.


Use Your Seat Belt!

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Uninsured Population Holding Steady at About 10%

Mother Jones

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The latest CDC numbers on the uninsured population are out, and as of September 2016 the number of uninsured in the US had dropped from about 17 percent before Obamacare to 10.3 percent. That continues to be below the original CBO estimate of 11 percent for the full year.

For all of Obamacare’s faults, this is a tremendous achievement at a surprisingly modest cost. It’s beyond belief that Republicans want to destroy it instead of making it better.

NOTE: As always, I’m using the CDC’s figures for the nonelderly population. This is because (a) this is what CBO used for its estimates, so I need to use comparable numbers, and (b) it’s the number we actually care about. The overall figure for all ages is currently 8.8 percent.


Uninsured Population Holding Steady at About 10%

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Raw Data: If Obamacare Is Repealed, 17-37 Million People Will Lose Health Coverage

Mother Jones

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As Republicans merrily head down their stated path of repealing Obamacare without bothering to replace it, here are the latest CDC numbers on the uninsured:

Let’s put that into raw numbers. There are currently 273 million people in America under the age of 65. If we abolished Obamacare and returned to the 2013 percentage of uninsured, 17 million people would lose health coverage.

And that’s optimistic. If Republican recklessness caused the insurance industry to abandon the individual market altogether, the number of people who would lose coverage is somewhere in the range of 32-37 million. That’s about 22 million people who are currently in the non-group insurance market and another 10-15 million who benefited from Obamacare’s Medicaid expansion.

Repealing Obamacare makes a great campaign slogan, but now Republicans have to actually govern. Do they really want to be responsible for 17-37 million people losing health coverage? Really?

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Raw Data: If Obamacare Is Repealed, 17-37 Million People Will Lose Health Coverage

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Spraying Pesticides May Not Kill Zika Mosquitos

Mother Jones

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In Miami Beach, daily crowds have been gathering outside city hall to protest a program to spray a potent pesticide called naled, in an effort to combat mosquitos carrying the Zika virus. After delays, officials began periodic naled sprayings Friday morning at 5 a.m.

People are concerned about the spraying because like other organophosphates, naled is a neurotoxin, or a poison that works by attacking the nervous system. Even at tiny doses, naled kills adult Aedes mosquitos—which, in parts of Miami, including Miami Beach, are known to carry the Zika virus. In South Carolina last week, aerial spraying of naled inadvertently killed millions of bees.

The EPA reports that naled is regularly sprayed on 16 million acres of land in the mainland United States “as part of routine mosquito control,” including in “highly populated major metropolitan areas.” That’s a lot of land—California, for comparison, occupies 100 million acres.

Here’s what we know about naled, its toxicity to people and ecosystems, and its potential as a tool to limit the spread of Zika.

• Is naled spraying toxic to humans? The European Union banned naled in 2012, citing “potential and unacceptable risk showed for human health.” But the US Centers for Disease Control and Prevention and the Environmental Protection Agency disagree. The chemical is used at such a low rate as a mosquito spray—about two tablespoons for each area the size of a football field—that it “does not pose a health risk to people or pets in the area that is sprayed,” the CDC says. Also, “Naled starts to degrade (break down) immediately on surfaces, in water, and in sunlight,” the CDC adds, meaning it doesn’t linger after spraying.

I asked Dana Barr, a research professor at Emory who has done extensive research on the ill effects of organophosphate exposure on kids’ neural development, whether people should worry about health effects from spraying. “Likely the small amount sprayed won’t pose significant risk,” she said. Barr added, though, that people who live in sprayed areas “need to consider their exposures from other sources as well,” like through garden insecticides and residues on food. A 2015 study by University of Washington, Harvard, and University of Texas researchers found that people who eat organic food have significantly lower levels of organophosphate traces in their urine than people who don’t.

Barr added that infants and pregnant women are the most vulnerable to harm from organophosphate exposure, and should “take precautions to stay inside during spraying”—which won’t be too hard, since the spraying are scheduled for early mornings (5 a.m.).

• Is spraying naled effective at slowing the spread of mosquito-borne illnesses like Zika? This one is surprisingly hard to answer. The CDC stresses it’s just one part of an “integrated mosquito control program” that includes “eliminating mosquito habitats, such as discarded containers and rain gutters” and other actions. But the agency insists that spraying is the “one method that can rapidly reduce the number of mosquitoes spreading Zika in a large area,” like Miami beach.

In a recent editorial in the medical journal JAMA, CDC Director Tom Frieden wrote that a spraying program in New Orleans, similar to the current one in Miami Beach, had reduced both indoor and outdoor adult mosquito populations by 90 percent.

However, the New Orleans figure cited by Friedan comes from an informal study that never underwent peer review, and some experts are skeptical of it. The Aedes mosquito, the variety that hosts Zika and other nasty pathogens, tends to live indoors, making it a tough target for spraying. “I know of no published reports that support Friedan’s figure,” Yale University professor emeritus of microbial diseases Durland Fish told Kaiser Health News. He added: “This is a domestic mosquito, meaning they live inside the house—in closets, under the bed, in the sink. Spraying outside won’t be very effective.”

A recent news report by the University of Minnesota’s Center for Disease Research and Policy also casts doubt of the efficacy of spraying, echoing concerns raised by Fish.

Will the spraying kill other bugs? While Aedes mosquitos live mainly indoors, protected from pesticide droplets falling from the sky, other critters aren’t so lucky. The South Carolina incident demonstrated how vulnerable honeybees are to an ill-timed naled spraying.

And a Florida International University team has published three papers since 2011—in the journals Environmental Toxicology and Chemistry, Science of the Total Environment, Chemosphere—finding that butterflies are even more susceptible to naled than bees. South Florida’s butterfly populations have declined dramatically in recent years. The Florida International University research, funded by the US Fish and Wildlife Service, prompted South Florida officials to scale back routine naled spraying last year. Butterflies are a key part of the food chain, serving as prey for birds and bats; they’re also important pollinators.

When naled degrades, it turns into another potent organophosphate called dichlorvos, which in turn can linger in water, a 2014 study by University of California at Davis researchers found. Once there, it’s highly toxic to aquatic species at the “low end of the food chain,” including insects and frog larvae, one of the study’s authors, Bryn Phillips, recently told CNN.

So while people probably don’t have much to fear from naled spraying, bees and butterflies do. As for Zika-carrying mosquitos, the jury is still out.

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Spraying Pesticides May Not Kill Zika Mosquitos

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