New rules could kick sick people off Medicaid

0:00Edwin Burgess:This message comes from IXL. IXL provides personalized learning and powerful insights that help teachers boost achievement and understand student progress in real time. Learn more at IXL.com slash NPR. WBUR Podcasts, Boston. Now they're going to have to go in and figure out who has a serious condition and who is sick enough from that condition that they can't meet this work requirement.

0:30Adela Flores-Brennan:The Trump administration is making it harder to qualify for Medicaid.

0:43Adela Flores-Brennan:It's Tuesday, June 9th, and this is Here and Now anytime from NPR and WBR. I'm Chris Bentley. Today on the show, a veterinary entomologist tells us just how much we should worry about the reemergence of a cattle-eating parasite in Texas. The New World screwworm is unique in that its larvae develop in the living tissue of warm-blooded animals. Also, a college football quarterback admitted to gambling at least$90 ,000 on sports, including his own team. But a court ruled he can keep playing.

1:20Edwin Burgess:This ruling could be cited in future cases for other athletes who engage in sports betting activity. However, before, you know, everybody panics, it could be cited, but it doesn't immediately open the floodgates across the country.

1:34Adela Flores-Brennan:Before we get to that story, though, Congress made big changes to Medicaid last year. And we're starting to see what those changes mean for poor, sick and disabled people who get their health insurance through the government. Rules revised by the Trump administration this month add new work requirements and a whole lot of new paperwork for people seeking coverage to prove they're eligible. That's because starting in January, people aged 19 to 64 will have to either prove they're too sick to work or else prove they worked 80 hours in the prior month or were in school or volunteered for 80 hours to keep their health insurance.

2:14Adela Flores-Brennan:The nonpartisan Congressional Budget Office estimates the changes could effectively kick 5 million Americans off Medicaid. Medicaid is a government-run health insurance plan administered jointly by the federal government and the states. So state workers are scrambling to figure out who will be affected by the new rules. That includes Colorado's state Medicaid director Adela Flores Brennan. She told Scott Tong she's working hard to keep people from losing their coverage?

2:42Edwin Burgess:Yeah, so our North Star at Colorado Medicaid is to really mitigate and minimize the loss of coverage because it's really important to us that our members remain covered. That being said, these requirements are going to be confusing. I do imagine that unfortunately, people will get caught up either in the paperwork requirements or not being able to meet the work requirements themselves to be able to stay enrolled.

3:19Adela Flores-Brennan:And speaking of big change, does Colorado have the resources, the staff, the computer systems, the know-how to put in place this huge change?

3:31Edwin Burgess:I think we have the know-how and we are working really, really hard to understand all of the requirements and build them into all of our systems. Now, I'm sure you're aware that we had some new regulations issued earlier this month and we are still working to understand the changes to how we were proceeding before those regulations came out. We're going to have to train up all of our eligibility workers in 64 different counties to be able to handle all of these new requirements.

4:06Adela Flores-Brennan:Well, there's one specific from these new work rules that's attracting a lot of attention. Here's my understanding of it. If you have a disease like cancer or HIV, the disease itself is not enough to stay on Medicaid. You have to show your condition significantly impairs your ability to work. In other words, you have to show you're too sick to work. And I want to play a cut of sound from Rachel Klein. She's deputy executive director of the AIDS Institute.

4:33Edwin Burgess:I think this is really just an impossible task for states. You know, they've already been trying to set up these systems with the understanding that they would have to figure out who has a serious or complex medical condition. And now they're going to have to go in and figure out who has a serious condition and who is sick enough from that condition that they can't meet this work requirement.

4:59Adela Flores-Brennan:And so the question for you is, could she be right?

5:03Edwin Burgess:I believe she could be right. This is a direction that we were not proceeding in. We were operating under the understanding that by having a diagnosis of a certain kind, that that would be sufficient to demonstrate medical frailty. So now this additional requirement that you have to demonstrate impairment is something that we haven't figured out how we are going to incorporate. And we are going to have to adjust to figure out how we move forward. Yeah.

5:39Adela Flores-Brennan:Are you impaired enough? Well, it just seems like a complicated question just hearing you talk about it. Just stepping back, the head of the center that runs Medicaid and Medicare, Dr. Mehmed Oz, said when he put these rules out that they're about empowering people to work. He recently said if you're on Medicaid and, quote, watching television or just hanging around, that is not why you're here. Do you assume many Colorado residents who are on the program are, as he puts it, watching television?

6:09Edwin Burgess:No, I don't assume that at all. I think having access to quality health care helps enable a person to be able to engage with the workforce. So I approach access to health care with a very different philosophy.

6:28Adela Flores-Brennan:We've been talking to Adela Flores Brennan, the Medicaid director for the state of Colorado. Director Flores Brennan, thanks much for the time.

6:36Edwin Burgess:Thank you.

6:40Adela Flores-Brennan:Coming up next, everything you ever wanted to know about Screw Worm, and probably a little more than you ever wanted to know. Indira Lakshmanan has that story in just a minute.

6:59Adela Flores-Brennan:This message comes from WISE, the app for international people using money around the globe. You can send, spend, and receive in up to 40 currencies with only a few simple taps. Be smart. Get wise. Download the WISE app today or visit wise.com. T's and C's apply.

7:17Edwin Burgess:This message comes from Prolon. Want to look and feel your best this spring? Prolon's five-day fasting mimicking diet is a clinically developed nutrition program with the goal of promoting fat loss while protecting lean body mass. Developed at USC's Longevity Institute, it aims to assist the body in entering a fasting-like state that helps reset metabolism, target visceral fat, and support healthy metabolic markers. Get 15 % off plus a bonus gift when you subscribe at prolonlife.com slash NPR. A flesh-eating parasite known as the New World Screwworm is back. Once a scourge on cattle herds across the southern and western United States, The screw worm was thought to have been eradicated in this country in the 1960s and contained in the Central American tropics.

8:06Edwin Burgess:Now, at least five cases have been detected in Texas and New Mexico in the past week, the majority of those in Texas livestock. But there was one case in a dog, according to Agriculture Department officials. Joining us now is Edwin Burgess. He's a veterinary entomologist at the University of Florida's Institute of Food and Agricultural Sciences. Dr. Burgess, welcome.

8:28Adela Flores-Brennan:Thanks for having me.

8:29Edwin Burgess:So first of all, tell us about the New World Screw Worm that's apparently not a worm. What is it?

8:36Adela Flores-Brennan:The New World Screw Worm is a shiny green fly. Sometimes they are referred to commonly as blowflies. And they look very similar to any kind of shiny green fly you might see in your backyard or around a garbage bin or a dumpster. But they are unique in that all other blowflies or most other blowflies develop their larvae in rotting organic material, garbage and things like that. The New World Screwworm is unique in that its larvae develop in the living tissue of warm-blooded animals.

9:13Edwin Burgess:So females lay their eggs in open wounds of cattle, but occasionally also in wildlife and pets. Can humans be infested?

9:23Adela Flores-Brennan:Very rarely humans can be infested. It is an extraordinarily rare occurrence, mainly because when you get a case of New World screwworm, because the larvae are feeding on living tissue, it is quite painful. So you know you have it very early on. And when people get it, it's usually dealt with in a very timely manner. So it does not pose a big risk to humans.

9:50Edwin Burgess:Okay. Well, this parasite was contained in Panama for decades, but then it was detected further north in Mexico about two years ago. Were the U.S. Department of Agriculture and the cattle industry expecting the screwworm to cross the border into the U.S.?

10:05Adela Flores-Brennan:It was a hope that it was not going to. The sterile insect technique facility in Panama continues to release sterile flies across all of the affected zones.

10:18Edwin Burgess:And explain to people how that works. How does that function to eradicate the disease?

10:23Adela Flores-Brennan:Yeah. So the main way sterile insect technique works is that the adult flies actually in their pupil stage, they get sterilized. And when they emerge from their pupae as the adult stage, the male's sperm is sterile. And one of the key biological factors that makes this technique works so well is that females only mate one time in their life. So when she encounters a sterile male and they mate, she stores that male sperm for the rest of her life and she fertilizes her own eggs as she's just about to lay them. So if the sperm is sterile, she can't fertilize her eggs and those eggs can't be viable.

11:10Adela Flores-Brennan:And that's what ultimately crashes the population.

11:13Edwin Burgess:Right. So the way of killing them off is basically releasing these sterile males who then cause the females to be unable to create the pest larva. All right. I think many listeners will be wondering if they eat meat from an infected cow, does the disease spread to humans like mad cow disease?

11:31Adela Flores-Brennan:No, it does not. There is not going to be anything in the meat if it came from an animal that had acquired and then recovered from a New World screwworm infestation. The meat is not going to be riddled with worms. There's really nothing for people to worry about in terms of the quality of meat that is going to be available as we're dealing with this pest.

11:56Edwin Burgess:And yet even so, this screwworm larva poses a danger to our food system, to farmers' livestock, and eventually perhaps to the price of beef, no? I mean, Canada has temporarily stopped importing livestock from Texas.

12:13Adela Flores-Brennan:Yeah. So a lot of that kind of volatility in the market is due to the restrictions on importing and exporting animals. And that measure is very important to consider because the main way that the fly spreads is through movement of animals that have the New World screwworm infestation. The flies do fly long distances, but it's not generally regarded as the main way that the fly spreads. It's really the movement of animals. And so that's why movement restrictions are being placed on animals. And that certainly does have an impact on the prices of meat and on the sale of cattle.

12:58Edwin Burgess:All right. So this screw worm had been contained in southern Panama for decades. what changed and how long will it take for the government to get a handle on this?

13:09Adela Flores-Brennan:It's hard to speculate. There hasn't been any formal announcements on why it broke containment in Panama. These things can happen when you're dealing with a live organism. It doesn't mean that it's a massive failure on the USDA's part necessarily. And it is a problem that will be ultimately solved with the sterile insect technique. It's what we used to eradicate it in the 1960s and then push it all the way through Mexico and Central America. And what that requires is an adequate number of flies. We need hundreds of millions of flies to cover all of that geographical area. And right now, we aren't at that capacity to do that.

13:52Adela Flores-Brennan:But the federal government and all of the participating states are working at a very, very fast pace to build up the capacity to rear enough of those sterile flies that we can then start to push it back through Mexico and Central America again.

14:06Edwin Burgess:That's Dr. Edwin Burgess, veterinary entomologist at the University of Florida's Institute of Food and Agricultural Sciences. Dr. Burgess, thank you.

14:14Adela Flores-Brennan:Thank you.