44: The Next Medicaid Cliff?

Dr. Jose Romero, Secretary of the Arkansas Department of Health, discusses the negative impact vaccine misinformation has on efforts to protect communities of color from the COVID-19 virus; Congressman Darren Soto of Florida considers what’s next in...

Dr. Jose Romero, Secretary of the Arkansas Department of Health, discusses the negative impact vaccine misinformation has on efforts to protect communities of color from the COVID-19 virus; Congressman Darren Soto of Florida considers what’s next in the push for Medicaid funding in the U.S. Territories; and ASTHO publishes two resources for ASTHO members thinking about how to recruit new forensic pathologists.

Webpage: Secretary of health receives Ohtli award for COVID efforts

ASTHO Resource: Reducing forensic pathologist shortages: Visas

ASTHO Resource: Reducing forensic pathologist shortages: Funding


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This is Public Health Review Morning Edition for Tuesday, October 12th, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.


As we wrap up National Hispanic Heritage Month later this week, we're thinking about the task of vaccinating communities of color against COVID-19.

Dr. José Romero is secretary of the Arkansas Department of Health. He says vaccine misinformation continues to make the job difficult.


I think that part of it is the social media that's spreading misinformation. That's part of it, the fact that they may not view this as a significant illness—I mean, I still hear that this is just a cold when we know it's not.

And the Latino population and, you know, many minorities, they're in that frontline group of individuals that are exposed to people, that their work conditions place them at higher risk for acquisition of the virus.

And so, they have to understand that that is the case and that the only way to control the pandemic is to protect themselves, protect their families, protect their communities.


Dr. Romero's work for vaccine equity was honored recently by Mexico's secretary of foreign affairs. He received the Ohtli award, the highest award given by Mexico to persons living outside the country.


Also today, the U.S. territories have about two months before the next federal deadline to fund Medicaid health services. So, what happens between now and then? Can territorial health departments expect a permanent solution from Congress, or will they get another extension on December 3rd?

We catch up with Congressman Darren Soto of Florida for his thoughts in today's morning conversation.

The territories got some breathing room, thanks to the extension, but what needs to happen between now and then to fix the problem once and for all?


Well, there's two ways we could look at it.

Our bill from now nearly two years ago that created Medicaid equality for the territories for a two-year span—you know, it came up to a deadline. It's hard to believe it's been two years since we passed that bill. Thank God, and thanks to Congress, even after all the delays, we passed the CR—continuing resolution—to extend that Medicaid funding until December, but we need a more permanent solution.

So, we could either, one, pass the bill into law that we've now passed out of the energy and commerce committee in a bipartisan fashion that would keep that FMAP, that federal share for Medicaid, as 76% for five years for Puerto Rico—we're talking about two, nearly $3 billion a year in Medicaid funds that it provides as an increase—along with all the rest of the territories that would have an eight-year extension.

Or, we could just finally do the right thing and have a permanent extension into the future; make it permanent to treat states and territories equally for their Medicaid funding, something that would create long-term stability and greatly improve their health systems as well as save lives in our territories.


What are the chances that any of that can happen before December?


I think the chances are very good that we will get the extension bill passed. And mind you, the first time we did it, it was two years; now, we're hoping for a five-year extension for Puerto Rico and an eight-year extension for all of our other territories—like the Virgin islands, Samoa, Guam, and Northern Mariana Islands—making sure that we're treating all of them equally.

And that's going to be key for the healthcare systems. We see these are areas that get battered by hurricanes and typhoons, sometimes they've even experienced earthquakes. They don't, for years, get equal amounts for their healthcare system, so you see hospitals that are in decline, doctors sometimes leaving our territories to go to the states for more lucrative careers, and nurses. And that takes a toll on these healthcare systems, leading to more rundown facilities, and Americans in our territories deserve better.


Finally, you represent a district in Florida. Why would people in your district care about Medicaid funding for the territories?


It's personal to us in Florida's ninth congressional district, in central Florida. I'm of Puerto Rican descent, as are many of my constituents—about 25% of us are of Puerto Rican descent in the district. So, this is something we care deeply about. Our families live down there, it's part of our culture and our heritage, and that expands out to really the whole Caribbean—the Virgin Islands—and of course we empathize and have the backs of our brothers and sisters and territories in the Pacific. So, for our constituents, this is very important.

Also, there's a direct link with population shifts between central Florida and Puerto Rico. They, sadly, had a loss of 11.8% of their population, more than any other place in the United States. And I, in a direct correlation, have the fastest growing district in the Congress—we grew 40% over the last 10 years. And we certainly welcome everyone, whether they're from the north or from the Caribbean—especially in Puerto Rico, a large part of that growth.

But we also want to make sure that there's stability with our region and that we could return Puerto Rico to prosperity so people don't feel like they have to leave because they don't have as good of a healthcare system, or they don't have as good of a commerce and economic system there. And healthcare is a big part of our economy. So, this in itself helps the local economy down there, with the main thing being saving lives and improving quality of life.

So, we have a direct link with all of the relocations of folks coming from Puerto Rico, where we want to see prosperity return to the island like we have here in central Florida.



Finally this morning, ASTHO members thinking about how to recruit new forensic pathologists will want to download two new resources addressing visas and funding concerns: one explains the role international medical graduates can play in a solution; the other considers possible funding approaches.


Find links to these documents in the show notes.


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Join us tomorrow morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.

Jose Romero MD

Secretary of Health, Arkansas Department of Health

Darren Soto

Congressman, Florida