It's hurricane season again, and public health hangs in the balance
June marks the beginning of the 2025 Atlantic hurricane season, and forecasters are warning of above-average activity.
More than half of U.S. coastal areas should plan to face a major hurricane of Category 3, 4, or 5. If our 2024 experience is a reliable predictor, we can anticipate more than $100 billion in damage, more than 100 fatalities and an increasingly problematic, if overlooked, element of these disasters: the threat to public health.
Hurricanes and other water-centric events, like flooding, are creating ideal environments for the transmission of infectious diseases, from mold exposure to flesh-eating diseases to mosquito-borne viruses.
Clusters of a potentially fatal infection caused by Vibrio bacteria, which can cause severe diarrhea and necrotizing skin lesions, hit Florida after Hurricane Ian in 2023. Cases in 2024 exceeded that total, with high burdens in Florida counties that experienced the worst flooding from Hurricane Helene.
In Texas last summer, health officials warned the public of the risk of contracting West Nile virus post-Hurricane Beryl.
Mosquito-borne illness is possible wherever there are mosquitoes. Florida, California and Texas all experienced locally acquired cases of dengue fever in 2024.
Chikungunya, which can result in lifelong physical debilitation, is also present in the United States, with travel-associated and locally acquired cases being documented in Gulf states as recently as 2019.
Several deaths from Eastern equine encephalitis occurred last year in northeastern states, with several towns instituting curfews to curb the mosquito-borne threat.
Rises in mosquito populations are a well-documented hazard after hydrologic disasters like hurricanes, tsunamis and floods. These events can compromise sewage pipes, contaminate drinking water and result in diffuse areas of standing water that become breeding grounds for mosquitoes.
Emergency preparedness professionals have long understood the risk. What's changing is the frequency of billion-dollar disasters — and with them, we suspect, greater damage, flooding, and disease risk.
The good news is that we can leverage past experience, predictive models and tools like state and regional medical stockpiles to mitigate some of the worst health impacts. By strategically positioning medical supplies and countermeasures closer to the point of need, health authorities can significantly reduce response time, minimize logistical challenges and save lives.
A number of states already have medical stockpiles for basic medications and personal protective equipment; others are creating or updating legislative authorities for them.
These stockpiles generally lack federal support and medical countermeasures for high-consequence threats. The utility of state or regional caches could be expanded to include emerging needs like vaccines, treatments and diagnostics for vector-borne infections.
Congress authorized the Department of Health and Human Services to conduct a pilot program matched by local funds for state stockpiling of medical countermeasures and other supplies for public health emergencies. The Biden administration did not request funding for state stockpiles and Congress has not appropriated funds for the program, however, stagnating the initiative.
Funding is the number one type of support that jurisdictions say they need to help them establish and maintain stockpiles.
Investing in state or regional stockpiles is a cost-effective approach to emergency preparedness. It minimizes the need for last-minute, high-cost procurements during crises, places more autonomy in the hands of states and helps maintain health care system resilience.
President Trump's executive order on preparedness recognizes ownership of preparedness at the state and local level, and calls on federal policy to help empower state and local jurisdictions to make smart infrastructure choices. This same ethos can extend to public health preparedness.
Last year's final report of the congressional Select Subcommittee on the Coronavirus Pandemic concluded that state stockpiles can provide a tailored local complement to the federal Strategic National Stockpile.
As natural disasters increase in frequency and intensity, the federal government can support local decision-makers in meeting their communities' unique public health readiness needs.
During COVID-19, many local officials did not know what was in the federal stockpile. Drawing stockpiles closer to the communities that will need them, tied to input from local, state or regional medical advisory groups, would increase awareness of stockpile contents and enable tailored input to support assets these communities need.
Redundancies built into state or regional caches could allow local healthcare providers access to critical supplies that allow them to meet medical standards of practice even in a crisis.
State stockpiles could facilitate greater efficacy of vendor-managed inventories and improve the quality and efficiency of supply rotations. Especially for countermeasures that have cold chain requirements or other complicated logistics, the federal role can be to provide the training and best practices to allow jurisdictions to successfully store and distribute these assets when needed.
COVID-19 revealed a national unpreparedness to increase production rationally based on identifiable gaps pre-disaster. For example, better local input on necessary ventilator functionalities would have improved the production of quality devices as demand surged, rather than devices produced by auto manufacturers that were failures.
State and regional stockpiles can reverse this underpreparedness and empower local communities.
Congress should show its federal support by extending the authorized timeline for the state stockpile program and, critically, funding it commensurately in the coming appropriations cycle.
By strategically positioning medical supplies and countermeasures closer to the point of need, a federal-regional-state partnership can significantly reduce response time, minimize logistical challenges and save lives before future hurricane seasons and other regional disasters occur.
Craig Vanderwagen is a former assistant secretary for preparedness and response in the Department of Health and Human Services and the founder and general manager of East West Protection, LLC, which provided private and public sector disaster preparedness support.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Hill
3 hours ago
- The Hill
Dangerous AI therapy-bots are running amok. Congress must act.
A national crisis is unfolding in plain sight. Earlier this month, the Federal Trade Commission received a formal complaint about artificial intelligence therapist bots posing as licensed professionals. Days later, New Jersey moved to fine developers for deploying such bots. But one state can't fix a federal failure. These AI systems are already endangering public health — offering false assurances, bad advice and fake credentials — while hiding behind regulatory loopholes. Unless Congress acts now to empower federal agencies and establish clear rules, we'll be left with a dangerous, fragmented patchwork of state responses and increasingly serious mental health consequences around the country. The threat is real and immediate. One Instagram bot assured a teenage user it held a therapy license, listing a fake number. According to the San Francisco Standard, a bot used a real Maryland counselor's license ID. Others reportedly invented credentials entirely. These bots sound like real therapists, and vulnerable users often believe them. It's not just about stolen credentials. These bots are giving dangerous advice. In 2023, NPR reported that the National Eating Disorders Association replaced its human hotline staff with an AI bot, only to take it offline after it encouraged anorexic users to reduce calories and measure their fat. This month, Time reported that psychiatrist Andrew Clark, posing as a troubled teen, interacted with the most popular AI therapist bots. Nearly a third gave responses encouraging self-harm or violence. A recently published Stanford study confirmed how bad it can get: Leading AI chatbots consistently reinforced delusional or conspiratorial thinking during simulated therapy sessions. Instead of challenging distorted beliefs — a cornerstone of clinical therapy — the bots often validated them. In crisis scenarios, they failed to recognize red flags or offer safe responses. This is not just a technical failure; it's a public health risk masquerading as mental health support. AI does have real potential to expand access to mental health resources, particularly in underserved communities. A recent NEJM-AI study found that a highly structured, human-supervised chatbot was associated with reduced depression and anxiety symptoms and triggered live crisis alerts when needed. But that success was built on clear limits, human oversight and clinical responsibility. Today's popular AI 'therapists' offer none of that. The regulatory questions are clear. Food and Drug Administration 'software as a medical device' rules don't apply if bots don't claim to 'treat disease'. So they label themselves as 'wellness' tools and avoid any scrutiny. The FTC can intervene only after harm has occurred. And no existing frameworks meaningfully address the platforms hosting the bots or the fact that anyone can launch one overnight with no oversight. We cannot leave this to the states. While New Jersey's bill is a step in the right direction, relying on individual states to police AI therapist bots invites inconsistency, confusion, and exploitation. A user harmed in New Jersey could be exposed to identical risks coming from Texas or Florida without any recourse. A fragmented legal landscape won't stop a digital tool that crosses state lines instantly. We need federal action now. Congress must direct the FDA to require pre-market clearance for all AI mental health tools that perform diagnosis, therapy or crisis intervention, regardless of how they are labeled. Second, the FTC must be given clear authority to act proactively against deceptive AI-based health tools, including holding platforms accountable for negligently hosting such unsafe bots. Third, Congress must pass national legislation to criminalize impersonation of licensed health professionals by AI systems, with penalties for their developers and disseminators, and require AI therapy products to display disclaimers and crisis warnings, as well as implement meaningful human oversight. Finally, we need a public education campaign to help users — especially teens — understand the limits of AI and to recognize when they're being misled. This isn't just about regulation. Ensuring safety means equipping people to make informed choices in a rapidly changing digital landscape. The promise of AI for mental health care is real, but so is the danger. Without federal action, the market will continue to be flooded by unlicensed, unregulated bots that impersonate clinicians and cause real harm. Congress, regulators and public health leaders: Act now. Don't wait for more teenagers in crisis to be harmed by AI. Don't leave our safety to the states. And don't assume the tech industry will save us. Without leadership from Washington, a national tragedy may only be a few keystrokes away. Shlomo Engelson Argamon is the associate provost for Artificial Intelligence at Touro University.
The Hill
5 hours ago
- The Hill
Congress should look to Tennessee as an example for Medicaid reform
As Congress wrestles with the need to trim spending, attention has turned to Medicaid, and to a lesser extent, Medicare. These are hardly new issues. Within seven years of the 1965 enactment of Medicaid, for those eligible for federal income support (largely those in poverty), and Medicare, primarily for those eligible for Social Security, Congress in 1972 turned its attention to concerns about containing costs in those programs. Tennessee has been a pioneer in managing its Medicaid costs, and Congress might benefit from the Tennessee experience with TennCare, the state's Medicaid program. About 30 years ago, Tennessee faced unsustainable annual increases in its Medicaid program. A popular Democratic governor, Ned McWherter, called the state's Medicaid program the Pac Man of the state's budget. He sought to find a way to pay for the Medicaid increases through a state income tax (Tennessee does not have one) but failed. The TennCare program was designed to address the issue by containing the rate of increase in costs. Tennessee received a waiver so that it could implement a universal and mandatory managed care program. Tennessee had no managed care in Medicaid, and a move to 100 percent managed care was projected to reduce costs by 20-25 percent on a recurring basis. Support from patient advocates was secured by agreeing that cost savings would be used to increase access to Medicaid to previously uncovered persons. The mandatory Medicaid managed care program was deemed such a success that, in 1997, Congress allowed states to implement Medicaid managed care without a waiver. Managed care introduced economic considerations into the process of medical decision-making. While the cost savings projections were pretty much on target; once those savings were fully realized, the projections recognized that the rate of cost escalation would be restored, albeit from a lower cost basis. That projection also turned out to be pretty accurate. A Republican governor, Don Sundquist, succeeded McWherter and unsuccessfully sought to implement an income tax. Another wonderful Democratic governor, Phil Bredesen, was elected to succeed Sundquist under a promise not to seek an income tax. Bredesen was determined to find a way to manage down the rate of increase of Medicaid spending. I served as his outside counsel. A reform team determined that the target for reform should focus on the concept of 'medical necessity.' That insight was informed by work I had done as part of an Institute of Medicine study group, which looked at hospital staffing in a system that had recently merged three hospitals. There were three distinct models, and no consensus about which was the 'right' one. Traditionally, the concept of 'medical necessity' was the term used to define the scope of benefits under health plans, including Medicaid. The concept assumed that there was a single correct way of practicing medicine, and that it had a justification based on scientific consensus. But the existence of clinical uncertainty called into question that traditional view. As it turned out, many alternatives were available at varying costs, and evidence of superiority of one particular approach was often lacking. Those insights led to the policy conclusion that, if a more expensive alternative were proposed, the state should not pay for that more expensive alternative unless there was good scientific evidence that it was superior and worth the additional cost. If an aspirin were adequate, it should be used instead of a more expensive prescription-based alternative. If an adequate outpatient procedure were available at lower cost, TennCare should not pay for a more expensive inpatient option. These insights resulted in a TennCare definition of 'medical necessity' that could serve as a national model at considerable (but hard to measure) cost savings. That definition has been in place for nearly 20 years and has been approved by a federal court. TennCare has kept costs manageable so that the state has been able to live within existing sources of revenue, and the state even proposed to accept financial risk if it could share in the cost savings from TennCare above a projected baseline. The TennCare definition includes the traditional requirement that a medical item or service be recommended by a treating physician (no doctor shopping) and that it be 'safe and effective.' The reasonably anticipated medical benefits must 'outweigh' the reasonably anticipated medical risks 'based on the enrollee's condition and scientifically supported evidence' to be covered under TennCare. That is, a medically based risk-benefit calculation is a requirement as part of medical decision-making. The innovative aspects have three components. First, a medical item or service must be required 'in order to diagnose or treat an enrollee's medical condition.' That circumscribes the type of item or service covered under the program. Second, the medical item or service must be the 'least costly alternative course of diagnosis or treatment.' That expressly incorporates economic factors into medical decision-making. An alternative course of diagnosis or treatment 'may include observation, lifestyle or behavioral changes, or, where appropriate, no treatment at all.' If an item or service can be safely provided in an outpatient setting at lower cost, then that is what TennCare will pay for. More expensive inpatient treatment is not 'medically necessary.' Third, the less costly alternative need only be 'adequate for the medical condition of the enrollee.' The yardstick is not the best possible standard or some comparison with private plans. The standard of 'adequacy' means that sub-standard medicine is not acceptable, but that some differences between benefits for TennCare enrollees and those on private plans are acceptable. These innovations were controversial 20 years ago, when proposed and enacted, but they have become part of the fabric of TennCare and have been in place successfully for two decades. They help shape the medical decision-making culture that costs are to be considered and that the issue is the adequacy of care not what might be available in some private plans. That type of modest stratification, by the way, is expressly endorsed in the Affordable Care Act. Section 1302(b)(5) expressly allows for supplementation by health plans beyond the essential health benefits mandated by the Affordable Care Act. In the discussions that led to these reforms, the estimated range of savings was from 1 percent to 5 percent of total Medicaid spending. In an environment in which a program entails large expenditures, even a 1 percent per year savings could be considerable. James F. Blumstein is University Distinguished Professor at Vanderbilt Law School and the director of Vanderbilt's Health Policy Center.
Yahoo
5 hours ago
- Yahoo
How Can the Democrats Be Losing to These Cruel, Stupid, Inept People?
Senate Republicans have no 'big, beautiful' bill. It isn't close to finalized. The Senate parliamentarian, combing through the details and determining which provisions will need a supermajority to pass, is hammering them. They're locked in ferocious internal debate about the cuts to Medicaid. They haven't held a single hearing on the bill in any committee. And they say they're going to start voting on it tomorrow. Even worse is the complete hypocrisy of the thing, which has been true of every Republican tax bill going back to 1981. Ever since Arthur Laffer sold the GOP on his ridiculous curve, they've been lying to the American people about how their tax cuts will produce more revenue. It has never happened. Ever. Some of the dumber Republicans may believe this, but the smarter ones know Laffer's theory is a lie, and they say it anyway. And so we watch as Senate Republicans argue about the degree to which they want to destroy Medicaid. You've been reading and hearing about this, I'm sure, and you may even have become familiar with the phrase 'provider tax.' Journalistic shorthand usually does a poor job of explaining what that actually is. Bear with me for this brief explanation, because it makes clear how cruel and deliberate these cuts are. Health care services that are reimbursed by Medicaid are, well, provided by a range of different 'providers.' Chief among these are hospitals, but the category also includes nursing homes, other long-term care facilities, doctors, physical therapists, even chiropractors: all sorts of people. But the big money revolves around hospitals, and specifically rural hospitals, which rely heavily on Medicaid dollars because they are poorer on balance than other hospitals. They tend to be run on a nonprofit basis. They are less likely than urban or suburban hospitals to have commercial insurance, and they're more dependent on Medicaid revenue because their client base tends to be poorer. There are about 1,800 rural hospitals in the United States. Here's a map. OK. Starting in the 1980s, during an earlier funding crisis, Congress allowed states to start taxing providers. In many states (this gets very complicated, and I'm not going to go into it that deeply), the cap on the tax that states can charge hospitals is 6 percent of the patient revenue money (it's called the 'safe harbor maximum' in wonkspeak). The Senate bill seeks to lower this cap over a few years to 3.5 percent. To make a long story short, when you reduce a tax, you reduce the amount of revenue it brings in. It's also worth bearing in mind here that Medicaid reimbursements rarely cover the cost of care to begin with, so these cuts will make an already dire situation much worse. Governors and state legislatures will be staring at a quite substantial reduction in Medicaid tax revenue. They will then be faced with three choices: one, raise some other sort of tax; two, cut some other state service, like education; three, cut Medicaid services. As congressional Republicans well know, most states are going to choose number three, because it's the easiest path. And that brings devastation. If you want to see why Republican Senator Thom Tillis is so freaked out, click on that map above and zoom in on his state, North Carolina. You'll see in detail how many rural hospitals there are operating at a loss, and how many have already closed. So this is what Republicans are debating—and deliberately and dishonestly telling the American people that it's a simple case of cutting 'waste, fraud, and abuse,' as if they have no choice in the matter. It's a monstrous lie. They have a choice. But of course it's a choice they'll never make. What is that choice? They could, in theory, reduce the tax cuts to the rich. The problem would be instantly solved. The proposed Medicaid cuts come to around $800 billion. The cost of making the 2017 income tax cuts permanent is around $2.2 trillion. So in other words, canceling the tax cuts would more than cover the proposed Medicaid cuts. In fact, the Republicans could leave nearly two-thirds of the tax cuts intact, and just pare them back, and leave Medicaid untouched. In a fantasy world, they could, dare I say it, eliminate the tax cuts altogether. They'd have $2.2 trillion to play with, and they could expand rural health care—you know, actually do something of substance for all the people who vote for them, besides scaring them into thinking that Democrats want to steal their guns and neuter their children. But you notice: No one ever, ever, ever discusses the tax cuts. No one. None of the, ahem, moderates—not Senator Susan Collins, not Representative Mike Lawler (at least that I've heard). Tax cuts aren't written in ink and on paper, to Republicans. They're written in lightning on tablets from Mount Sinai. They cannot be discussed. And these aren't just your usual, run-of-the-mill GOP tax cuts. They're worse. They're the most redistributive tax cuts in modern American history, and by redistributive, I don't mean from the top down. I mean to the top from the rest of us. Here are a few facts about the House's version of the bill, from the Institute on Taxation and Economic Policy, or ITEP: The richest 1 percent of Americans would receive a total of $121 billion in net tax cuts in 2026. The middle 20 percent of taxpayers on the income scale, a group that is 20 times the size of the richest 1 percent, would receive less than half that much: $56 billion in tax cuts that year. The $121 billion in net tax cuts going to the richest 1 percent next year would exceed the amount going to the entire bottom 60 percent of taxpayers (about $79 billion). The poorest fifth of Americans would receive less than 1 percent of the bill's net tax cuts in 2026, while the richest fifth of Americans would receive 70 percent. The richest 5 percent alone would receive 45 percent of the net tax cuts that year. There's a lot more. The richest 1 percent ($916,900 and above) will get an average cut of $68,430, or 2.5 percent. The poorest 20 percent (up to $27,000) will get a whopping cut of $30, or 0.2 percent. In percentage terms, the cut for the rich is 10 times the cut for the poor. But wait—incredibly, it gets worse. ITEP estimates that when you throw in the costs of Donald Trump's tariff proposals, the net impact on the bottom 20 percent will be a tax increase of 2.2 percent. The tariffs aren't finalized, of course, so we can't really know the hard number, but as a general rule, tariffs cost poorer people more since they're spending a far higher percentage of their income on imported necessities. The whole thing is just a disgrace. A policy disgrace. A moral disgrace. Rural hospitals will close, and working-class people will die so that Trump's golf buddies can get tax cuts of tens or hundreds of thousands of dollars. The American people don't know all the above facts and figures, but they do seem to know in their bones that this bill is a heist. It's deeply unpopular. But even so, the Democrats could be doing much more here. Why don't they fan out across the country one day next month and have events at money-losing rural hospitals that face potential closure? Back in the spring, when they did those anti-DOGE events in Republican districts, it seemed to have an impact. At least they were visibly doing something. There are rural hospitals in every state. Democrats could do a lot worse than to try to show rural Americans that they care. But it's like Jon Lovitz, playing Michael Dukakis, said on Saturday Night Live back in 1988: I can't believe we're losing to these guys. If Democrats were more aggressive, this bill would kill Republicans off in 2026 and 2028. It's that cruel, it's that stupid, it's that inept. Democrats need to find dramatic ways of saying so. This article first appeared in Fighting Words, a weekly TNR newsletter authored by editor Michael Tomasky. Sign up here.
