May 11, 2022 - Podcasts

Why millions of Americans could soon lose healthcare coverage

As many as 14 million Americans on Medicaid could lose their coverage when the pandemic public health emergency expires. The declaration – and the temporary reforms it allowed for – are set to end on July 15th, if the Biden administration doesn’t extend them. This could result in a historic jump in the U.S. uninsured rate.

  • Plus, improving location accuracy on wireless 911 calls.
  • And, a new record for gas prices.

Guests: Axios' Adriel Bettelheim and Margaret Harding McGill.

Credits: Axios Today is produced by Niala Boodhoo, Sara Kehaulani Goo, Alexandra Botti, Nuria Marquez Martinez, Alex Sugiura, and Lydia McMullen-Laird. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

Go deeper:


Good morning! Welcome to Axios Today! 

It’s Wednesday, May 11th. 

I’m Niala Boodhoo. 

Here’s what we’re watching today: improving location accuracy on wireless 911 calls. Plus, a new record for gas prices.

But first, today’s One Big Thing: why millions of Americans could soon lose healthcare coverage.

NIALA: As many as 14 million Americans on Medicaid could lose their health coverage when the pandemic public health emergency expires. The declaration and the temporary reforms that it allowed for are set to end on July 15th if the Biden administration doesn't extend them. This can result in a historic jump in the number of uninsured Americans.

Here to explain is Adriel Bettelheim, senior healthcare editor at Axios. Hi, Adriel.

ADRIEL BETTELHEIM: Hi, nice to be with you!

NIALA: Adriel, remind us who Medicaid covers and what were the changes to Medicaid during the pandemic that allowed more people to have coverage?

ADRIEL: Well, this is the safety net program, of course, for the indigent. And it has become the biggest source of healthcare especially since Obamacare made it easier for states to expand their programs. Pretty early in the pandemic Congress increased the share of federal Medicaid spending of states promised continuous coverage, meaning they promised not to kick enrollees off the program roles and that would stop the programs usual churn, and it would avoid millions of people becoming uninsured, right as COVID was peaking.

NIALA: And so now, do we know how many million Americans could lose coverage if the pandemic public health emergency expires on July 15th?

ADRIEL: Right, it's all tied to the state of the emergency. Uh, the Kaiser Family Foundation took a stab at modeling. Each state takes different approaches so there's quite a difference in estimates, but they're saying between 5.3 million and 14.2 million people could drop off the program roles during this redetermination because their incomes no longer hit the eligibility requirements. Now some of those folks may have found work and gotten job-based health coverage for themselves, maybe for their families, but the biggest loss as Kaiser says would fall on adults who gained coverage through the Affordable Care Act Medicaid expansion, parents who qualify for Medicaid, but aren't disabled as well as kids. 

NIALA: So Adriel, it's up to the Biden administration to decide whether or not the pandemic public health emergency continues. Do we have a sense of where the administration is on this?

ADRIEL: All signs are pointing to them letting the emergency expire July 15th, and that there's a lot of health policy beyond just Medicaid attached to that. But it's a part of this is a political decision. This administration came into power saying that they were going to take control of the pandemic, get shots in people's arms, get disease counts down, and they've accomplished some of that. But when you continue to have the nation in crisis mode, it's kind of like an admission that you haven't gotten the job done. So I think it is in their political interest to sort of declare this over, move on to other things that fight inflation. But there are some good practical public health reasons perhaps for letting it extend through the summer, into the fall, especially if they see the possibility of more COVID waves on the horizon. So it's that classic struggle between a political decision and some pragmatic public health decisions. 

NIALA: Axios’ senior healthcare editor Adriel Bettelheim. Thanks Adriel.

ADRIEL: Thanks very much.

In a moment, we’re back with one cell carrier’s fix to delayed 911 responses.

Welcome back to Axios Today! I’m Niala Boodhoo.

When you call 911 from a wireless phone - it doesn’t always connect you to the nearest dispatch center. That can mean delays in life or death situations. AT&T announced yesterday that it’s launching a solution to that problem –  Axios’ Margaret Harding McGill has the exclusive… but says there are plenty of other tech problems with our 911 systems that need addressing… Hey Margaret.

MARGARET HARDING-MCGILL: Hey, thank you for having me.

NIALA: Margaret first exactly what is AT&T rolling out?

MARGARET: AT&T has a new service that's going to route the n911 calls from wireless customers to the closest dispatch center, which I'm sure you're thinking like, “wait, doesn't that already happen?” Actually it doesn’t. Typically calls from wireless phones are routed based on the closest cell phone tower. So if you're in Washington, DC, the closest cell phone tower to you might actually be in Northern Virginia, which means your 911 call would get routed to Northern Virginia, like an Arlington police or fire response, and then they would have to then transfer your call back to DC and that can be a delay. So the idea is instead of going based on the closest cell tower, AT&T will be able to say, “okay, you're in DC you need to go to the DC 911 center” and route you directly there.

NIALA: From a non-technological standpoint, it seems logical that this would have happened already. Why hasn't it though?

MARGARET: Apparently it has been historically faster for call routing to rely on the location of the cell tower rather than spending time pinpointing the caller's exact location before you relay that call to a 911 center. But now technology has gotten to the point where they can do that routing so fast that it makes sense to do that on the front end, rather than having calls transfer from 911 center to 911 center.

NIALA: Do we know how much of a delay this issue was causing? If your nine one one call was getting bounced to a couple of places?

MARGARET: So the FCC took a look at this issue back in 2018 and noted that 911 miss routes are not occasional and in fact occurred frequently and on occasion with deadly consequences. And they pointed to a report out of California, which found that 3.7 million calls to 911 were transferred from  one 911 center to another in the state out of a total volume of 28 million.

NIALA: So just to be clear, this hashad deadly consequences.

MARGARET: It has unfortunately. The FCC noted in its report, a woman who drowned after accidentally driving off the road and in Georgia, she was able to call 911. But that call was picked up by a cell tower in another county. There were minutes that were lost while the dispatchers were trying to figure out which county she was located at and she, she did die. There was also another case of a woman who was fatally shot in Florida and the call was routed to another 911 center in Florida and had to be transferred. She also died.

NIALA: Margaret you've also written about next generation 911 centers that are trying to close some other technology gaps and our emergency systems. What's happening with that?

MARGARET: So next generation 911 centers have the capability of accepting text messages, videos, phone calls, and sharing data more easily than their legacy counterparts. So about 3000 of the 6,000 911 centers have the ability to to accept texts. But if you talk to anyone in the emergency response community, they will say that the nation's 91 systems are hopelessly analog, that there are way behind the times. They look at all the information that you can get in your phone and are so frustrated that that information can't be used in an emergency. The danger is you run into a situation where you have digital haves and have nots when it comes to an emergency response where the quality of your emergency response might be determined based on what county you're in and how advanced their capabilities are. Think of how much better the response might be in a medical situation if your smartwatch directly contacts 911 and is sharing details of your wellbeing, as opposed to having to rely on somebody else to send that information in.

NIALA: What is it going to take to have our 911 centers catch up to the technology that already exists?

 It's going to take a lot of money. Congress last year. and as part of the Build Back Better Act floated a 10 billion for upgrading the nation's 911 centers but that funding was slashed and obviously Build Back Better did not advance.

NIALA: Margaret Harding-McGill covers tech policy for Axios from Washington. Thanks, Margaret.

MARGARET: Thank you.

Margaret, you've written about next generation 911 centers that are trying to close some of the other technology gaps in our emergency systems -- what's happening there?

Three more stories we’re following today:

A new report shows deadly gun violence in the U.S. spiked during the pandemic’s first year: The rate of firearm homicides jumped 35% between 2019 and 2020, according to the CDC – 2020 had the highest rate of homicides linked to guns since 1994.

We’ve broken yet another record for gas prices. The average price in the US for a gallon is now at $4.37 - according to AAA - replacing the last record high on March 11. Important context though: when you adjust for inflation, we were still paying about a dollar more per gallon in 2008.

And – Apple says it’s discontinuing the iPod - more than two decades after it was introduced. Blame smartphones for the demise of our once favorite technology. Just for old times sake - remember this sound? 

[ipod sound]

That’s all we’ve got for you today! 

I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

Go deeper