WOn Monday, the Senators of the United States announced a $10 billion deal to increase funding for coronavirus response. Many public health professionals were shocked that this package would not provide aid for vaccinations in foreign countries. The program which has paid for coronavirus testing, treatment and vaccines to uninsured Americans is another likely area of cutbacks. Experts warn that this lack of funding will not only affect the most vulnerable Americans but could also lead to future COVID-19 outbreaks.
Late last month, the program to help uninsured persons began ending. Biden administration repeatedly requested $22.5 billion in additional emergency pandemic relief. It warned that there would be a shortage of vaccines to provide a booster for all Americans and would not be enough money to purchase more monoclonal antibody to combat the coronavirus.
This funding bill represents less than half the amount requested by the Administration. “This will obviously not meet all of those dire needs in this country,” White House Press Secretary Jen Psaki said at a press conference on Monday. This bill will be used to purchase more COVID-19 tests, vaccines and treatment drug treatments. Psaki stated that the Administration would continue pushing for global coronavirus assistance, although this may not occur until after spring. Uncertain if the government will provide additional assistance for domestic responses.
The uninsured program has stopped taking COVID-19 treatment and testing claims since March 22. It will no longer accept vaccine claims from uninsured persons after April 5. Many hospitals, pharmacies and community health centers across the U.S. face the prospect of losing federal funding.
‘Pulled the rug out from under us’
When Dr. Wendy Williams, the chief medical officer for Coastal Family Health Center, a group of community health centers along Mississippi’s gulf coast, found out last month that the federal COVID-19 program for uninsured people was ending due to a lack of funding, it felt “like somebody pulled the rug out from under us,” she says. Her clinics’ patients include many Spanish and Vietnamese speakers, migrant workers, and people who work on ships docked in the area’s ports. Half of these people don’t have any health insurance.
Williams and her employees have relied on federal programs to aid them in treating, testing, and immunizing their patients throughout the pandemic. They submitted as many claims as they could, with less than one week notice of the March deadline. But Williams estimates the center has between $250,000 and $500,000 in testing and treatment costs that will never get reimbursed because staff couldn’t submit those claims in time.
Although large hospitals and private labs may now charge patients who are not insured, they can also turn away those people. However, safety net hospitals, community health centers, and other hospitals that serve the same purpose, have been able to help these patients. “We’re a safety net. We can’t turn people away,” Williams says. “But it just makes it difficult in this environment that we’re living in. We had budgeted for that, we knew how much we were going to get back from the uninsured portal so we could plan, and now we can’t do that.”
Safety net hospitals and community health centers often have small budgets. Many will reduce the number of services that they provide if there is no federal funding, according to Dr. Ron Yee. Yee is the chief medical officer of National Association of Community Health Centers. “When health centers are pressed and their margin is gone, they start cutting those enabling services of transportation, translation, enrollment, health education,” he says. “And this is a really critical time to have all those services because we’re in catch-up mode because of the pandemic.”
Safety net hospitals, which also serve large uninsured populations, will likely will cut back on social services, reduce clinic hours or put off plans to upgrade their facilities, says Beth Feldpush, senior vice president of policy and advocacy at America’s Essential Hospitals. She also mentions that staffing is a concern because many of the health care workers who left during the epidemic have either retired or become burnt out. “Hospitals that have more capital at their disposal in the first place will have an easier time paying out more money for contract labor,” Feldpush says. “For our members and for their staff, there’s almost a double hit here.”
High-priced tests and treatments
Some providers ask uninsured patients to pay the substantial costs of COVID-19 treatment, testing and claims. Some patients who were not insured paid tens to thousands of dollars for COVID-19 treatments in the early days of the pandemic. The uninsured program has spent more than $19 million to pay hospitals, community centers and laboratories since its creation in May 2020.
Some labs with large funding from this program have changed their policies. Quest Diagnostics has advised clients that it is no longer possible to receive reimbursements for the testing of uninsured people. QuestDirect now allows those without insurance to pay $125 or $100 through QuestDirect if ordered through Quest affiliated physicians.
Labcorp’s at-home COVID-19 testing kits now cost $119 for those without insurance. Curative operates over 13,000 sites in 18 states. It has now stopped offering testing to patients who aren’t insured in any location where it is not possible to obtain funding. While the company works with local and state partners, it is also piloting charging for testing at two locations. However, in some states that have large populations of uninsured, this could prevent many from accessing testing. “We are deeply concerned about this recent development and the impact it will have on uninsured patients,” said Pasquale Gianni, a Curative spokesman.
Similar problems are faced by smaller companies. In De Queen, Ark., pharmacist Elee Coleman is worried about how the end of the uninsured program will affect her family’s pharmacy, Her parents also own De Queen Health and Wellness Pharmacy. Coleman said that the shop provided 15,000 COVID-19 injections, 1000 COVID-19 tests and 1,400 monoclonal anti-body treatments. This has helped a rural area where about half of the population is Hispanic. Hispanic Americans are more likely to die from COVID-19 than whites. The pharmacy is still waiting on about $150,000 in reimbursements from the federal government that it now doesn’t know if it will see, plus another 70 claims that it couldn’t submit in time, like Williams in Mississippi.
On March 16, when the Department of Health and Human Services’ Health Resources and Services Administration (HRSA) announced the uninsured program was ending, it told providers that “submitted claims will be paid subject to the availability of funds.” The agency declined to say how much money is left in the program. However, it is continuing to process claims received before the deadlines.
According to HRSA spokespersons, Omicron has swept the nation and the uninsured have been spending approximately $2 billion per month in claims. While that could vary as the pandemic changes, experts say it’s clear the $10 billion in new funding that Congress is aiming to pass is not sufficient. “Right now, when claims for testing and treatment services are low, dedicating what would have to be a small share of that $10 billion to fund this program might extend it for a little while longer, but there certainly would not be enough money of that $10 billion to support this program during another COVID wave,” says Jennifer Tolbert, a director at the nonpartisan Kaiser Family Foundation (KFF) who has been tracking the COVID-19 uninsured program. “That simply just leaves very little money to fund this program.”
Coleman claims that Coleman and her parents still haven’t decided whether they will be continuing to provide COVID-19 vaccines, testing and treatment to the uninsured. But the end of this funding will be “a huge loss for our store,” she says. “It’s going to impact the community a lot, not just our pharmacy.”
‘Continually caught off guard’
Although the number of coronavirus-related deaths has been declining and healthcare providers have not become overwhelmed by COVID-19 testing and treatment requests, it is still a pandemic. In the United States, there are hundreds of deaths every day. There is an increasing prevalence of the BA.2 variant and the Food and Drug Administration approved a booster shot for Americans aged 50 and over.
Yee stated that while COVID-19 vaccinations are free for all, certain uninsured patients may be hesitant to seek COVID-19 treatment, testing and vaccines because they fear being charged. He says that community health centers were key in encouraging patients to get care during previous spikes. “We’ve pushed a lot of those visits away from emergency rooms and hospitals, when they had those surges when they were running out of ventilators and they were overwhelmed,” Yee says. “This could be put in jeopardy if we don’t have proper funding going forward.”
Yee also notes that the community health centres can treat people who are not eligible for other medical care due to the outbreak of coronavirus. If community health centers cut back on services, or people choose not to seek heath care because they fear the price tag, uninsured people’s health problems are often exacerbated. That leads to more hospitalizations and more costs to the country’s health care system in the long run.
“The cost of all these things have been put on hold—you can have more hospitalizations for depression, you can have people that are having heart attacks and strokes, you can have people with diabetes that is out of control,” Yee says. “We’re gonna end up way behind in terms of care and access, but also the cost to the federal government.”
Tolbert, of KFF, worries that Congress’s decision to allow funding to lapse now is “short-sighted” at this point in the pandemic. “We have been continually caught off guard in our response to COVID-19,” she says. “Now is the time when you want to be shoring up resources, in case that there is another surge so that we are better prepared.”
Williams from the Mississippi Coastal Family Health Center states that the funding will soon be terminated.
“If there’s another surge, and we have to test and treat thousands and thousands of people again, those resources have to come from somewhere,” she says. “God willing it doesn’t happen, but if it does, I honestly don’t know what we’ll do.”
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