WASHINGTON (AP) — For the first time, the United States came close to providing health care for everyone during the coronavirus pandemic — but for only one condition, COVID-19.
Now things are going back to how they were as federal money for COVID care for the uninsured dries up, creating a potential roadblock to timely access.
But the virus is not contained, even if it is better controlled. And hospitals and clinics with safety nets experience significantly higher costs for salaries and other basic operating expenses. They fear they are unprepared if there is another push and no safety net.
“We haven’t turned anyone down yet” said Dr. Mark Loafman, chair of family and community medicine at Cook County Health in Chicago. “But I think it’s only a matter of time… People don’t get treatment for cancer or high blood pressure every day in America because they can’t afford it.”
A $20 billion government COVID program has covered the costs of testing, treatment and vaccines for the uninsured. But it was closed. Special Medicaid COVID coverage for the uninsured in more than a dozen states is also likely facing its final months.
At Parkland Health, Dallas’ frontline hospital system, Dr. Fred Cerise questions the logic of recalling federal dollars at a time when health officials have rolled out a new “test to treat” strategy. People with COVID-19 can now get antiviral pills to take home, hopefully avoiding hospitalization. One example is Vice President Kamala Harris, who recently tested positive but is back in the White House.
“The test to treat will be very difficult for the uninsured,” predicts Cerise, president and CEO of the system. “If it’s a large-scale change in strategy and it happens without funding, people will be hesitant to embrace it.”
Federal Department of Health and Human Services officials say new antiviral drugs like Paxlovid have been paid for by taxpayers and are supposed to be free for patients, even those who are uninsured.
But they recognize that some uninsured people cannot afford the medical consultation needed to get a prescription. “We are hearing from state and local partners that the lack of funding for the uninsured program is creating challenges for individuals to access medications,” said Dr. Meg Sullivan, chief medical officer of the HHS Preparedness and Response Division.
The nation has never pinched cash on the pandemic before.
“We are well below universal health coverage in the United States, but for a while we had universal coverage for COVID,” said Larry Levitt, health policy expert with the nonpartisan Kaiser Family Foundation. “It was extraordinary.”
Recently, an urgent request for $22.5 billion from the White House for COVID priorities did not advance to Congress. Even a clean version is blocked. Part of the Biden administration’s request involves $1.5 billion to replenish the Uninsured Persons Program, which paid for tests, treatments and vaccine-related bills for uninsured patients. The program has now stopped accepting claims due to a lack of funds.
This program, along with a lesser-known Medicaid option for states, has allowed thousands of uninsured people to seek treatment without worrying about the cost. Bipartisan support has caved in as congressional Republicans raise questions about pandemic spending.
The uninsured program was administered by the Health Resources and Services Administration, an agency of HHS. Medical providers seeing uninsured people could submit their bills for reimbursement. Over the past two years, more than 50,000 hospitals, clinics and medical practices have received payments. Officials say they can reactivate the program if Congress frees up more money.
The Medicaid coverage option began under the Trump administration as a way to help states pay to test uninsured people. President Joe Biden’s coronavirus relief bill also extended it to treatment and vaccine costs. It’s like a limited insurance policy for COVID. Coverage cannot be used for other services, such as knee replacement surgery. The federal government pays 100% of the cost.
Fifteen states, from the deep blue of California to the bright red of South Carolina, have taken advantage of this option, along with three US territories. It will end once the federal coronavirus public health emergency is over, currently scheduled for later this year.
New Hampshire Medicaid Director Henry Lipman said the coverage option allows his state to enroll about 9,500 people for COVID care that includes the new antiviral drugs that can be taken at home.
“It’s really the safety net for people who don’t have access to insurance,” Lipman said. “It’s a limited situation, but in the pandemic it’s a good backup to have. It makes a lot of sense with such a communicable disease.
With COVID cases now at relatively low levels, demand for testing, treatment and vaccinations is down. But the urgency felt by hospitals and other medical service providers is driven by their own results.
In Missouri, Golden Valley Memorial Healthcare CEO Craig Thompson worries that federal funding is evaporating just as operating costs are soaring. Staff won raises, drug costs increased by 20% and supply costs by 12%.
“We are now out of this pandemic…into probably the highest inflationary environment I have seen in my career,” said Thompson. The health system serves a predominantly rural area between Kansas City and Springfield.
In Kentucky, Louisville Family Health Centers shut down a testing service for uninsured people after federal funds ran out. The private company they were working with planned to charge $65 per test.
Things are manageable now because there is little demand, spokeswoman Melissa Mather said, “but if we get hit by another omicron, it’s going to be very difficult.”
Floridian Debra McCoskey-Reisert is uninsured and lost her older brother to COVID-19 during the first wave two years ago. During one of their last conversations, he made her promise that she would not catch the virus.
McCoskey-Reisert, who lives north of Tampa, has managed to avoid getting sick so far. But she is overshadowed by fear of what might happen if she or her husband were infected.
“If one of us gets sick from COVID, we have no way to pay for it,” she says. “It would probably put us out of business if we couldn’t find other help.”
The withdrawal of the uninsured reflects some of the biggest problems in the US health care system, said Chicago Hospital physician Loafman.
“Quite frankly, as a society, we care for people who are uninsured for COVID because it affects us,” he said. “You know, a gated community doesn’t keep a virus out…that’s kind of the sad truth is that our selflessness on this was really motivated.”
Hollingsworth reported from Mission, Kansas.
Copyright 2022 The Associated Press.