COVID coverage for all is declining despite rising hospital spending

For the first time, the United States has come close to providing health care for all during coronavirus pandemic — but only for one condition, COVID-19.

Things are now returning to the way they were before as federal COVID treatment money for the uninsured dries up, creating a potential barrier to timely access.

But the virus cannot be contained, even if it is better controlled. And hospitals and social care clinics are seeing a sharp increase in payroll and other basic operating expenses. They fear they won’t be ready if there’s another surge and no support.

“We haven’t turned anyone down yet,” said Dr. Mark Loafman, chairman of family and community medicine at Cook County Health in Chicago. “But I think it’s just a matter of time… In America, people don’t get treated for cancer or get treated for blood pressure every day because they can’t afford it.”

The government’s $20 billion COVID program covers the costs of testing, treatment and vaccines for uninsured people. But it was closed. Special Medicaid COVID coverage for the uninsured in more than a dozen states is also likely to end in recent months.

At Parkland Health, Dallas’ cutting-edge hospital system, Dr. Fred Cerise questions the logic of cutting federal dollars at a time when health officials have rolled out a new “test-treat” strategy. People with COVID-19 can now receive antiviral pills to take at homehope to avoid hospitalization. Vice President Kamala Harris, who recently tested positive but is back in the White House, is an example.

“The test treatment will be very difficult for the uninsured,” predicted Cerise, president and chief executive officer of the system. “If it’s a large-scale change in strategy and it’s happening without funding, people won’t want to accept it.”

Federal Health and Human Services officials say new antivirals like Paxlovid have been paid for by taxpayers and should be free for patients, even uninsured ones.

But they acknowledge that some uninsured people cannot afford the medical advice needed to get a prescription. “We’re hearing from state and local partners that the lack of funding for the uninsured program is creating problems for people accessing medicines,” said Dr. Meg Sullivan, Chief Medical Officer for HHS Preparedness and Response.

Previously, the nation did not save on pandemics.

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“We’re missing universal health coverage in the US, but we’ve had universal COVID coverage for a while,” said Larry Levitt, a health policy expert with the non-partisan Kaiser Family Foundation. “It was extraordinary.”

Recently, the White House’s urgent request for $22.5 billion for COVID priorities failed to pass in Congress. Even the stripped down version is stuck. Part of the Biden administration’s request includes $1.5 billion to replenish the Uninsured Program, which paid bills for testing, treatment, and vaccines for uninsured patients. Now the program has stopped accepting applications due to lack of money.

This program, along with the lesser-known state option Medicaid, has enabled thousands of uninsured people to get health care without worrying about costs. Bipartisan support gave way as congressional Republicans raised questions about pandemic spending.

The uninsured program was administered by the Health Resources and Services Administration, HHS. Health care workers visiting uninsured people may submit their bills for reimbursement. Over the past two years, more than 50,000 hospitals, clinics and doctor’s offices have received payments. Officials say they may turn the program back on if Congress allocates more money.

The Medicaid coverage option emerged under the Trump administration as a way to help states pay for testing for uninsured people. President Joe Biden’s coronavirus relief bill extended it to spending on medical treatment and vaccines. It’s like a limited COVID insurance policy. The coverage cannot be used for other services such as knee replacement. The federal government pays 100% of the cost.

Fifteen states, from dark blue California to bright red South Carolina, have used this option, as well as three US territories. It will end as soon as the coronavirus federal public health emergency, which is currently projected for later this year, ends.

New Hampshire Medicaid director Henry Lipman said the coverage option allowed his state to enroll about 9,500 people for COVID treatment, including new antivirals that can be taken at home.

“It’s really a safety net for people who don’t have access to insurance,” Lipman said. “It’s a limited situation, but during a pandemic it’s a good backup. It makes a lot of sense in such an infectious disease.”

Now that the number of COVID cases is at a relatively low level, the demand for testing, treatment and vaccination is declining. But the urgency that hospitals and other healthcare providers feel is driven by their own profits.

In Missouri, Golden Valley Memorial Healthcare CEO Craig Thompson is worried that federal funding is evaporating and operating costs are skyrocketing. The staff got a raise, the cost of drugs increased by 20%, and the cost of supplies increased by 12%.

“Now we are out of this pandemic … into what is probably the highest inflation environment I have seen in my career,” Thompson said. The healthcare system serves the mostly rural area between Kansas City and Springfield.

In Kentucky, the Louisville Family Health Centers shut down a testing service for uninsured people after federal funds dried up. The private company they worked with planned to charge $65 per test.

Things are under control right now because there’s little demand, “but if we get another omicron, it’s going to be very difficult,” spokeswoman Melissa Mather said.

Florida-based Debra McCosky-Reisert is uninsured and lost her older brother to COVID-19 during the first wave two years ago. In one of their last conversations, he made her promise that she would not contract the virus.

McCosky-Reisert, who lives north of Tampa, until he fell ill. But she is overshadowed by fear of what might happen if she or her husband becomes infected.

“If one of us gets sick with COVID, we won’t be able to pay for it,” she said. “It will most likely bankrupt us if we can’t find other help.”

The drop in uninsured reflects some of the larger problems in the US health care system, said Loafman, a Chicago hospital physician.

“Frankly, we as a society care about the uninsured for COVID because it affects us,” he said. “You know, a closed community doesn’t protect against a virus… it’s kind of the ugly truth that our altruism about it was really motivated.”