When Senators announced on Monday that they reached a deal for $10 billion in additional funding for the coronavirus response, many public health experts were dismayed that the package will not include aid for vaccines abroad. But another area that is likely to get shorted is the program that has covered the costs of coronavirus tests, treatments and vaccines for uninsured Americans. That lack of funding could not only hurt the most vulnerable Americans, experts say, but also fuel future outbreaks of COVID-19.
The program for uninsured people began winding down late last month. The Biden Administration repeatedly asked lawmakers for $22.5 billion more in emergency pandemic relief, warning that the government would soon not have enough vaccines for every American to receive another booster and that it would run out of money to buy more monoclonal antibodies to treat the coronavirus.
The new funding bill is less than half of what the Administration requested. “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. The new bill will go toward purchasing more COVID-19 vaccines, tests and therapeutic drug treatments. Psaki said the Administration will continue to push for global coronavirus aid, but that may not happen until later this spring. It remains unclear whether the domestic response will get any additional support.
In the meantime, the uninsured program stopped accepting claims for COVID-19 testing and treatment on March 22, and will not accept claims for vaccinating uninsured people after April 5. Hospitals, community health centers and pharmacies around the U.S. are already confronting the end of federal funding; many tell TIME they are worried that without a way to pay for testing, treating and vaccinating the 31 million Americans without insurance, the U.S. may be left flat-footed in the next phase of the pandemic.
‘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. About 50% of them do not have health insurance.
Throughout the pandemic, Williams and her staff have relied on the federal program to help them test, treat and vaccinate their patients. With less than a week of notice before the March deadline, they scrambled to submit as many claims as possible. 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.
While large hospitals or private labs can now begin charging uninsured people, or turn them away, community health centers and safety net hospitals have a mission to serve 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.”
Community health centers and safety net hospitals often operate on thin margins. Without federal support, many will begin paring back the services they offer, says Dr. Ron Yee, chief medical officer of the 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. Staffing is also a major concern, she adds, since many health care workers have left the field during the pandemic due to retirement or burnout. “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.”
Expensive tests and treatments
As the deadlines pass for providers to submit COVID-19 testing, treatment and vaccine claims, some providers are asking uninsured people to cover the significant costs themselves. Early in the pandemic, some uninsured patients were charged tens of thousands of dollars for COVID-19 treatment. Since the uninsured program was created in May 2020, it has paid more than $19 billion to hospitals, community health centers, laboratories and other providers.
Some large labs that have received significant funds from the program have already changed their policies. Quest Diagnostics, which operates one of the largest networks of labs in the country, has notified clients that they can no longer expect to be reimbursed for testing uninsured patients. Those without insurance can now pay $125 through QuestDirect or $100 if they order through a physician affiliated with Quest.
Labcorp’s at-home COVID-19 testing kits now cost $119 for those without insurance. And Curative, which operates 13,000 testing sites across 18 states, has stopped providing testing to uninsured patients in all locations where there are not other funds in place to pay for the cost. The company is working with state and local partners to explore other backup funds for uninsured patients, and is piloting programs to charge for testing at two sites, but in states with large numbers of uninsured residents, the lack of federal funding could mean many cannot access testing. “We are deeply concerned about this recent development and the impact it will have on uninsured patients,” said Pasquale Gianni, a Curative spokesman.
Smaller companies are facing similar problems. In De Queen, Ark., pharmacist Elee Coleman is worried about how the end of the uninsured program will affect her family’s pharmacy, De Queen Health and Wellness Pharmacy, which her parents own. Coleman says their shop, which has provided some 15,000 COVID-19 shots, 1,000 COVID-19 tests, and 1,400 monoclonal antibody treatments to patients, has been a lifeline in a rural county, where many are uninsured and roughly 60% of the population is Hispanic. Hispanic Americans have seen disproportionate illness and death from COVID-19. 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. It is still processing claims submitted before the deadlines.
In recent months, as Omicron swept across the country, the uninsured program was spending about $2 billion per month on claims, according to a HRSA spokesperson. 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 says she and her parents have not yet decided if they will continue to offer COVID-19 testing, treatment and vaccines to uninsured customers. 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’
While coronavirus cases have been dropping and health care providers are no longer overwhelmed with demand for COVID-19 tests and treatments, the pandemic is far from over. Hundreds of people are still dying every day in the U.S. The prevalence of the BA.2 variant is increasing and the Food and Drug Administration recently approved another booster shot for Americans 50 years and older.
Yee warned that although COVID-19 vaccines will remain free to all patients, some uninsured people may avoid seeking COVID-19 testing, treatment and vaccines out of fear they will be charged. During previous surges, community health centers played a key role by encouraging these patients to seek care, he says. “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.”
In addition to relieving the coronavirus related burdens, community health centers treat many people who have avoided other health care during the pandemic, Yee adds. 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 of Coastal Family Health Center in Mississippi, says the funding is ending too soon.
“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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Contributor: Abigail Abrams