WASHINGTON ( Associated Press) – For the first time ever, the US came close to providing health care for all during the coronavirus pandemic – but for just one condition, COVID-19.
Now, things are back to the way they were in the form of federal funding for uninsured drought COVID care, creating a potential barrier to timely access.
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But the virus is not controlled, even if it is controlled better. And safety-net hospitals and clinics are seeing increasingly high costs for salaries and other basic operating expenses. They fear they won’t be ready if there is no more bounce and no backstop.
“We haven’t turned anyone away yet,” said Dr. Mark Loffman, MD, president of family and community medicine at Cook County Health in Chicago. “But I think it’s just a matter of time … people in America don’t get cancer treatment or blood pressure treatment every day because they can’t afford it.”
The $20 billion government COVID program covered the cost of testing, treatment and vaccines for uninsured people. But it has been closed. Special Medicaid COVID coverage for uninsured people in more than a dozen states is also likely to face its final months.
At Parkland Health, the frontline hospital system for Dallas, Dr. Fred Seris questions the logic of dialing back the federal dollar after health officials launched a new “test-to-treat” strategy. The hope is that people with COVID-19 can now take antiviral pills at home to avoid hospitalization. Vice President Kamala Harris, who recently tested positive but is working at the White House, is an example.
“Test-to-treat for uninsured individuals will be very difficult,” predicted Seris, the system’s president and CEO. “If this is a massive strategy change, and it is coming without funding, people will be reluctant to adopt it.”
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Federal Department of Health and Human Services officials say new antiviral drugs like Paxlovid have been paid for by taxpayers, and are thought to be free for patients, even uninsured people.
But they acknowledge that some uninsured people cannot afford the medical consultation needed to obtain a prescription. “We hear from state and local partners that a lack of funding for the insured program is creating challenges for individuals to access medicines,” said Dr. Meg Sullivan, chief medical officer of the HHS Preparedness and Response Department.
The nation hasn’t spent a penny on the pandemic before.
“We lack universal health coverage in the US, but for a time, we had universal coverage for COVID,” said Larry Levitt, health policy expert at the nonpartisan Kaiser Family Foundation. “It was extraordinary.”
A recent White House urgent request for $22.5 billion for COVID priorities failed to proceed in Congress. Even a smaller version stuck. Part of the Biden administration’s request includes $1.5 billion to replenish the uninsured program, which paid bills related to testing, treatment and vaccines for uninsured patients. The program has now stopped accepting claims due to lack of funds.
That program, along with a lesser-known Medicaid option for states, allows thousands of uninsured people to receive care without worrying about cost. Bipartisan support has given way as Republicans in Congress raise questions about pandemic spending.
The uninsured program was run by the Health Resources and Services Administration, an HHS agency. Medical providers seeing uninsured people can 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 could revamp the program if Congress releases more money.
The Medicaid coverage option began under the Trump administration as a way to help states pay for testing for the uninsured. President Joe Biden’s coronavirus relief bill expanded this to cover the cost of treatments and vaccines as well. It is like a limited insurance policy for COVID. 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, along with three US territories, have taken advantage of the option. It will end once the federal coronavirus public health emergency is over, currently forecast for later this year.
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New Hampshire Medicaid director Henry Lippman said the coverage option allowed his state to sign up about 9,500 people for COVID care, which includes new antiviral drugs that can be taken at home.
“It’s really a safety net for people who have no access to insurance,” Lippman said. “It is a limited situation, but it is a good backup in a pandemic. It matters a lot with this kind of communicable disease. ,
With COVID cases now at relatively low levels, there is less demand for testing, treatment and vaccination. But the urgency felt by hospitals and other medical service providers is driven by their own bottom lines.
In Missouri, Golden Valley Memorial Healthcare CEO Craig Thompson is concerned about federal funding fading away as operating costs rise. The wages to employees have increased, the cost of medicine has increased by 20% and the cost of supplies has increased by 12%.
“We are now out of this pandemic … in perhaps the highest inflationary environment I have seen in my career,” Thompson said. The health system serves a largely rural area between Kansas City and Springfield.
In Kentucky, the Family Health Centers of Louisville closed a testing service for uninsured people after federal funds dried up. The private company they were working with planned to charge $65 per test.
Things are manageable now because there’s so little demand, spokeswoman Melissa Mather said, “but if we hit another Omicron, it’s going to be very difficult.”
Floridian Debra McCosky-Reisert is not abima and lost her older brother to COVID-19 in the first wave two years ago. In her last conversation, she promised that she would not catch the virus.
McCoskey-Reisert, who lives north of Tampa, has so far managed to avoid getting sick. But she is overshadowed by the fear of what might happen if she or her husband becomes infected.
“If any of us get sick with COVID, we have no way of paying for it,” she said. “If we don’t get any other help it’s likely to bankrupt us.”
Loffman, a Chicago hospital physician, said the layoffs on the uninsured reflect some of the bigger problems in the US health care system.
“Clearly, we as a society care for people uninsured for COVID because it is affecting us,” he said. “You know, a gated community doesn’t keep a virus out…