The novel coronavirus, or Covid-19, is starting to spread in the United States, and already stories are emerging of patients hit with big medical bills. So Democrats are now trying to make the testing and treatment of the viral disease free to patients.
Rep. Ruben Gallego (D-AZ) announced Tuesday he would introduce a bill that would make Medicaid cover testing for and treatment of Covid-19 for every American, no matter how they get their insurance. This would be an important change to US health care: The federal government would assume responsibility for medical care for every American under these particular circumstances.
Research shows people skip treatment, even for serious conditions, all the time because they worry they can’t afford the cost. In other countries, this is generally not a problem because the government sets hard limits, usually quite low, on what patients can be required to pay for care and everybody has health coverage.
Millions of Americans either have no insurance or their insurance doesn’t provide very good benefits (about one in four are uninsured or underinsured, according to the Commonwealth Fund). With the coronavirus, a disease that is often mild for many patients though they can then spread it to more vulnerable people, it’s in the interest of public health to have people get tested if they think they have the virus. You don’t want costs to be a barrier.
Gallego’s spokesperson said he was working with his legislative counsel to finalize the exact text, and he would release it in the coming days. Sen. Elizabeth Warren (D-MA) is one of the 2020 presidential candidates calling on Congress to pass a bill requiring health insurers to fully cover Covid-19 tests and treatments.
One advantage of using Medicaid is there would be no wait for the new benefits to start, said Sara Rosenbaum, a law professor at George Washington University. Under current law, there is a one-year waiting period between when federal regulators decide a service must be covered for free as preventative care and when private insurers are actually required to satisfy that mandate.
“It makes a lot of sense to have Medicaid cover it, at least in the meantime,” Tim Jost, a health law professor at Washington University in St. Louis, said.
Some states are doing what they can as well. New York Gov. Andrew Cuomo announced he would require insurers in New York and Medicaid to cover treatment and testing cost-free with an emergency declaration. States have some discretion with what their Medicaid programs cover, and more states may follow his example.
But ERISA, the federal law that regulates health insurance for large employer plans that cover many Americans, is a barrier to state officials who want to do more. Cuomo’s order, for example, noted it applied to health plans regulated by the state — plans available to small businesses or individuals — but not the self-funded employer plans covered by ERISA. About half of New Yorkers are covered by those plans untouched by Cuomo’s order.
Democrats want to make Covid-19 testing and treatment free
The final text is still in the works, but the basic idea of Gallego’s bill sounds pretty simple: Medicaid would cover any trip to the primary care doctor or emergency room or any lab tests, any treatment at all, for people who fear they have the coronavirus and people who end up needing treatment for it.
For now, there are just over 100 cases in the US and there have been six deaths. But if the virus spreads, some people might skip getting testing or treated, which can worsen the outbreak or lead to more complications for patients. Even modest cost barriers seem to decrease use of medical services.
Under Gallego’s bill, the provision would apply when a national emergency is declared for an outbreak. Everybody would have their treatment covered by Medicaid, which generally covers any medical service with no cost for the patient.
In an outbreak, you don’t want people avoiding the doctor or hospital because they think they can’t afford it. And the research shows they will do exactly that. According to Gallup, one in three Americans say they have skipped a medical treatment in the last year because of the cost, and one in four say they’ve avoided care for a serious condition. More narrowly focused studies have yielded the same kinds of results.
That trend has increased steadily for years and has recently spiked. It may be relevant that various studies show out-of-pocket costs for people who do have health insurance keep rising faster than inflation.
This is not a problem in other countries. As a WHO expert told Vox’s Julia Belluz recently, China — which actually relies on commercial health insurance much like the US — had the government start covering the cost for Covid-19 care so patients wouldn’t have to pay:
China took a whole bunch of steps when they realized they had to repurpose big chunks of their hospital systems to [respond to the outbreak]. The first thing is, they said testing is free, treatment is free. Right now, there are huge barriers [to testing and treatment] in the West. You can get tested, but then you might be negative and have to foot the bill. In China, they realized those were barriers to people seeking care, so, as a state, they took over the payments for people whose insurance plans didn’t cover them. They tried to mitigate those barriers.’
The other thing they did: Normally a prescription in China can’t last for more than a month. But they increased it to three months to make sure people didn’t run out [when they had to close a lot of their hospitals]. Another thing: Prescriptions could be done online and through WeChat [instead of requiring a doctor appointment]. And they set up a delivery system for medications for affected populations.
In countries with national health plans, like Taiwan and Australia, patients can go to their doctor to get checked for the coronavirus at a low cost. The Netherlands, with its universal private insurance, still sets limits on cost-sharing and primary care visits are free.