WASHINGTON — For the first time, the US came close to providing health care for all during the pandemic — but only for covid-19.
Now, federal money for covid care of the uninsured is drying up, creating a potential barrier to timely access.
The virus is not contained, even if it’s better controlled. And safety-net hospitals and clinics are seeing sharply higher costs for salaries and other basic operating expenses. They fear they won’t be prepared if there’s another surge and no backstop.
“We haven’t turned away anybody yet,” said Dr. Mark Loafman, chair of family and community medicine at Cook County Health in Chicago. “But I think it’s just a matter of time. … People don’t get cancer treatment or blood pressure treatment every day in America because they can’t afford it.”
A $20 billion government covid program covered testing, treatment and vaccine costs for uninsured people, but that’s been shut down. And special Medicaid covid coverage for the uninsured in more than a dozen states is likely facing its last months.
At Parkland Health, the front-line hospital system for Dallas, Dr. Fred Cerise questions the logic of dialing back federal dollars at a time when health officials have rolled out a “test-to-treat” strategy under which people with covid-19 can now get antiviral pills to take at home, potentially avoiding hospitalization. Vice President Kamala Harris, who recently tested positive but is back working at the White House, is an example.
“Test-to-treat will be very difficult for uninsured individuals,” said Cerise, president and CEO of the system. “If it’s a change in strategy on the large scale, and it’s coming without funding, people are going to be reluctant to adopt that.”
Officials at the federal Department of Health and Human Services say the new antiviral drugs, such as Paxlovid, have been paid for by taxpayers and are supposed to be free of charge to patients, even uninsured ones.
But they acknowledge that some uninsured people can’t afford the medical consultation needed to get a prescription.
“We hear 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 for the department’s preparedness and response division.
“We’re well short of universal health coverage in the US, but for a time, we had universal coverage for covid,” said Larry Levitt, a health policy expert with the nonpartisan Kaiser Family Foundation. “It was extraordinary.”
A recent White House request for $22.5 billion for covid priorities failed to advance in Congress. Part of the Biden administration’s request involves $1.5 billion to replenish the Uninsured Program, which paid for testing, treatment and vaccine-related bills for uninsured patients. The program has stopped accepting claims because of a lack of money.
That program, along with the lesser-known Medicaid option for states, allowed thousands of uninsured people to get care without worrying about costs. But bipartisan support has given way as congressional Republicans raise questions about pandemic spending.
The Uninsured Program was run by the Health Resources and Services Administration, an agency within the Department of Health and Human Services. 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 turn the program back on if Congress releases more money.
The Medicaid coverage option began under the Trump administration as a way to help states pay for testing uninsured people. President Joe Biden’s coronavirus relief measure expanded it to cover treatment and vaccine costs as well. The federal government pays 100% of the cost, but the coverage can’t be used for other services.
Fifteen states have taken advantage of the option, along with three US territories. It will end once the federal coronavirus public health emergency is over, which is currently forecast for later this year.
New Hampshire Medicaid Director Henry Lipman said the coverage option allowed his state to sign up 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 any access to insurance,” said Lipman. “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, the demand for testing, treatment and vaccination is down. 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 seeing federal funding evaporating just as operating costs are soaring. Staff members have gotten raises at the same time that drug costs have risen by 20% and supply costs by 12%.
“We’ve now exited this pandemic … into probably the highest inflationary environment that I’ve seen in my career,” Thompson said.
In Kentucky, Family Health Centers of Louisville closed a testing service for uninsured people once federal funds dried up. The private company it was working with planned to charge $65 a test.
Things are manageable now because there’s little demand, said spokeswoman Melissa Mather, “but if we get hit with another omicron, it’s going to be very difficult.”
Retrenchment on the uninsured mirrors some of the bigger problems of the US health care system, said Loafman.
“Quite frankly, we as a society take care of the uninsured for covid because it’s affecting us,” he said. “You know, a gated community doesn’t keep a virus out. … That’s sort of the ugly truth of this, is that our altruism around this was really self-motivated.”
The White House is stepping up its warnings about a coronavirus surge this fall and winter and is making contingency plans for how it will provide vaccines to the American public if Congress does not allocate more money for the covid-19 response, according to a senior administration official.
With prospects for a fresh round of emergency coronavirus aid appearing shaky on Capitol Hill, administration officials met last week with key senators, including two leading Republicans, to press their case. Democrats have been thinking about wrapping covid-19 aid into another emergency package for Ukraine, but it was unclear whether they will do so.
The Biden administration is preparing for the possibility that 100 million Americans — roughly 30% of the population — will get infected with the coronavirus this fall and winter, according to the administration official.
The 100 million figure is not as high as the total number of Americans known to have become infected with the highly contagious omicron variant during a wave in December and January. It is based on a variety of outside models, although the official did not specify which ones, and it assumes that a rapidly evolving virus in the omicron family — not a new variant — will spread through a population with waning immunity against infection.
In addition, the 100 million figure, which the official described as a median of what could be expected, assumes a lack of federal resources if Congress does not approve any more money for tests, therapeutics and vaccines, and it assumes that many vaccinated and previously infected people would become infected again.
Should that scenario play out, the administration’s goal is to prevent a spike in hospitalizations and deaths. One way that might be accomplished would be to revive mask mandates, the official said.
A recent report by the Centers for Disease Control and Prevention said 60% of Americans, including 75% of children, had been infected with the coronavirus by February and that the omicron variant was responsible for much of the toll.
The official predicted that the next coronavirus wave in the United States would begin this summer in the South, with a significant number of infections as people move indoors to escape the heat. In the fall, it would begin to spread across the rest of the country, particularly in the North, although the spike in cases would not be as steep.
After dropping substantially after the winter omicron surge, newly confirmed US cases have been rising again. As of Friday, the average of new US cases had reached about 70,200 a day, an increase of 52% over the past two weeks, according to a New York Times database. But infections are thought to be undercounted, especially with Americans having access to at-home testing.
Virus hospitalizations are also climbing nationally, with an average of more than 18,400 people, an increase of 20% from two weeks ago. And deaths have ticked up for the first time in weeks, inching upward by 1%, to an average of 371 a day.
If Congress does not approve more money for the domestic response, the official said, then the administration will use funds designated for testing and therapeutics to develop a bare-bones vaccination program that would cover just older Americans and those with compromised immune systems. Officials have said they cannot provide enough boosters for the general population in the fall without more funding.
Both Moderna and Pfizer are now working on so-called bivalent vaccines that can protect against some known variants. If those vaccines are authorized by federal regulators in time, and if a substantial number of Americans take them or get booster shots that are already authorized, then the fatality rate should drop to less than 0.1% of people who get infected, the official said. But if access to vaccines is limited, then the United States could see hundreds of thousands of deaths, the official said.
Last month, a panel of outside experts who made recommendations to federal regulators grappled with the challenges involved in revamping vaccines, including when such decisions might be made and the uncertainty of which variant of the virus could be dominant in the fall.
The official said testing will be a particular challenge. Test makers are already laying off employees as demand for rapid at-home testing drops. The Strategic National Stockpile needs 1 billion rapid tests going into the fall but will have only 400 million to 500 million without additional funding, the official said.
Information for this article was contributed by Heather Hollingsworth and Ricardo Alonso-Zaldivar of The Associated Press and Sheryl Gay Stolberg of The New York Times.