New York is among the first states in the country to waive some fees and expenses for people who undergo testing for the coronavirus, as public health officials are increasingly worried that medical bills will discourage the poor and uninsured from getting medical care.
The federal government is also considering paying for care for those affected, possibly based on funds available through federal disaster relief programs. There are “initial conversations,” Dr. Robert Kadlec, a senior official at the U.S. Department of Health and Human Services, told Congress on Wednesday.
In addition to the nation’s 27.5 million uninsured, some lawmakers are concerned that the tens of millions who are underinsured — Americans with high deductibles or limited insurance — may also be at risk of unexpected expenses as more and more people are exposed to the virus.
The health insurance system “is designed to make you think twice to seek care every time you get a runny nose, fever and cough,” said John Graves, a health policy expert at Vanderbilt University. Even though identifying people with the virus in the early stages is critical to preventing a spread of the disease, Dr. Graves said, many people are likely to wait out any symptoms to avoid expensive care.
New York said it would require some health insurance companies to waive any cost sharing for coronavirus testing, including the cost of going to the emergency room, doctor’s office or urgent care center if within a plan’s network.
“Containing this virus depends on us having the facts about who has it — and these measures will break down any barriers that could prevent New Yorkers from getting tested,” Gov. Andrew M. Cuomo said in a statement on Monday.
Nationwide, public health experts and others are urging government agencies to find ways to ensure people do not hesitate to get tested or seek care. In a letter released Monday, many notable experts called on lawmakers “to ensure comprehensive and affordable access to testing, including the uninsured.”
In a letter to be sent on Wednesday, Senator Patty Murray, Democrat of Washington, and about three dozen of her colleagues expressed “serious concern that this Administration’s health care sabotage and absence of a plan to lower drug prices undermine our ability to respond” to the coronavirus and other infectious disease outbreaks.
“When a patient who has potentially been exposed to the virus develops symptoms consistent with Covid-19, they should be able to seek appropriate medical care without being worried they cannot afford it, “ they said.
They and others point out that the Trump administration’s decision to allow weaker insurance plans has made more workers vulnerable to billing overcharges because they have much higher deductibles and less overall coverage than those protected under the Affordable Care Act.
Vice President Pence said on Tuesday that both Medicaid and Medicare programs would cover the costs of the tests for those enrolled.
In the last week or so, a few stories have already gone viral of families in quarantine or hospitalized with the illness who were billed for thousands of dollars.
Federal regulations give the director of the Centers for Disease Control and Prevention authority to decide whether to cover the medical bills of patients the government places in mandatory isolation or quarantine. But no official ruling has yet been issued about assuming costs for the hundreds of people repatriated from China and from the cruise ship Diamond Princess who were placed in quarantine for weeks.
The regulations also don’t address payments for charges faced by patients who turn up at a doctor’s office themselves with coronavirus symptoms.
Nor is there a clear answer as to whether the coronavirus test is free. Federal and state government health agencies may be unlikely to charge anyone for the actual test, but U.S. officials say billing may vary from state to state. If labs run by private companies ramp up and begin offering testing under U.S. plans for expanded measures, they could be issuing separate bills unless the federal or state government waives those fees, too.
People could also get billed for additional services like the cost of a doctor’s visit, especially if they face high deductibles. Vaccines are generally covered as a preventive service, although development of a vaccine for this virus is still a year away or more.
As more and more states report cases, some state insurance regulators say they are weighing whether commercial insurers should waive deductibles or lower co-payments, especially in the middle of a public health crisis.
“That’s a conversation we will be having with insurance companies in Pennsylvania,” said Jessica Altman, the state’s insurance commissioner, who urged consumers to contact their insurers or the state insurance department if they have questions.
“Insurance regulators are going to be looking at this and watching,” Ms. Altman said. “Everyone is going to be paying attention — everyone is.”
In Illinois, the state insurance department said it “encourages health insurance issuers to consider all feasible and prudent options to reduce the barriers of cost-sharing for testing and treatment of Covid-19 during the outbreak.”
And in Florida, where cases have just begun to surface this week, insurance regulators said they were “actively monitoring the situation” and talking with insurers and others at both state and federal levels.
Insurers say they are following the guidance from the C.D.C. and have discussed with federal and state officials how to handle widespread outbreaks. “In this instance, we haven’t set any of these policy liberalizations up yet, but are prepared to do so,” said a spokesman for CVS Health, which owns Aetna, one of the nation’s largest private insurers.
Some legislators — particularly those who support expanding public health insurance — argue that the government ought to help pay the bills of any patients tested for the coronavirus. There is some precedent for this: In 2015, Congress appropriated millions to reimburse hospitals for the care they provided to Ebola patients.
“If you’re going to get tested for coronavirus, and you’re getting a battery of tests and doctor bills, then the government should pay,” said Representative Ro Khanna, Democrat of California. “If we’re overinclusive and end up paying for a few people we shouldn’t have, that’s fine. It’s worth it to have everyone incentivized to get tested.”
When Alex M. Azar II, the health and human services secretary, told Congress last week the administration could not control the price of any potential coronavirus vaccine, he set off a firestorm among some lawmakers and advocates for the poor.
Insurers should be required to cover the cost, just as they do now for the annual flu shots. some argued.
“We know how to make flu vaccines available to everyone,” said Cheryl Fish-Parcham, the director of access initiatives at Families USA, a consumer group. Others contended that Mr. Azar and other administration officials should guarantee that any vaccine for this virus should either be made affordable or free.
So far, however, people seeking testing and treatment for respiratory illnesses are at risk for large unpaid bills. In late January, a Miami resident complained he might be liable for the bulk of his $3,271 hospital bill from Jackson Memorial Hospital, according to a Miami Herald article. He was never tested for the virus but underwent other testing to determine what might be wrong.
In thinking about any potential pandemic, “it really seems like, unintentionally, the high deductible structure is designed to impede a public health response,” said Ted Doolittle, a former Medicare official who is now the health care advocate for Connecticut.
“We would be hobbling ourselves as a community to have people even have the first thought of finances pop into their head when they are thinking about getting tested or treated,” Mr. Doolittle said.
After James Moyer, 38, was left with $1,500 in unpaid medical bills when he was treated at his local emergency room in Philadelphia for the flu, he said he was unlikely to return unless “it’s a legitimate emergency.” He spent two years slowly paying off the medical bills because he hadn’t met his deductible.
As it is, even a trip to urgent care could be prohibitive. After three days of fever and cough, Sophronia Knott went to a clinic in Greenville, N.C., where she lives. The cost of the visit and a prescription for Tamiflu cost her $130, more than a tenth of her monthly pay as an adjunct professor.
“My dad had to loan me the money to be seen that night,” Ms. Knott, 25, said.
Would she go again? “It would depend a lot on how close it was to payday, if I could afford to go,” she said. “If the symptoms cropped up just after I got paid, I might not mind. But if it were the summer, when class isn’t in session and I have less money, I’d definitely try a home remedy instead.”
