The Trump administration plans to use money from the recent stimulus bills to pay hospitals for treatment of uninsured coronavirus patients. It says the plan is more efficient than reopening enrollment in the Obamacare markets to achieve the same goal.
The money would be drawn from a $100 billion fund to help hospitals respond to the crisis that hospital groups expected would be spent on their more immediate financial needs.
President Trump announced the policy on Friday at his daily briefing. “That should alleviate any concern uninsured Americans may have about seeking the coronavirus treatment,” he said.
Using the hospital funds to pay for uninsured coronavirus patients could be a targeted way to pay for coronavirus care for the growing number of Americans who lack health insurance. But critics say it may not go to hospitals in the states hit the hardest so far and does little to address concerns over the millions of people now without coverage for medical care unrelated to the virus.
“The Trump administration has painted itself into an ideological corner on this, and millions of Americans are going to pay the price,” Eliot Fishman, senior director of health policy at the consumer group Families USA, said in an email.
Unlike funds to hospitals to pay for the uninsured who develop Covid-19, “insurance coverage would give newly unemployed people access to primary care, urgent care and prescription drugs to get symptoms checked and treated,” Mr. Fishman said, including those with health problems other than coronavirus.
Congress left the legislation establishing the hospital fund deliberately vague, to allow its allocation to shift as the epidemic played out. But hospitals have asked for as much money as possible to be paid to them immediately — to address pressing concerns about paying their staff, buying equipment and retrofitting their facilities to accommodate the flood of patients with the coronavirus.
The administration’s plan, by contrast, would pay hospitals after the fact, and would tend to shift more money toward states with more uninsured patients. New York, California and Washington, which have experienced early surges in infections, entered the crisis with very low levels of uninsured residents. Republican-led states, like Florida and Texas, that have declined to expand Medicaid are likely to benefit more from funding targeted directly at uncompensated care.
At the briefing, Alex Azar, the secretary of Health and Human Services, said hospitals would be paid the same prices they receive for Medicare patients, lower rates than private insurance typically pays for such care. He also said that hospitals that accept the funds would be barred from sending any additional bills to patients. Mr. Trump declined to answer a question about whether the coverage would apply to undocumented immigrants.
The new policy builds on earlier policy from Congress and voluntary actions from private insurers to eliminate financial barriers to testing and care related to the coronavirus. Both insured and uninsured Americans can already receive tests for the illness without paying anything out of pocket, thanks to recent legislation. Major insurance companies are also waiving out-of-pocket costs for many of their customers for 60 days on any care related to coronavirus.
Nationwide, millions of Americans have lost their job-based coverage as the virus has caused a sudden downturn in the economy.
The administration recently decided against reopening Obamacare insurance marketplaces in 38 states, another move that could have helped uninsured Americans obtain coverage for coronavirus care as well as treatment for unrelated conditions. While people who recently lost job-based coverage because of a layoff are eligible to sign up under current law, a broader special enrollment period would have eased that transition and helped previously uninsured Americans as well.
Mr. Azar noted at the briefing that Americans who have lost insurance may have access to marketplace coverage or Medicaid in some states, options made possible by the health law that the White House continues to oppose in the courts.
Consumer groups and public health experts said paying hospitals for uncompensated care would not help the millions of Americans who are now without coverage.
“It’s a failure, a fundamental failure, to understand how people get care,” said Dr. Georges C. Benjamin, the executive director of the American Public Health Association in Washington. He says the focus on paying hospitals for coronavirus patients doesn’t help doctors treat people, including those without the virus, outside of the hospital to lessen the burden on emergency rooms and hospital staff.
Even hospitals that stood to benefit say using the funds for uncompensated care does not necessarily help the places that are struggling the most and have the least cash reserves to handle the expense.
“Addressing uncompensated care is important, but that alone will not solve the problems Covid-19 creates for our hospitals,” said Erin O’Malley, senior director of policy for America’s Essential Hospitals, the trade group representing the hospitals that treat the large numbers of people without insurance or who qualify for Medicaid.
The virus has left many hospitals in financial distress. Most have put their most profitable lines of business on hold by canceling procedures that are not seen as essential. And some have been investing heavily to ready themselves for coronavirus patients. They have been paying above-market rates for masks, respirators and other medical equipment. Some hospitals, even in large systems with strong balance sheets, have begun laying off staff.
“Uninsured patients need coverage for Covid,” said Chip Kahn, the chief executive of the Federation of American Hospitals, a trade group representing for-profit hospitals. “But Job 1 for the $100 billion fund is to keep hospital doors open and provide resources to cover the extra supplies, equipment and staff necessary to beat the coronavirus.”
Mr. Azar said details about how the rest of the hospital fund would be spent were still being developed.
