COVID Settling Provokes Harm from Insurance Gaps

December 6, 2022

Summary: As the COVID crisis subsides from pandemic to endemic, special funding to support its care is disappearing. This leaves many uninsured without access to COVID care, despite daily cases still exceeding 50,000. Once again, COVID exposes massive gaps in our health insurance.

For the Uninsured, Covid Care Has Entered a New Stage of Crisis
New York Times
Dec. 6, 2022
By Noah Weiland and Sarah Kliff

When Mandy Alderman caught the coronavirus in June for a second time, she hoped her usual primary care physician could prescribe a monoclonal antibody treatment or Paxlovid, the antiviral pill that has been shown to reduce the severity of an infection. But without health insurance, she could not afford a visit.

Ms. Alderman, 44, a former medical assistant in Lawrenceville, Ga., found a doctor willing to prescribe a cocktail of other drugs, but not the proven Covid-19 medications she wanted. She took what she could get. She had to lean on her aunt for the $85 it cost to retrieve the drugs from a Publix grocery store pharmacy near her home.

“I felt like I was irrelevant,” Ms. Alderman said, recounting the ordeal. “I felt like I didn’t matter.”

Difficulty getting care for Covid-19 has become an increasingly common problem for poor, uninsured Americans. After paying about $25 billion to health care providers over the course of the pandemic to reimburse them for vaccinating, testing and treating people without insurance, the federal government is running low on funds for Covid care for the nearly 30 million Americans who are uninsured. …

Adding to the dilemma for the uninsured, the administration is planning to allow vaccines and treatments for Covid-19 to hit the commercial market by next summer — a move that could further hinder access for those without health coverage.

The result, public health experts say, is the end of the universal access that Americans have had to Covid care during the pandemic, a rare exception in the fragmented U.S. health care system. As federal funding dries up, people without insurance may be left footing the bill for tests and treatments, or they may be discouraged from seeking care altogether. …

The problem is especially acute in states that have yet to expand Medicaid under the Affordable Care Act. Those areas, where Republicans partly or entirely control state government, tend to have a larger share of residents without health insurance than the states that have adopted the expansion.

“Because of Covid, we’ve been able to temporarily create a bright spot for care,” said Kody H. Kinsley, the top health official in North Carolina, one of the states that has not expanded Medicaid. He added, “That island is slowly vanishing.”

Michele Johnson, the executive director of the Tennessee Justice Center, a legal aid group that helps poor residents in the state, which is one of those that has not adopted the expansion, warned that people without coverage were facing a new risk of Covid-induced medical debt.

“We’re back to the old ways,” Ms. Johnson said, adding, “People are going without vitally important services, and/or they’re going into debt for the rest of their lives.”

For much of the pandemic, the federal government covered the cost of vaccinating, testing and treating the uninsured through a fund run by the Department of Health and Human Services. But that program shut down in the spring because of a lack of funding, and in September, the government stopped providing free at-home tests through the Postal Service for the same reason.

Roughly 50,000 coronavirus cases — a figure that is almost certainly a significant undercount — are being reported in the United States each day, and people without insurance can face an array of costs. Bills for tests can be large and unpredictable; some people have faced charges of more than $3,000 for the routine nasal swab. For those who become seriously ill, a hospitalization can cost more than $1 million.

Comment by: Jim Kahn

As we’ve written before, the COVID pandemic has revealed the hazards of our grossly inadequate insurance system. Including hundreds of thousands of excess COVID deaths.

Epidemiologists now speak of COVID settling into an “endemic” state – more predictable and manageable. Indeed, President Biden declared the pandemic over. In a sense, this is fair: major accomplishments in vaccination and therapeutics – including the highly effective drug Paxlovid – have transformed an overwhelming public health crisis into merely a serious ongoing health issue.

With this much-appreciated pivot, federal funding for special COVID support is falling. Programs to subsidize COVID care for the uninsured and under-insured are sunsetting. (Not that these protections were ever perfect, as we’ve noted.)

As a consequence, individuals infected with COVID face serious financial barriers to care: untenable choices between medical risks and financial burdens. The NY Times article elegantly describes this heart-wrenching situation.

Why do we do this to ourselves?

Oh, yes, I remember. Because there are profits to be made in preserving the scarcity of insurance and care. Because maintaining the fiction that health care can work as a market commodity enriches those who exploit the convoluted structures and rules we establish to pursue this myth.

How many decades of increasing failures of our health insurance non-system are enough?

When are the moral precept “health care is a right” and the practical insight “universal insurance saves money” sufficient to motivate doing the right thing?

When?