As a political fight tied to COVID dollars continues on Capitol Hill, people without health insurance and the providers that serve them are among those already left out.
By Steven Ross Johnson, Newsweek
Senate lawmakers’ recently announced plan to allocate $10 billion in funding toward combating the COVID-19 pandemic comes at a time when cases are rising in some states and the country faces a potential new wave of infections from the BA.2 omicron subvariant, which already accounts for nearly 3 out of every 4 new cases in the U.S.
Yet even if lawmakers overcome a fight over immigration that has stalled the funding compromise and manage to approve it, time already has run out for a federal program that reimburses providers for testing, treating, and administering vaccinations to uninsured Americans, and the plan does not include money dedicated to continuing those efforts.
That stands to increase the burden on key health care providers like safety-net hospitals and community health centers, many of whom operate on thin margins already and threatens to exacerbate existing health disparities among the people they serve.
“It’s not a great time for us to lose any money,” says Melissa Mather, chief communications officer for Family Health Centers, Inc., a nonprofit community health center based in Louisville, Kentucky.
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According to a summary of the agreement, $5 billion of the proposed funding would go toward therapeutics, while another $750 million is allocated for research and development of vaccines for emerging variants and for vaccine manufacturing.
But the plan does not include money for the Health Resources and Services Administration to continue its uninsured program, which last month stopped accepting reimbursement claims from health care providers for COVID-19 testing and treatment of uninsured individuals “due to a lack of sufficient funds.” The program’s deadline was this past Tuesday for reimbursement claims tied to administering vaccines.
Lisa Kidder Hrobsky, senior vice president for federal relations, advocacy and political affairs for the American Hospital Association, says the HRSA program has provided more than $18 billion to help uninsured individuals get access to key COVID-19 services. While supportive of the latest funding relief plan, she says it represents a missed opportunity to address growing concerns that a cut in resources to combat the pandemic could limit ongoing efforts to vaccinate people in the most vulnerable communities.
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“While we are appreciative of the funding hospitals and health systems have been provided by Congress and the administration, we are disappointed that this most recent round of COVID-19 relief does not address ongoing concerns from the hospital field,” Kidder Hrobsky says.
Federal officials have required that COVID-19 vaccines, with the country’s current supply already purchased by the government, be provided at no out-of-pocket cost. And while Medicaid coverage can offset the costs of COVID-19 services for the uninsured in some states, as a Kaiser Family Foundation analysis notes, the reimbursement program’s suspension stands to face some providers with the quandary of continuing to provide vaccines or services like testing to the uninsured and absorbing the costs, billing for some services as allowed, or simply no longer offering services they previously did.
“Whichever way providers respond, the result will likely be reduced access for uninsured patients in most states due to more limited provider access and/or potential out-of-pocket costs,” the KFF brief says.
One example of how the program’s stoppage already has shifted services lies in the Louisville area, where Mather says Family Health Centers had worked with a private testing firm to operate four COVID-19 testing sites that provided more than 50,000 free tests.
Mather describes the relationship with the testing company as a good one. In addition to performing the laboratory tests, the company handled administrative duties like billing health insurers and making reimbursement claims to the Health Resources and Services Administration for testing the uninsured.
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But Mather says with HRSA ending reimbursement claims for testing, Family Health Centers was notified that the testing firm would have to start charging uninsured individuals an upfront fee of about $65 to continue testing. Family Health Centers serves a patient population of more than 43,000, with an estimated 70% of patients from low-income households and more than 20% uninsured.
“We really kind of looked at that situation and asked ourselves if this was the best situation for what we’re trying to do, which is to create access in underserved communities for low-income populations who may or may not have health insurance,” Mather says.
So Family Health Centers made the decision to end the partnership and now conducts testing exclusively within its own multiple locations, where the administrative costs are about $20. Mather says the lower costs allow the health center to offer the service at a discounted rate, or for free for patients without the means to pay.
“We felt we’re at a time where there really isn’t a huge demand, and we could take it on and be able to provide better access to testing at lower costs,” Mather says.
Mather says Family Health Centers also remains committed to providing vaccinations to people regardless of their ability to pay. But she acknowledges that the end of federal reimbursement to cover the administrative cost of approximately $41 per person will require the health center to find alternative means to make up those costs – whether that involves getting testing and treatment costs covered through private insurance, Medicare or Medicaid, or assisting patients in applying for eligibility to pay for those services through the health center’s sliding fee scale.
“Losing that extra support is never great,” Mather says, “but at the same time we’re not going to leave our neighbors in a lurch.”
Nationwide, the stoppage in the reimbursement program also threatens to create or exacerbate disparities in communities where access to health care services can be limited to the local pharmacy.
Retail pharmacy chain Walgreens, whose stores have administered more than 60 million vaccines and 26 million tests since the beginning of the pandemic, says it remains committed to providing access to COVID-19 services and medications. A company representative says they are awaiting further guidance from the Biden administration and federal agencies regarding the end of reimbursement, and that the company remains “hopeful for a path forward that ensures uninterrupted access to COVID-19 services.”
Fellow retail pharmacy giant CVS Health says the company is “fully confident” the Biden administration and Congress will “find a solution to help ensure people without insurance continue to have access to COVID-19 testing, vaccines and treatment.” (U.S. News collaborates with CVS Health to produce Healthiest Communities.)
Neither CVS nor Walgreens stated whether they plan to continue providing no-cost COVID-19 vaccinations. A potential decline in that arena among pharmacies could significantly impact the nation’s overall vaccination campaign: As of March 17, nearly 235 million vaccine doses had been administered by retail pharmacies at more than 41,000 retail and long-term care locations in the U.S., according to the Centers for Disease Control and Prevention.
For safety net hospitals, which tend to serve higher numbers of low-income and uninsured patients than other hospitals, the loss of the federal reimbursement also raises uncertainties. Still, Airica Steed, executive vice president and chief operating officer for safety net health system Sinai Chicago in Illinois, says the organization plans to continue to test, treat and vaccinate patients with or without the federal funding.
The loss of the funding is a challenge, she says, but is just part of the many financial constraints providers like Sinai are accustomed to operating under as a routine part of doing business. The system’s network includes four hospitals and 17 community clinics, among other entities.
“Given the fact we already function in a capacity where we have the delicate balance of funding versus not, we figure out a way to really navigate through that in a successful way,” Steed says.
Israel Rocha Jr., CEO of Chicago-based Cook County Health – one of the country’s largest public health care systems – says the system also remains committed to its COVID-19 community outreach strategy, but acknowledges the loss of federal funding could put limits on access. The system serves more than 300,000 patients annually, and close to half of those cared for are uninsured.
Since last July, Cook County Health has shifted its vaccination strategy from focusing on mass vaccination centers to more of a community-based approach, using mobile and pop-up sites and offering in-home vaccinations for homebound individuals.
“With what we have, we’re going to do as best we can, and so we are going to continue to do that in our mission against COVID,” Rocha says. “We are concerned there will be some reduced access throughout the community if those resources aren’t there.”
Rocha fears a lack of adequate funding for the COVID response effort could make it harder to effectively scale up capacity and resources to respond to a new wave of infections. Notably, the funding plan formed by Senate lawmakers is far short of the more than $22 billion initially requested by the Biden administration.
“If there were to be an increase in infections without that additional federal funding, it’s uncertain if the same amount of availability would be there for everyone,” Rocha says.