New federal laws may not protect uninsured coronavirus patients as hoped
The small crew of health care workers at Guadalupe Clinic in Wichita — aided by dozens more who volunteer there — sees nearly 2,000 people a year.
Every one of them is uninsured, and all visits are free.
Guadalupe can’t yet check patients for COVID-19. But emergency federal legislation might help the nonprofit roll out that service to the low-income neighborhoods it serves.
“Our patients live in small apartments, small houses,” where COVID-19 can spread quickly, executive director J.V. Johnston said. “So testing would be important for us.”
Stimulus funds promise to cover coronavirus testing and treatment for the uninsured.
Still, benefits for the 250,000 people without health insurance in Kansas remain unclear. Experts see potential loopholes in the new federal laws and policies that could risk leaving people on the hook for hundreds, even tens of thousands, of dollars for hospital stays.
And while the Trump administration says the offer to help will stop when funding runs out, it has yet to say how much money it’ll spend.
The confusion could keep many sick people from seeking care. At the same time, the uninsured often work essential jobs that don’t give them the luxury of hiding from the virus at home.
“This crisis is exposing big gaping holes in our health care system,” said Sabrina Corlette, a professor at the Georgetown University Center on Health Insurance Reforms. “When we have a public health crisis like this … the last thing you want is someone to hesitate to get tested and treated.”
Help on the way
The Kaiser Family Foundation estimates coronavirus could put between 670,000 and 2 million uninsured people in the hospital nationwide.
The uninsured may face a higher risk of contracting the novel coronavirus because so many work face-to-face jobs, such as cashiering and housekeeping.
Two stimulus bills passed by Congress in March should benefit people without health coverage.
The Families First Coronavirus Response Act gives states the option of covering COVID-19 testing for the uninsured through Medicaid. That would include both the lab work and the office visit for the patient.
But it wouldn’t help with coronavirus treatment, which can total daunting sums. Kaiser and the Peterson Center on Healthcare estimate inpatient bills for a serious case of COVID-19 could top $20,000 even when people do have job-based health plans that negotiate down the prices.
The Trump administration came under fire to act. It has declined to reopen access to the Obamacare exchange but vowed instead to use money in another stimulus bill, the CARES Act, to reimburse hospitals at Medicare rates for treating the uninsured.
Kaiser initially estimated that could use up between $13.9 billion and $41.8 billion of a $100 billion portion of the CARES Act meant to help hospitals cope with the pandemic. Now that the Trump administration has said the money would also go for care beyond hospital admissions, Kaiser says the plan could use up even more funds.
This has sparked some controversy among health care providers worried the dollars won’t stretch, Kaiser senior fellow Karyn Schwartz says.
“That’s less money that’s available to help them buy protective equipment for their staff,” she said.
The White House and Congress have since agreed to add $75 billion for health care providers to weather the storm. But the administration has yet to say how much CARES money it will set aside for the uninsured — while making clear that help will stop if that unspecified amount of money runs out.
Waiting to hear more
The typical patient at Guadalupe cobbles together paychecks from various part-time jobs that don’t offer health coverage, said Johnston, the clinic’s executive director.
As the pandemic costs people their jobs, he expects more will likely need help.
“If they have no income,” he said, “they’re going to buy food and pay their rent before they pay their health insurance.”
Johnston is eager to learn how reimbursement for testing will work and whether Guadalupe can participate. The money will flow through state Medicaid programs, and his donation-funded clinic has never billed Medicaid before because it only sees the uninsured.
“So it’s (up) in the air now,” he said, “but hopefully that’s the case.”
Like other states, Kansas is still working out the kinks of this unprecedented use of its Medicaid program.
As of late April, the Centers for Medicare and Medicaid Services said it had only approved two states to cover coronavirus testing for the uninsured.
Once Kansas clears that same hurdle, CMS said in an email, Medicaid could kick in retroactively, for tests conducted no earlier than March 18 (when the new law took effect).
Risk for surprise bills
Even bigger questions remain about how billing will work for the far costlier treatment of COVID-19.
The CARES Act contains provisions meant to prevent “surprise bills” — when a hospital or a doctor charges patients for more money directly beyond what health plans pay.
But several health insurance experts studying the act expressed concern that it shields uninsured patients from hospital charges without protecting them against independent billers under the same roof, such as anesthetists or emergency department staff.
They have similar concerns about how billing will shake out when someone tests negative after treatment has begun. And what if, they wonder, the patient can’t get a coronavirus test at all and is given one for the flu instead?
“We know due to the lack of testing capacity,” Georgetown’s Corlette said, “that many, if not a majority, of people who present with COVID-19 symptoms are turned away without a test. But they’re still charged for the visit.”
The complexity of it all — and lack of clarity — doesn’t surprise Katherine Hempstead, a health insurance expert at the Robert Wood Johnson Foundation.
“We have a very complicated, highly segmented health care system,” she said, and now a pandemic has sent the country scrambling for fixes to help millions of Americans get testing and treatment. “You can kind of see all these little patches that we’re trying to erect.”
In Kansas, if those patches don’t work well — hampering efforts to control the coronavirus or leaving patients saddled with the kind of massive medical bills that drive mounting public frustration with American health care — it could fuel the political push to extend full Medicaid coverage to more low-income adults.
That includes Derby resident Melissa Dodge.
She fears what the novel coronavirus would mean for her 9-year-old daughter with heart and lung problems. Or the danger it could pose for her mother, who is over 60.
But she has another worry: As a single mother caring for her four children while working part time, she has no health insurance.
“My anxiety was always high because I knew the financial risks” of being uninsured, Dodge said. “Add a new global pandemic on top of that, and it’s terrifying.”
Dodge takes every precaution she can. When the pandemic hit, her employer agreed to move her shift later in the evenings and let her spend more of it stocking shelves — two things that reduce her exposure to other people.
When she gets home past midnight, she peels off a face mask, scrubs her hands and changes clothes before so much as sitting down.
Though she doesn’t qualify for Medicaid, her children do. She has driven to Topeka before to beg lawmakers to give people like her the same benefit.
“It’s a lifesaver for my family,” Dodge said. Her 9-year-old has had multiple heart surgeries. Another of her children is autistic.
But if she needs care for herself, Dodge struggles with what that debt would do to her family.
“The financial aspect of COVID is probably one of the most unspoken scary parts of it,” she said.
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