Patient Access to Care Stymied Amid COVID-19 Funding Debate

Patient access to care for COVID-19 hangs in the balance as Congress mulls over extending federal funding for testing and treatment services, according to a recent Kaiser Family Foundation brief contending lapses in funding could severely impact uninsured people.

Particularly, the funding lapse will make it impossible for those without insurance coverage to get access to free COVID-19 testing and treatment services, the researchers said. Once funding runs out, these services will come with high patient financial responsibility that could dissuade patient access to care.

Currently, Congress is at an impasse regarding federal COVID-19 funding that has allow the Health Resources and Services Administration (HRSA) to reimburse healthcare providers who issue COVID-19 tests and treatments to the uninsured. Funding is set to run out on April 5 should Congress not act, and the KFF brief asserted that could create a sticky situation for folks without coverage.

Although providers can bill private insurance companies for COVID-19 services, the KFF brief said it won’t work like that for the uninsured. The HRSA COVID-19 Uninsured Program created mechanisms for providers to get reimbursed for services rendered to uninsured patients, usually at Medicare rates.

When that program goes away, there will not be a system by which uninsured patients can get free COVID-19 testing and care, the KFF brief explained.

“Although all providers must continue to provide vaccines at no cost, some providers may start billing patients for other COVID-related services, while others may stop providing the services altogether,” the researchers wrote. “In other cases, the loss of funding may increase the financial strain on safety net providers that continue to provide the services regardless of patients’ ability to pay.”

“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.”

Moreover, the lapse in government funding could exacerbate existing health disparities, the researchers added. Being that Black people are more likely to lack insurance coverage compared to their White peers, problems in care access for the uninsured will disproportionately affect this demographic. This comes as the pandemic has overly impacted Black and Brown people compared to White people.

“Any changes that result in more limited access to COVID-19 testing, treatment services, or vaccines, or that require people to pay out-of-pocket for these services, will likely exacerbate these disparities and may also result in more financial burden,” the researchers wrote. “Such changes would also disproportionately affect low-income people and those who are uninsured.”

There will likely be consequences for individuals with Medicare, Medicaid, and private insurance coverage, too, the researchers said. When the nation runs out of the tests, treatments, and vaccines it has already bought, it will spark new reimbursement and therefore cost—including out-of-pocket patient cost—issues.

For those with Medicare and Medicaid, providers will still have to offer COVID-19 tests and vaccines without cost-sharing. COVID-19 treatments will also be covered with no out-of-pocket patient cost, but that could change when the public health emergency officially ends.

For individuals with private insurance, running out of COVID-19 test and treatment supplies would likely spark new contracts. That could result in higher premiums and higher costs for individuals, which often deter access to care.

In addition to COVID-19 testing and treatment, the federal government is teetering on the edge of free vaccine coverage for all. The US currently maintains a sizeable stockpile of COVID-19 vaccines, but the Congressional standstill has kept the government from purchasing more doses. Once its current supply runs out, vaccines and boosters will incur an out-of-pocket patient cost, which could dissuade some from getting inoculated.

That could also cause some problems should it be determined that a fourth dose is necessary.

When government funding runs out, subsequent patient financial responsibility could exacerbate a problem that already existed early during the pandemic: limited patient access to care. In December 2020, survey data from ResearchScape on behalf of VisitPay found that a third of people were more worried about the financial strain from COVID-19 treatments than getting the illness itself.

Thirty-five percent of respondents said they’d put off getting COVID-19 treatment to avoid high bills, exactly the reality the KFF researchers lamented.

This trend isn’t entirely new. For years, experts have identified high patient financial responsibility as a key barrier to care. As recently as December 2021, three in 10 patients were telling a Gallup Poll conducted on behalf of West Health skipped a medical service within the previous three months due to cost.