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The first COVID-19 case in the United States was discovered in January. Since then approximately, 12,000 tests have been conducted by U.S. public health laboratories. South Korea also announced their first case in January, and they’ve conducted nearly 250,000 tests to date.
A shortage of testing kits in the U.S. has been well documented, and will eventually be resolved. But patient costs will continue to be front and center. We must prevent high costs from decreasing the availability of testing and treatment. The U.S. Department of Health and Human Services must cover vaccination (once a vaccine is developed and approved), diagnostic testing and treatment without any cost-sharing (i.e. co-payments, co-insurance or deductibles).
As the pandemic explodes across the country, we know that costs are weighing heavily on the minds of many Americans and legislators.
America’s Health Insurance Plans (AHIP), the chief lobbying organization for private insurers, recently announced that it will work to ensure “out-of-pocket costs are not a barrier to people seeking testing for, and treatment of, COVID-19.” But this is not enough.
Insurance is complicated and hard to navigate. With complex networks and bills that frequently perplex beneficiaries, many rightly question AHIP’s transparency. Meanwhile, President Trump has not been clear or accurate: after announcing that insurance companies would waive all co-pays for testing and treatment, the insurance industry pushed back, saying it had not agreed to include treatment.
The recently passed U.S. House bill would make COVID-19 diagnostic testing free for everyone, but it remains to be what will happen with the legislation in the U.S. Senate. A uniform requirement from the federal government is needed to clarify what services are covered, and how expensive they are.
As healthcare providers, we are disheartened that we cannot tell our patients who are — literally and figuratively — worried sick how much the COVID-19 care they need and deserve will cost.
In the early stages of a local outbreak, Massachusetts -- along with several other states, including Washington and New York -- issued a bold directive for free diagnostic testing and in some cases treatment. The U.S. government should follow the lead of these states.
A uniform requirement from the federal government is needed to clarify what services are covered, and how expensive they are.
There is precedence for requiring private insurers to cover preventive care (vaccines and screening tests) without cost-sharing. Under the Affordable Care Act (ACA), private insurers must cover vaccines approved by the Centers for Disease Control and Prevention (CDC) without cost-sharing. Diagnostic testing, while not strictly a preventive service, should also fall under the purview of the ACA mandate. Vaccination coverage clearly falls under the current requirement by the ACA. For example, influenza vaccination is covered under this directive.
The eventual COVID-19 vaccine should be treated similarly, and must be added to the CDC’s list of covered vaccinations to make this possible.
Vaccinations require herd immunity, a concept in immunology that dictates a critical mass of the society needs to have immunity to prevent community spread of an infectious disease. If the immunization is free at the point of care, Americans will more readily obtain it.
In the case of a pandemic disease such as COVID-19, diagnosis is preventative care because it encourages better compliance with isolation measures intended to avoid disease spread. Testing could also streamline quarantine and isolation measures if cases are detected earlier.
A federal directive requiring free access to diagnostic tests, treatment and the eventual vaccine will reduce the spread of the virus within communities.
One of the most progressive measures the U.S. government could take, would be waiving all cost-sharing related to COVID-19 care. In the past few years, there has been an increase in high deductible health plans. Many underinsured individuals will face cost-sharing exceeding a thousand dollars to receive inpatient care.
While no precedent that we are aware of exists, covering all treatment related cost-sharing is morally and financially responsible. Decreasing barriers to care will likely help control community spread and thereby reduce U.S. health system costs overall. Worst-case estimates imply over 20 million Americans could be hospitalized. Unsurprisingly, insurers oppose removing cost-sharing related to COVID-19 treatment. However, it is possible for a compromise to be reached that would waive most elements of cost-sharing such as deductibles for related treatment.
A federal directive requiring free access to diagnostic tests, treatment and the eventual vaccine will reduce the spread of the virus within communities. Federal intervention also provides a regulatory framework to enact faster responses to future public health crises.
Coronavirus is a threat. To thoroughly contain it, we must thoroughly screen for it. And to thoroughly screen for and prevent it, the U.S. government must make all COVID-19 care free for patients.
Nicole Bustos is a rising fourth-year graduate student at Massachusetts Institute of Technology. Her research examines transmission of respiratory infectious diseases.
Alex Pomerantz is a rising fourth-year medical student at Harvard. He has conducted health care delivery and public health research that has been published locally and nationally.
Aakash Shah M.D. M.B.A. M.Sc. is a practicing emergency room doctor and public health expert who was involved in the care of the first confirmed cases of COVID-19 in New Jersey.
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