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U.S. working on blueprint for COVID-19 treatment costs for uninsured

Antonita Madonna  Thomson Reuters Accelus Regulatory Intelligence

Antonita Madonna  Thomson Reuters Accelus Regulatory Intelligence

The administration of U.S. President Donald Trump said it was working on details of a proposal to directly pay hospitals for treatment costs of those without insurance coverage, amid growing fears that efforts to ease the financial toll of the coronavirus infection on the uninsured and underinsured were lagging.

“The White House coronavirus task force is working on a proposal for the president to use some of the $100 billion that we’re making available to hospitals to compensate the hospitals directly for any coronavirus treatment that they provide to uninsured Americans. We’re working out the details of that,” Vice President Mike Pence said at a White House briefing on Thursday.

The president is expected to make a final decision Friday on the proposal, which would draw on money allocated for healthcare providers in the $2 trillion coronavirus stimulus package adopted last week.

Individuals hospitalized with COVID-19 could face bills averaging between $42,000 and $75,000, depending on the number of other health complications they have, according to nonprofit organization FAIR Health.

Health policy experts have feared treatment cost concerns may deter millions of individuals without comprehensive coverage from seeking timely treatment, or leave patients with large medical bills at a time when job losses are peaking. About 28 million Americans are uninsured, while roughly 10 million have reported job losses in the last two weeks.

No SEP on federal marketplace yet

The Trump administration on Wednesday pulled back from earlier suggestions it would open a COVID-19-related special enrollment period on the federal health exchange. More than 35 states depend on the federal healthcare exchange for their residents to buy coverage on the individual market.

States relying on the federal exchange had hoped a special enrollment period would allow more uninsured and underinsured to sign up for more comprehensive coverage. The health insurance industry had also supported the idea, despite the potential of piling on more risk at existing rates.

The administration said individuals losing their jobs could check the federal marketplace to see if they qualify for special enrollment. Individuals, however, are required to have had some form of health coverage in their job to qualify for a special enrollment at this time. Many small employers do not provide their employees with coverage. Signing up may also require documentation and evidence of the job and coverage loss – tough to procure in a crisis.

More than 35 states have applied for a waiver during the federal emergency period to relax eligibility for state Medicaid enrollment, but there are no standard criteria that would ensure the federal government-assisted program would cover all the uninsured in the state.

Families USA, a consumer health advocate, called on the Trump administration to step up federal assistance to state Medicaid programs to 100 percent for uninsured individuals’ COVID-19 treatment, and allow Medicaid to cover treatment costs regardless of immigration status.

Some insurers step up coverage for patients

Some insurers, like Humana, Cigna, and CVS Health’s Aetna, have voluntarily offered to cover the costs of COVID-19 treatment for their patients without any cost-sharing requirement, albeit with network restrictions in some cases.

Their coverage would apply to all their fully-insured plans, but these carriers have limited to no control over employer-sponsored insurance plans for which they act as administrators. About 61 percent of the country’s population gets its coverage through an employer.

A spokesperson for Aetna said its decision to cover COVID-19 treatment costs applies to all its fully-insured commercial plans. Selfinsured employers will be given an opportunity to opt-out. A spokesperson for Humana said the company is reaching out to self-funded clients to determine their “desired approach,” as it could not make coverage policy changes without their approval.

The number of coronavirus cases continues to climb rapidly and on Thursday crossed 1 million worldwide, with about one-fifth of them in the United States. Nearly 6,000 Americans have lost their lives. Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases said, “People need to understand that things will get worse before they get better.”

To keep up-dated on the latest news and information regarding the COVID-19 pandemic, the economic impact, and the government’s response, at Thomson Reuters’ COVID-19 Resource Center, and you can follow or the Reuters App.

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