‘It’s crazy’: Service providers stop Covid care for the uninsured after congressional inaction

The cuts at the non-profit clinic, which serves about 11,000 patients, are just one example of how Covid-19 programs across the country have shrunk over the past month due to Congress’s inability to provide new funding to fight the coronavirus. pandemic.

Curative, a large private testing company, is no longer offering its services to uninsured people at more than 10,000 testing sites across the country. In New York, a pharmacist who administered thousands of doses of the vaccine a week to underinsured communities has stopped his outreach work. In Maine, a community health center serving one of the state’s poorest neighborhoods is postponing plans to expand its dental and mental health services to pay for Covid treatment.

Dried dollars make it harder for low-income people who rely on these suppliers for testing and vaccines to get them, threatening to widen health inequalities across the country. Less access could also prolong the pandemic, allowing the virus to circulate and perhaps providing a safe haven for new, more dangerous variants.

“From my point of view, this is crazy,” says Neil Smaller, a pharmacist in Woodstock, New York, who led the propaganda operation. From September to March, he traveled to neighboring areas to receive several thousand vaccinations a week. When the federal reimbursement that covered the administrative costs of those shots ran out, he had to stop, although he continues to give vaccines for free to people who come to his pharmacy.

“The moment we get a little ahead of this problem, they rip off all of our defenses,” Smaller said. “I know people are tired, but this virus is more patient than we are.”

The cuts come amid a new increase in both infections and hospitalizations. As of April 25, there were an average of 44,416 cases in a 7-day period, more than 20 percent more than the previous week, according to the Centers for Disease Control and Prevention. Hospital admissions rose 6.6 percent from the previous week.

In March the White House requested $22.5 billion from Congress in Covid relief, including $1.5 billion that would provide a flow of money to providers who offer testing, treatment, and vaccines to uninsured and underinsured Americans. But Republicans were outraged by the price, and this tranche of money was cut from the deal, which is now being considered by lawmakers.

A $10 billion bipartisan deal collapsed earlier this month when Republicans demanded a vote on an amendment that would preserve Trump-era policies restricting immigration due to the pandemic.

But even if Congress approves this smaller package, it likely won’t have more money to reimburse service providers for their services to uninsured Americans.

“Ensuring access for the uninsured is absolutely essential,” Ashish Jha, White House Coordinator for Covid-19 Response, said at a press briefing Tuesday. “If Congress continues not to fund these urgent priorities, it will become harder and harder for people to access health care.”

The lack of federal funding could undo significant progress in mitigating racial disparities in Covid-19 outcomes and return the country to the start of the pandemic, when people of color were getting sick and dying from the virus at a higher rate than their white counterparts. In 2021, the uninsured rate was highest among Hispanic and Black American adults, according to the data. CDC data.

Compensating Covid health care providers for uninsured Americans to reach these groups has been a key focus of the federal government’s response to the pandemic since April 2020, when the Health Resources and Services Administration began paying providers for testing and treatment.

Since then, the agency has paid more than $20 billion in claims from more than 50,000 testing, treatment and vaccination providers under the HRSA Covid-19 Uninsured Program. Through a separate fund, more than 3,800 providers have received an additional $13 million in compensation for vaccine administration claims for underinsured individuals. Funding for these programs ended on March 22 and April 5.

“The government is really irresponsible to withhold funding for Covid when Covid is far from over and health systems are already overwhelmed,” said Colin Elias, CEO of Community Clinical Services in Lewiston, Maine. “We have to pay a living wage to our employees who work very hard.”

The clinic, which began applying to HRSA for Covid-19 testing in May 2020, was already operating at a loss. Elias said that now that it has to pay the cost of Covid treatment for its uninsured patients, the clinic is postponing recruitment of new employees and plans to expand its dental, primary and mental health services.

Both federally funded medical centers, known as FQHCs, and vaccine providers who receive doses from the CDC are required to treat patients regardless of their insured status, leaving groups to decide how to provide care without receiving reimbursement for any invoices. costs, including supplier time. and paperwork.

The CDC warned vaccine providers last week that it could stop providing free vaccines if the agency finds that providers are charging patients for vaccinations, turning people away for lack of insurance, or billing patients to go to the office to get a shot, according to an email received. . POLITICO. The CDC did not respond to a request for comment.

Curative, the testing company that received nearly $600 million in reimbursement for testing and was the largest beneficiary of the uninsured HRSA program, said it is now looking into other ways to continue testing for all patients. The company did not say how many tests were reimbursed, but noted that “less than a quarter” of the tests were sent to HRSA while the program was still accepting claims. The company says it has conducted more than 31 million tests in 40 states.

“We are deeply concerned about this recent event and its impact on uninsured patients,” the company said in a statement. “Our real-time data shows that the pandemic is not over yet and points to a potential spike in cases on the horizon.”

At the moment, many medical centers that function as an insurance network for uninsured Americans are trying to find room in their budgets to cover the cost of continuing Covid care. Some are cutting back on immunization activities. Others are cutting back on their workforce development efforts.

“We are truly the last game in town in many, many communities. The county is out. The hospitals decided, “OK, we just need to focus on our operations,” said Jana Eubank, executive director of the Texas Association of Community Health Centers. “If the centers can’t do this job, I’m really concerned about what will happen to many of our marginalized populations and people on the front lines who are most vulnerable to contracting Covid.”

Many health centers are still able to provide services only because the demand for testing and vaccinations remains relatively low. A wave like Delta or Omicron could send medical centers back to their limits and not have enough time to step up their Covid responses.

“We’re doing well right now, but if there’s another wave in two months, we can’t guarantee they’ll have enough dollars for it,” said Vasheria Keyes, director of regulation at the National Public Health Association. centers. “I don’t know if we have the resources to keep building capacity again and again and again.”

Not all medical centers are in dire straits. Those who serve the majority of the Medicaid population say they are in a better financial position than their sister organizations, which serve mostly uninsured patients, because most of their income is stable.

Laura Owens, CEO of Carolina Family Health Centers in North Carolina, said federal uninsured dollars made it easier for health centers to serve their community because they didn’t even have to think about someone’s insurance status when providing care.

“The main benefit of this program, beyond budgets, plans and workflows, is that it has definitely reduced the barriers to care for individuals,” Owens said. “People didn’t have to make vaccination or testing decisions when they didn’t have an insurance card in their wallet.”

Free testing is also still available to the uninsured at other locations, including pharmacies like CVS and Walgreens and some health departments, although testing for the latter appears to have slowed or stopped in some parts of the country.

But declining access threatens to reopen a care gap that many have been trying to close since the start of the pandemic. Health advocates who work with migrant workers in rural areas say their patients struggle to get to city facilities and book appointments for testing or vaccinations, with no documentation or language skills to navigate the health system.

“The agricultural workers we serve have no transport, no means, no documents to show at the [government-run] testing sites,” said Isabelle Garcia, executive director of the RCMA, a migrant advocacy group in Florida. “Before the (HRSA) program ended, it was still difficult – many clinics and tests are in or out of town – but it was more affordable.” Now, she says, people just don’t get tested.

Marilyn Sumerford, executive director of Access Family Health Services in Northeast Mississippi, says getting care should be as easy as possible when working with vulnerable populations.

“Any barrier, no matter how big, that prevents people from getting the services they need,” Summerford said, “our healthcare system will pay for it for years to come.”