Program to cover uninsured patients falls short of promise

WASHINGTON — Marilyn Cortez, a retired cafeteria worker in Houston with no health insurance, spent much of July in the hospital with COVID-19. When she finally returned home, she received a $36,000 bill that compounded the stress of her illness.

Then someone from the hospital, Houston Methodist, called and told her not to worry — President Donald Trump had paid it.

But then another bill arrived, for twice as much.

Cortez’s care is supposed to be covered under a program Trump announced this spring as the coronavirus pandemic was taking hold — a time when millions of people were losing their health insurance and the administration was doubling down on trying to dismantle the Affordable Care Act, the law that had expanded coverage to more than 20 million people.

“This should alleviate any concern uninsured Americans may have about seeking the coronavirus treatment,” Trump said in April about the program, which is supposed to cover testing and treatment for uninsured people with COVID-19, using money from the federal coronavirus relief package passed by Congress.

The program has drawn little attention since, but a review by The New York Times of payments made through it, as well as interviews with hospital executives, patients and health policy researchers who have examined the payments, suggest the quickly concocted plan has not lived up to its promise.

It has caused confusion at participating hospitals, which in some cases have mistakenly billed patients like Cortez, who should be covered by it. Few patients seem to know the program exists, so they don’t question the charges. And some hospitals and other medical providers have chosen not to participate in the program, which bars them from seeking any payment from patients whose bills they submit to it.

Large numbers of patients have also been disqualified because COVID19 has to be the primary diagnosis for a case to be covered (unless the patient is pregnant). Since hospitalized COVID patients often have other serious medical conditions, many have other primary diagnoses. At Jackson Health in Miami, for example, only 60% of uninsured COVID19 patients had decisively met the requirements to have their charges covered under the program as of late July, a spokeswoman said.

For now, as tens of thousands of new coronavirus cases are reported each day in the United States, the COVID-19 Uninsured Program is Trump’s best offer.

“This is not the way you deal with uninsured people during a public health emergency,” said Sara Rosenbaum, a professor of health law and policy at George Washington University.

The program has clearly paid what, in many cases, would be staggering and unaffordable bills for thousands of COVID-19 patients. In addition to hospital care, it covers outpatient visits, ambulance rides, medical equipment, skilled nursing home care and even future COVID vaccines for the uninsured, “subject to available funding.” It does not cover prescriptions once patients leave the hospital, or treatment of underlying chronic conditions that make many more vulnerable to the virus.

Health care providers in all 50 states had been reimbursed a total of $851 million from the fund as of last week — $267 million for testing and $584 million for treatment— with hospitals in Texas and New Jersey receiving the most.

But the Kaiser Family Foundation, a nonpartisan research organization, has estimated that hospital costs alone for uninsured coronavirus patients could reach between $13.9 billion and $41.8 billion, far more than what the program has paid out so far.