Providers losing federal cushion for uninsured COVID care

Christina Paz was typing up notes about a patient she’d just seen at Centro San Vicente, El Paso’s largest community health center, when an email from Washington showed up. “Lord,” she thought as she read it at the clinic’s nursing station. “Oh, my God.”

The brief email told Paz, a nurse practitioner who is the clinic’s chief executive officer, that at 11:59 p.m. on March 22 the federal COVID-19 Uninsured Program would stop accepting claims for testing and treating for the deadly virus on patients who had no way to pay their medical bills.

On the Wednesday afternoon when Paz opened the federal notice, that deadline loomed just six days away. For a clinic where nearly two-thirds of patients are classified as “unfunded,” the $252,000 the federal program has sent Centro San Vicente has been a lifeline as its staff treated more than 2,000 patients for COVID and tested thousands more.

Now, the health center blocks from the Rio Grande is one of more than 50,000 providers of health services nationwide that have run out of time to claim reimbursement from the U.S. Department of Health and Human Services for coronavirus testing and care of those without health coverage. And another deadline nears — Tuesday — to submit charges for vaccinating the uninsured.

The wind-down of the uninsured program is among the first concrete casualties of a decision by Congress to exclude about $15 billion in pandemic relief from a large spending plan adopted for other parts of the government and the Ukraine war.

The Biden administration has been trying to draw attention to the consequences if lawmakers continue bickering over whether to provide more coronavirus aid. (The Washington Post reported late Thursday that key senators had agreed on the framework of a $10 billion package to continue funding COVID vaccines, antiviral treatments and other supplies for Americans, but that would drastically cut plans to help vaccinate millions of people around the world.)

Since it was created in spring 2020 as one of several pools of pandemic aid for health care providers, the uninsured program has provided more than $20 billion in reimbursements to medical labs, hospitals, doctor’s offices, pharmacies and clinics. But as it winds down, its absence — unless Congress acts — will be felt most keenly in the health care system’s safety net, focused on patients who have no health coverage. Often, those patients are low-income Black Americans or Latinos whose communities have been scarred by the greatest illness and death from the pandemic.

Last month, the White House Office of Management and Budget sent House and Senate leaders a two-page letter laying out “immediate needs to avoid disruption to ongoing COVID response efforts over the next few months.” One item was $1.5 billion for the uninsured program — less than the program has been spending in a month.

Advocates for hospitals and community health centers have been pressing lawmakers to pour more money into the program.

Talks are continuing on Capitol Hill, with Republican lawmakers stipulating that they will consider more pandemic aid only if they become convinced there is a clear way to pay for it.

Under rules set by the Centers for Disease Control and Prevention, coronavirus vaccines must be given at no charge. The question of possibly charging for coronavirus tests is more ambiguous.

One company that operates coronavirus testing sites and medical labs, Quest Diagnostics, has notified clients that, without the ability to bill HRSA, it no longer can provide tests for free to the uninsured, according to a spokeswoman, Kimberly Gorode. Quest will now charge people without health coverage $125 for a PCR test, Gorode said.

At Centro San Vicente, where 80 percent of patients are Hispanic and most live under the poverty line, Paz said she is still shell-shocked by the uninsured program drying up. It was the “huge cushion,” she said, that allowed the clinic’s four sites across El Paso to avoid furloughs and layoffs as the costs of coping with the pandemic soared.

“We all knew at some point the funding was going to stop,” she said, but “I don’t have a strategy how we are going to compensate.”

The one thing she knows, Paz said, is that “COVID is not going away.”