Hospitals in New York City, including Maimonides Medical Center in Brooklyn, continued to struggle in the past week with an influx of Covid-19 cases.
Photo: Spencer Platt/Getty ImagesCoronavirus patients are confronting steep medical bills despite efforts by the federal government and insurers to soften the financial blow, prompting a renewed push by lawmakers for possible legislative fixes that may come too late—if at all—for many people in the pandemic.
Among the issues patients face: Out-of-network emergency room doctors and other clinicians can still bill patients for charges not covered by insurance. Plans that don’t comply with the Affordable Care Act may not cover hospitalization or cap the daily hospitalization benefit. And more Americans are in plans with high out-of-pocket costs and deductibles.
More than 22 million Americans filed for unemployment in the past four weeks, and many of those people are losing their employer-sponsored health insurance as well as their jobs. Many still won’t qualify for Medicaid, especially in states that didn’t expand the state-federal program for low-income and disabled people, which covers one in seven Americans.
An estimated 50 million Americans could be infected under a 20% infection rate, based on a study by Wakely Consulting Group of people covered by commercial as well as some federal plans. At least 5.5 million could require hospitalization, with 1.3 million needing intensive care. The cost for each of those intensive-care patients could top $30,000.
Republicans on Senate and House committees are striving to include legislation in the next stimulus bill that would protect patients from out-of-network bills. Some Democrats are backing a bill that would entice holdout states to expand Medicaid by having the federal government pick up the tab for three years.
The spurt of proposals reflect a widening bipartisan concern that many Americans remain vulnerable to major health costs that could undermine consumers’ financial security and impede an economic recovery. Democrats believe the situation will give them a boost in the 2020 election as more people are hit with medical bills, making them more likely to vote for the party that has sought to expand coverage under the ACA. Republicans and President Trump have backed a lawsuit seeking to strike down the health law and its coverage gains.
“The most important thing in the next piece of legislation is to expand free testing to free treatment—people shouldn’t hesitate to go to a doctor or go to a hospital if they think they’re sick,” House Energy and Commerce Committee Chairman Frank Pallone (D., N.J.) said Friday.
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Mr. Pallone said Democrats hoped to boost funding for Medicaid and reopen the enrollment period for the health-insurance exchanges for people who had lost their jobs. The Trump administration has so far declined to allow a special enrollment window in the 38 states that use the federal ACA exchange after initially considering such a move last month as the pandemic shutdown was beginning.
“We have to understand more and more people don’t get health insurance through their jobs because they don’t have a job, and that’s why the ACA enrollment has to be opened up again,” he said.
Lawmakers from both parties are also hoping to pass a legislative compromise struck last year to end surprise medical bills, but it wasn’t yet clear whether it would be included in the next coronavirus aid package.
“I would like to get surprise billing done—every bill does not need to be a coronavirus bill,” House Minority Leader Kevin McCarthy (R., Calif.) said in an interview Friday with The Wall Street Journal.
Senate Democrats this past week unveiled a $30 billion proposal for ramping up testing nationwide and reporting test results to contain the spread of the virus. Greater testing could limit infections and reduce the number of Americans who wind up facing treatment costs.
Similarly, lawmakers were also pushing to create a national public-health workforce that could help expand testing and contact-tracing of people who learn they have the virus.
“The only way we can get our economy back up and running is by addressing the health crisis—the two issues cannot be separated,” Senate Minority Leader Chuck Schumer (D., N.Y.) said Wednesday. Until a vaccine is developed, “the best way we can assess the potential readiness of the country to restart economic activity is through comprehensive, sophisticated widespread testing,” he said.
“The broad consensus is that this is going to be absolutely necessary as we reopen,” said Rep. Ami Bera (D., Calif.) “That’s where we’re putting our muscle.”
Many of the roughly 156 million people with employer-provided coverage are likely to see high medical bills for any treatment. People with employer-provided health coverage could be billed about $1,460 if they are hospitalized with pneumonia and receive in-network care, based on a study on potential coronavirus costs by the Kaiser Family Foundation and the Peterson Center on Healthcare.
“It’s expensive,” said Christina Stanton, 50 years old, of New York City, who was recently discharged from the hospital for coronavirus. She has a $1,200 deductible and is covered under an employer-sponsored plan.
The Trump administration has said it would tap an earlier $100 billion stimulus plan to reimburse hospitals for the cost of treating uninsured coronavirus patients, a cost estimated by Kaiser to range from $13.9 billion to $41.8 billion.
Insurers are taking steps to alleviate the financial impact. CareFirst BlueCross BlueShield will let consumers defer up to two months on premium payments with no interest or penalty. Blue Cross Blue Shield of Wyoming is waiving out-of-pocket costs and deductibles for coronavirus treatment through June 30.
“Health-insurance providers are making new announcements every day about how they’re proactively working to care for Americans during the Covid-19 crisis,” said Kristine Grow, a spokeswoman for America’s Health Insurance Plans, an industry group.
Health insurers have been warning that premiums could be higher in 2021 because of the costs related to coronavirus treatment. State regulators have to approve rate increases for many plans, which could limit the increases.
But premiums for many workers could still go up because a number of large companies pay their own insurance costs. Their rate increases aren’t subject to the review. About 60% of employees with health coverage get their benefits under such an arrangement.
Cost Projections
The Kaiser Family Foundation, a health-care research nonprofit, estimates the total cost of treating uninsured coronavirus patients at between $13.9 billion and $41.8 billion. That is based on several other projections:
- 20% to 60% of people will ultimately become infected, based on estimates from epidemiologist Marc Lipsitch at the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health
- 15% of those infected will require hospitalization, similar to the assumption in a model of hospital use for the virus developed by the Harvard Global Health Institute
- That hospitalization rate will be reduced by 20% because the uninsured are almost entirely under age 65 and largely at lower risk for severe illness, based on a model recently published in the Proceedings of the National Academy of Sciences
- 15% of hospitalizations will require intensive care, including use of a ventilator, consistent with estimates from the Centers for Disease Control and Prevention and model results from the Institute for Health Metrics and Evaluation
- 2% to 7% of uninsured people will require hospitalization, ranging from about 670,000 to slightly more than two million admissions, similar to modeling published in the PNAS
Write to Stephanie Armour at stephanie.armour@wsj.com and Kristina Peterson at kristina.peterson@wsj.com
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