End to federal program covering COVID-19 costs for the uninsured worries local health officials – St. Louis Post-Dispatch

Wayne Snap, a chemist in the St. Louis County Health Department clinical lab, grabs a sample on Tuesday, Feb, 22, 2022, in the process running a small batch of COVID-19 test samples in the Berkeley headquarters building of the agency. Photo by Christian Gooden, cgooden@post-dispatch.com

ST. LOUIS A federal program that has given tens of millions of dollars to Missouri providers to defray the cost of COVID-19 testing and treatment for the uninsured came to an end Wednesday, leaving clinics and hospitals worried about the impact on tight budgets and continuing efforts to contain the spread of the deadly coronavirus.

From a public health and a community health perspective, anything that puts a damper on testing and treatment is really a bad idea because the consequences are increased (infection) rates and higher degree of transmission, said BJC HealthCares Dr. Clay Dunagan, speaking on behalf of the St. Louis Metropolitan Pandemic Task Force, which includes all the major hospital systems in the region.

Hospital leaders fear uninsured patients may not seek testing and treatment when exposed or sick because they are worried about the cost, miss the window for prevention therapies or end up requiring more costly care in the emergency room.

Dr. Clay Dunagan, BJC HealthCare senior vice president and chief clinical officer .

The health systems, as always, will do whats clinically appropriate for the patient sitting in front of us, Dunagan said. It will become just another unfunded mandate on the health system for taking care of uninsured patients.

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The end of the funding for the uninsured is the first casualty in a budget impasse between Congress and President Joe Bidens administration over its request for an additional $22.5 billion for the ongoing response to the virus.

The uninsured program has been in place since May 2020. It reimburses hospital, clinics, doctors, laboratories and other service providers for COVID-19 care of the nations uninsured population, which totals about 28 million people. In Missouri, the latest federal census data shows 12% of those under the age of 65 are uninsured or about 612,000 Missourians.

The program is run by the federal Health Resources and Services Administration, which warns on its website that it stopped accepting claims at midnight Wednesday for testing and treatment. After April 5, the program will no longer be able to accept claims for vaccination costs.

A White House fact sheet says other COVID-related efforts also will soon be in danger without new funding, such as the development of new vaccines and maintaining a robust capacity for testing.

The federal government also has no more funding for additional monoclonal antibody treatments for high-risk individuals who get COVID-19. Starting Monday, state allocations of the treatments will be cut by more than 30% to spread out the existing supply.

Waiting to provide funding once were in a surge will be too late, the fact sheet stated.

Republicans argue money to pay for new expenditures should be found in the trillions that Congress has already provided since the pandemic began two years ago, including a $1.9 trillion measure Democrats pushed through Congress over unanimous GOP opposition a year ago.

GOP leaders say the administration has not provided figures on how much of that money remains unspent. At this weeks Republican leadership press conference, U.S. Sen. Roy Blunt, R-Missouri, called on using unspent funds.

My advice to the administration is be totally transparent with where that $1.9 trillion went. Lets see whats left, Blunt said. Lets see if we couldnt find, out of whats left, some money to fully pay for whatever the administration would like to do next to add to the accounts that I personally believe need to be added to, but I dont think we need to do it as an emergency.

Administration officials say they have provided details, according to the Associated Press. Only around $300 billion of the $1.9 trillion relief measure remains unspent and most of that has been promised to specific recipients like states and cities.

The St. Louis County Health Department of Public Health responded to a reporters inquiry about the end to the uninsured program with a statement that urged Congress to revive the program.

Vaccination, testing and treatment (whenever indicated) are the cornerstones of the response strategy in the current phase of the pandemic, the statement read. Any disruptions in support for health care providers on this front will only result in more disease and misery for our community.

$402 millionHRSA officials say the uninsured program has reimbursed care for millions of people during the two-year-old pandemic. The program pays out about $500 million a week in claims, and more than 50,000 service providers have taken advantage of it.

In Missouri, federal data shows, 1,165 providers have used the program and been reimbursed nearly $402 million to test, treat and vaccinate the uninsured between May 29, 2020, and March 3, 2022.

Most about $300 million has been used to cover testing costs. Most of that money has gone to private laboratories processing the tests for places like health departments, homeless shelters and clinics.

Quest Diagnostics received nearly $225 million in claims for processing tests for the uninsured, some of which could also come from out-of-state.

When contacted by the Post-Dispatch, Quest company officials referred a reporter to a March 21 letter that the American Clinical Laboratory Association sent to congressional leaders asking them to replenish the uninsured program.

Last year, members of the association processed more than 8 million tests for the uninsured. In January and February, during the peak of the omicron variant-driven COVID wave, labs were processing 500,000 tests per month.

This critical program has provided life-saving access to COVID-19 testing for uninsured individuals and ensured that all Americans could access a test when needed, the letter stated.

The letter went on to warn that testing remains an important tool against a possible new wave of infections by the omicron subvariant BA.2, which is already increasing cases in some states. The federal government must continue to protect COVID-19 testing and ensure that all Americans, regardless of insurance status, will have access to COVID-19 testing without cost-sharing.

Vince Ojeda, the CEO of Biodivision Diagnostics, a small lab in Collinsville, said the lab has had to shut down its uninsured program, which was processing tests for the homeless service providers across the country, like St. Patrick Center in St. Louis, and groups assisting refugees at the southern border.

Our mission during the pandemic has been to serve the underserved, Ojeda said. But, he said, we simply cannot afford to pay for the supplies needed, the collection staff required, and the technology and technical staff in our laboratory without being reimbursed.

Amanda Laumeyer, senior director of philanthropy for St. Patrick Center, said the agency was using Biodivision to process weekly tests at its homeless shelter for women.

The testing has been essential in catching positive cases and preventing spread within the shelter, Laumeyer said. She learned of the end to the program from a reporter.

We dont know how this will affect us, she said. We will have to look at other ways to find free testing, or wed possibly have to look into having to stop providing testing.

Many patients have used urgent care clinics promising free COVID-19 testing when they have been exposed to an infected person or have symptoms.

Total Access Urgent Care, with nearly 30 urgent care clinics across the St. Louis region, has used the federal program to get reimbursed $6.8 million for testing and $1 million for treating the uninsured, data shows.

Ashley Williams, vice president of patient experience for Total Access, said the company has relied on the program since its inception and was caught off guard this week when it ended.

The clinics will now start charging those without insurance $199 for a COVID-19 test, Williams said, which just covers the cost of the provider to see the patient and the lab to process the test.

Theres no mark-up on that lab charge, she said. We want to make sure that people have access to COVID testing, and that we do everything we can to help everyone, insured and uninsured.

Omicron subvariant{p style=text-align: left;}Affinia Healthcare operates more than half a dozen federally qualified health centers in St. Louis that care for patients on Medicaid and the uninsured.

Affinia Chief Operating Officer Kendra Holmes said the areas low case levels and positivity rates have allowed Affinia to switch gears to another federal program that began a month ago providing health centers with free COVID-19 home-testing kits and highly protective N95 face masks for those who need them.

Anyone, not just Affinia patients, can pick up two kits a week, she said. Each kit contains two COVID-19 tests that provide results in 10 minutes using a self-collected nasal swab.

Affinia is also working to provide kits to places like homeless shelters, Holmes said. This is definitely going to help with the testing piece.

She said staff is also focusing on helping any uninsured patients they come across to enroll in Medicaid, which recently expanded eligibility in Missouri, or the federal Health Insurance Marketplace, where participation costs are lower thanks to pandemic relief funds.

Holmes said it makes sense to pivot funding to other areas such as understanding and treating long COVID serious symptoms that can linger months after the infection which Affinia providers are seeing more of.

The virus, however, has been shown to be unpredictable with each new wave and mutation.

The omicron subvariant BA.2, estimated to be 50% more infectious than omicron, is causing an increase in several states in the Northeast and South. In New York, Connecticut and Arkansas, cases are up by more than 20%, according to The New York Times data tracker.

St. Louis County health department officials warned on Wednesday that the new subvariant has been detected in Missouris wastewater surveillance, and it has caused some cases of COVID-19 in the county.

Dunagan, with the hospital task force, said he expects the strain to cause an uptick in cases, but how much is unknown.

Anything that puts pressure on testing and treatment is going to decrease our ability to contain it, he said. I dont know how severe the withdrawal of funding (for the uninsured) will be in that regard, but it certainly doesnt help.

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End to federal program covering COVID-19 costs for the uninsured worries local health officials - St. Louis Post-Dispatch