Will the feds pay for uninsured Americans’ COVID-19 treatment and testing?

With the Trump administration accused of sitting on money intended to pay for COVID-19 testing and treatment of uninsured Americans, more than half the $175 billion Congress set aside to defray pandemic-related expenses is already spent.

The federal government’s COVID-19 program for testing and treatment of uninsured patients provides reimbursements on a rolling basis directly to health care facilities. The Families First Coronavirus Response Act Relief Fund includes $2 billion ($1 billion appropriated through the FFCRA, plus $1 billion appropriated through the Paycheck Protection Program and Health Care Enhancement Act).

In addition, the CARES Act and other federal legislation have provided $175 billion in health care funding, with $2 billion specifically set aside for reimbursing medical providers for testing and treating the uninsured for COVID-19.

In Iowa, the Siouxland Community Health Center has been the state’s single largest recipient of federal reimbursement for COVID-19 testing of people who lack insurance. The center was among the leading medical facilities to offer testing in Iowa, launching  its own drive-through testing site on March 17 — weeks before the state launched its own Test Iowa program using a Utah contractor.

Payments for testing and treating those without insurance are considered a critical element of the fight against the virus. That’s partly because most people’s health coverage is tied to their job. As a result of the pandemic, unemployment skyrocketed in April by 15.9 million people, eventually totaling 29 million people who either lost their jobs or dropped out of the workforce.

For that reason, the American Medical Association has urged Congress to provide employers with financial subsidies that would enable them to preserve the health benefits of workers, even if those benefits have been curtailed as a cost-saving measure.

Of the $175 billion allocated for the provider relief fund, the U.S. Department of Health and Human Services has already committed $113 billion, leaving $62 billion remaining. The department cautions that its program to pay for treating uninsured COVID-19 patients is “subject to available funding.”

The Kaiser Family Foundation has warned that if the money runs out, uninsured patients could be hit with medical bills for care they thought would be covered through the fund. Or they may avoid treatment altogether.

U.S. Sens. Patty Murray, D-Wash., and Chuck Schumer, D-N.Y., sent a letter Monday to Health and Human Services Secretary Alexander Azar, arguing that the Trump administration hasn’t distributed almost $14 billion in funding for testing and tracing, including $2 billion they say was allocated to provide testing for the uninsured. DHHS officials blame Congress, saying it failed to give the department clear guidance on how to spend the money.

“We call on you to immediately disburse the remainder of the $25 billion in funds to ramp up testing and contact tracing capacity, as well as to make sure providers are aware of and able to easily access the $2 billion that Congress appropriated to provide testing for the uninsured,” Schumer and Murray wrote in their letter.

Nationally, about $130 million has been paid out for testing and treating the uninsured.

For COVID-19 testing and treating, a patient is considered uninsured if he or she does not have coverage through an individual or employer-sponsored plan, a federal health care program, or the Federal Employees Health Benefits Program. Health care providers are not required to confirm immigration status prior to submitting, and collecting on, claims for reimbursement.

Where is the money going in Iowa?

According to data based on reimbursements through the federal programs, the Iowa hospitals and clinics that have received the most funding for COVID-19 testing of uninsured patients, as of June 18, 2020, were:

1. Siouxland Community Health Center, Sioux City: $26,289
2. Iowa Physicians Clinic and Medical Foundation, Des Moines: $10,043
3. Genesis Medical Center, Davenport: $7,960
4. MercyOne Medical Group Northeast Iowa, Waterloo: $5,507
5. East Central Iowa Acute Care, Cedar Rapids: $5,027
6. MercyOne Clive Pulmonary Care Clinic, Des Moines: $4,206
7. MercyOne Clinton Medical Center, Clinton: $3,364
8. The Iowa Clinic, West Des Moines: $3,116
9. MercyOne North Iowa Medical Center, Mason City: $3,054
10. Sioux Center Health, Sioux Center: $3,045

The top Iowa recipients of funding for the treatment of the uninsured with COVID-19 through June 18 were:

1. MercyOne Medical Group Northeast Iowa, Waterloo: $110,642
2. MercyOne Dubuque Medical Center, Dubuque: $100,900
3. University of Iowa Hospitals, Iowa City: $39,116
4. St. Luke’s Regional Medical Center, Des Moines: $38,349
5. MercyOne Siouxland Medical Center, Sioux City: $35,801
6. MercyOne Des Moines Medical Center, West Des Moines: $34,398
7. Jefferson County Health Center, Fairfield: $22,295
8. UnityPoint-Marshalltown, Marshalltown: $21,414
9. Ottumwa Regional Health Center, Ottumwa: $19,352
10. Central Iowa Hospital Corp., Des Moines: $18,947