As Congress pursues legislative action to address the health and financial crises resulting from the COVID-19 pandemic, it has taken some steps to address critical needs in our health coverage system, but left many challenges unattended. Congress made significant progress on covering the cost of COVID-19 testing in its second response package, the Families Act, but it made only limited progress in addressing overall health care costs facing consumers in its phase 3 response to the pandemic passed last week, the CARES Act.
As Congress debates its next COVID-19 legislative response effort (phase 4), it must ex pand health care coverage in three main ways: (1) ensure that all individuals, whether or not they have health care coverage, can receive free treatment for COVID-19; (2) expand coverage options for uninsured individuals, and (3) expand support for state budgets to ensure they continue to provide coverage and care. Doing these three things will save lives and prevent severe financial harm for people who get sick.
CARES Act Health Coverage Provisions
The CARES Act did take a few, though limited, steps to alleviate the costs to patients incurred as a result of the pandemic and to ensure that people do not avoid testing because of cost. The law expands on the testing provided in the Families First Act (phase 2) to cover other services that result in getting tested, and also expands the types of tests covered for private plans. It also ensures that private plans cover the cost of free vaccines for COVID-19 as soon as they are approved by the relevant medical authorities, and provides about $400 million for mental health services in response to the pandemic. And finally, it sent $150 billion to state and local governments to cover unanticipated COVID-19-related costs, reducing the likelihood and scale of cuts that states might make elsewhere, in the short term, to cover emergency costs.
The CARES Act did not, however, address the cost of treatment for COVID-19, which could be thousands or tens of thousands of dollars for each patient. Covering these costs is critical to ensuring people do not avoid testing or treatment and thus spread the disease; it is also critical to individual health and finances for people who do get sick.
The CARES Act also fails to make it easier for people to get insurance coverage in the wake of a global pandemic, taking no action to open up new coverage enrollment options, encourage the expansion of Medicaid, or bring down coverage costs as millions of people lose their jobs or see their hours reduced.
Progress in the House
Before Congress passed the Senate’s CARES Act, Democrats in the House released their own version of a phase 3 legislative package, with a more comprehensive proposal to address coverage needs and treatment costs; this package influenced some of the final provisions that ended up in the CARES Act, and those that did not make it in provide a good starting point for phase 4.
First, provisions in the House bill make the treatments and vaccines free for people enrolled in Medicaid, CHIP, and Medicare—and provide a special Medicaid coverage provision for uninsured people (already reporting tens of thousands of dollars of bills) to receive free treatment and vaccines for COVID-19. The bill also has provisions that require private plans to get rid of cost-sharing for treatment, reimbursing insurers directly for those costs instead. And while the bill included investments in mental health services, it did not cover the full cost of mental health services stemming from the current pandemic.
Second, the House bill includes provisions that support state efforts to retain and expand coverage. The House bill has an automatic increase to the Federal Medicaid Assistance Percentage (FMAP) as unemployment increases, which means that if the economy gets worse, new aid to states dealing with the combination of new enrollees and lower revenue will receive federal help. Additionally, similar to the CARES Act, it also provides some money for state and local governments (though $50 billion more). However, neither bill went far enough to address the significant revenue shortfalls that states will likely face, straining their health care and coverage system.
Finally, the provisions in the House bill expand access to coverage and makes it more affordable in the wake of other financial demands that will face families: they expand premium tax credits, bring down costs of COBRA payments, encourage new Medicaid options by increasing the federal dollars available for states to expand Medicaid, and open up healthcare.gov for a special enrollment period to allow anyone to enroll in an insurance plan right now (an action that the Trump administration could take through existing authority).
Even as the CARES Act leaves significant work to do, some states have filled gaps left by federal inaction. For example, twelve states that run their own marketplace have created a special enrollment period for anyone to sign up for coverage; two states and D.C. have mandated the insurance cover free treatment for COVID-19; and most states have gotten some form of an 1135 waiver to their Medicaid program, allowing them to do things like streamline enrollment processes.
Even as state and federal policymakers urgently attempt to catch up to the unconscionable delays and ongoing failures by the Trump administration in testing and supplies, congressional leaders have begun to lay out plans for what should come next. It may be several weeks or longer before Congress comes back to the table. When it does, it will be imperative that it takes more aggressive action to cover more people and make sure that coverage makes COIVD-19 treatment free. The House bill provides a good place to start.
Header photo: U.S. President Donald Trump speaks in the Rose Garden after introducing a new point-of-care COVID-19 test kit developed by Abbott Labs at the White House in Washington, DC.