Access to COVID-19 treatment is key to helping Americans combat the disease, as well as containing its spread. To their credit, on March 29, Humana and CIGNA—the fourth- and fifth-largest health insurers—under massive public pressure, waived “all COVID-19 costs” for all of their members. But, tens of millions of other Americans continue to face powerful financial barriers to care. Our corporate health care system is not designed to ensure everyone gets needed care, much less to protect the public health.
Over the last month, as the novel coronavirus laid siege on the US, the largest health insurers did nothing to reduce barriers to COVID-19 care. Instead, their web sites advised their members to practice good hygiene and suggested they visit the CDC online for more information. News reports revealed that Americans were loath to seek care for fear of the cost. And, that remains the case for most of the 87 million uninsured and underinsured in this country.
Today, United Healthcare, the largest health insurer in the country, waived all cost-sharing for its members. But, Anthem, the second-largest health insurer, does not appear to have waived costs for treatment. Aetna, the third-largest health insurer, has only waived some costs for some of its members.
Kaiser Permanente, a non-profit, considered to offer the best health plans in the US, is still not covering the full cost of treatment. Deep down on its coronavirus web page, it simply says: “If you’re diagnosed with COVID-19, additional services, including hospital admission (if applicable), will be covered according to your plan details.”
To ensure people receive COVID-19 treatment and to help stem the spread of the virus all COVID-19 care needs to be free. In a recent eHealth survey, more than six in ten people (64 percent) under 65 said that they would not be able to afford their full deductible. Deductibles averaged $1,655 in 2019. Seventy percent of Americans don’t have $1,000 in cash for emergencies.
Paying health care costs is generally a heavier lift for older adults and people with disabilities, who need more care and live on small fixed incomes. Yet, most health insurers offering Medicare Advantage plans—corporate health plans that provide Medicare benefits to 24 million older and disabled Americans—are not providing their members who are most at risk of becoming gravely ill or dying from COVID-19, easy access to COVID-19 treatment. Curiously, Aetna waived cost sharing for its members under 65 and kept cost-sharing in place for their Medicare Advantage members.
The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, has failed to mandate that Medicare Advantage plans waive all costs for COVID-19 care. It has simply given them permission to do so. What’s worse is that CMS’ authority over these corporate health plans appears limited at best.
For example, CMS has required that they cover all COVID-19 care at out-of-network facilities at the same cost as at in-network facilities, without a referral. But, the biggest health insurers’ web sites don’t even inform their Medicare Advantage members of this emergency benefit. As a result, they deter older people from seeking treatment in order to avoid liability for thousands of dollars in copays. Inexplicably, CMS has failed to inform people of this emergency benefit on its coronavirus web page.
Furthermore, CMS did not take a lead among health insurers and provide emergency coverage for the full cost of COVID-19 treatment for people in traditional Medicare. Fortunately, the vast majority of people in traditional Medicare have supplemental coverage which picks up all or virtually all of their out-of-pocket costs. But, the six million people in traditional Medicare without supplemental coverage must pay deductibles and coinsurance costs, with no out-of-pocket cap. This unlimited cost-sharing presents a daunting obstacle to care for them.
In short, Humana, Cigna and UnitedHealthcare members are better off thanks to their insurers’ decision to cover all COVID-19 costs. But, they alone cannot protect us from the ongoing threat the novel coronavirus presents to the public health. For that, everyone else in this country also needs full COVID-19 coverage. Neither other corporate health insurers nor the federal government has stepped up on that front.
It should go without saying that our nation’s failure to provide health care for all has cost us far more than it ever would have cost to provide everyone coverage. “Skin in the game,” the ill-conceived concept that people with health insurance should pay a piece of their health care costs, is a health insurance design feature that is killing our citizenry and belongs in the graveyard. If our lawmakers want to ensure the health and financial well-being of our nation, they will need to guarantee health care for everyone in America.
