What happens if you get COVID-19, the disease caused by the novel 2019 coronavirus?
For starters, you may get a cough and get a fever. Your life may be in jeopardy if you’re elderly, or have a compromised immune system. People won’t go near you for fear of catching the modern plague. And on top of all that, if you’re an American, there’s a pretty good chance you’ll have to wade through bureaucracy—and, despite murky promises from the White House, and a potential piece of aid legislation from Congress, take a sizable hit in the wallet.
Until recently, there were clear criteria to indicate who could receive a COVID-19 test: recent travel to a country like China or Italy, or contact with a person who had tested positive. But the Centers for Disease Control and Prevention (CDC) have since revised the rules, casting a wider net that includes more or less anyone with symptoms, who seems to be at risk for a serious case of the disease—older and immunocompromised patients in particular.
But that doesn’t mean you can actually get tested at your local hospital. It doesn’t matter if you’re a movie star with a Cadillac health insurance plan walking into Cedars Sinai Medical Center, or an uninsured Uber driver in Duluth, Minnesota. “It's really hard to get a test,” said Kao-Ping Chua, a practicing pediatrician and researcher on overuse of health care at the University of Michigan in Ann Arbor. “As far as I can tell, everybody, regardless of their insurance status, has an equal amount of hassle,” Chua told The Daily Beast.
There’s no single reason for this. As Time reported, there’s been a sort of comedy of errors in which the necessary combination of test kits, facilities where tests can safely be conducted, and labs where tests can be sent, simply doesn’t exist. If you’re lucky enough to become symptomatic in Connecticut, Colorado, or Washington, you may be sent to a convenient Wendy’s-style drive-thru for rapid—and possibly free—testing. Otherwise, according to Chua, your doctor might have to just send you home with no answer.
“It can be frustrating,” he said.
To make matters worse, even if you manage to get a test, and you find out it’s some other disease, you’ll probably get a bill.
“Over half the non-elderly population gets coverage through an employer, and among those who do, about 80 percent have a deductible,” said John Graves, a healthcare policy researcher at the Vanderbilt University School of Medicine, who also worked as a modeler on the Affordable Care Act, a.k.a. Obamacare. That means doing your duty to your community isn’t enough. You’ll also have to fulfill your obligation to your insurance company when the bill comes around. Or, if you don’t have insurance, you might simply have to pay for the whole thing.
“If you are uninsured and/or you are undocumented, showing up at the hospital or an urgent care—or at some other point of contact with the health care system, including a safety net provider like a federally qualified health center—might entail a significant personal financial risk,” according to Rena Conti, health policy researcher at the Questrom School of Business at Boston University. “It’s up to every single point of care—or a locality, county, city or state—to decide how and whether they're going to underwrite that bill for you,” she said.
This is the disturbing reality of where things stand weeks—or months—into American exposure to a deadly pandemic.
“There's been kind of a recognition that's been informed by a lot of research indicating that when people face out of pocket costs, they do cut back on their care,” said Graves. “The problem is that patients are their own worst doctors, and they cut back indiscriminately on both necessary and unnecessary care.”
The theory behind “cost-sharing” insurance plans—particularly the ones with deductibles as high as $6,900 for an individual—is “to put people's skin in the game so they don't overuse care,” according to Chua. But once tests are available, seeking one out if you have symptoms is crucial, no matter how healthy you may be, and how likely you are to recover effortlessly. “This is trying to prevent a potentially lethal disease from affecting yourself and everybody around you,” Chua said, adding, “there should be no unnecessary care in getting tested. This is not like an unnecessary MRI.”
So chances are, you’ll just have to pay up. Which is especially frustrating because, as Chua noted, "In general, it is believed that many if not most cases of COVID-19 will be mild—in these cases, home care and self-isolation is sufficient."
There may be some relief down the line, as Graves noted. “There's been some talk on the insurer side about waiving copayment and cost-sharing requirements,” he explained. But while your test might be reimbursed, he said, “I haven't seen anything about treatment falling outside of the typical deductible or copayment structure that someone would normally face.”
In other words, the insurance company might kindly waive the cost of the test, but if you test positive, and then have to be placed on a respirator, and hospitalized for two weeks, the savings you get from that free test is going to feel like a drop in the bucket.
There have also been discussions of legislation to waive some of these costs, as Conti noted. “But even if state or federal government did pursue that type of legislation, it wouldn't necessarily cover many people who are insured by their employer and who are insured by what are called ERISA-exempt plans, which include many federal and state workers, and many workers who work at a large Fortune 500 or 1000 companies,” she told The Daily Beast.
According to Graves, a program that reimburses everyone for their COVID-19 treatments would be easy to roll out. “Almost every provider in the United States, including labs and hospitals, has an established reimbursement channel through Medicare,” he told The Daily Beast. As an emergency measure, Graves explained, the government could just decide that testing is going to be covered as a Medicare benefit for all Americans. “There's a very established pathway for which they could just reimburse providers for that service,” he said.
Admittedly, mustering the political will to provide all this money is the hard part. But in light of the $1.5 trillion in short-term loans to banks the Federal Reserve just announced, it’s fair to say certain types of generosity on the part of the federal government aren’t completely unheard of.