The short answer is that as of this writing—9 am Sunday, March 8, 2020–no one seems to know. Two laboratory giants, LabCorp and Quest, are distributing tests next week, probably enough for our immediate needs.
Vice president Pence, appointed by the president as the Covid-19 czar, has said “With regard to the cost, let me be very clear: HHS has designated the coronavirus test as an essential health benefit. That means, by definition, it’s covered in the private health insurance of every American, as well as covered by Medicare and Medicaid.”
Well, not exactly. Click here for an analysis of Pence’s statement. Health insurers do have the option to decide exactly what are and are not “essential health benefits” (EHBs). Some insurers consider maternity coverage essential and others don’t. Same goes for birth control.
To date, there’s been no federal mandate insisting that Covid-19 testing be covered. On the plus side, some insurers have agreed to provide the service, but the standard policy benefits will likely apply. That means there will be “cost sharing,” meaning you’ll pay a portion of an amount that’s difficult to determine because the cost of the test is not known.
Three of our more civilized states (NY, CA, WA) have mandated that the Covid-19 test become available as an EHB without any cost sharing, which sounds good unless you have a super-high deductible and a month later you receive a bill.
What about people who don’t have insurance?
And then, of course, there are the uninsured. Under Trumpian rollbacks, the number of people who have no health insurance has increased to 27 million US citizens.
Even if insurance companies were mandated to provide testing as an EHB for their enrollees, no one is required to provide free testing.
However, Rep. Ruben Gallego (D-AZ) is introducing a bill to ensure that Medicaid covers Covid-19 testing and, if a test result is positive, that all follow-up care is free to uninsured Americans. This is certainly reasonable in light of recent surveys showing that uninsured (and the under-insured) people simply don’t go to doctors because they fear financial hardships.
It also makes sense for the health of the general public. Sick people who know that testing is free will be more likely to get tested. If they have the virus they can be treated and/or self-quarantine so as not to spread Covid-19 in the community.
In China, where they’re apparently getting their epidemic under control, testing is free, treatment is free, and medicines are given in three-month supplies so crowds don’t gather in pharmacies. This Vox piece addresses what we and the rest of the world can learn from China’s experience.
So, failing now to accomplish what I set out to convey about Covid-19–namely, how much the test will cost–I regret that as of today no one can make even an educated guess. As for availability of the test, ask your doctor. At WHC, we lease our lab to a company that’s owned by Northwestern. When I asked the tech, he shrugged and said he didn’t know when the test would be available. He also has no idea of the potential cost.
Still more questions
I’d like to close this Health Tip by trying to summarize a somewhat related article you can access online here, from the Journal of the AMA/JAMA. It was pretty much overlooked in the avalanche of grim information about Covid-19 and our elected leaders’ failure to begin testing weeks ago. I didn’t see anything in the press about it.
The JAMA piece may help explain how and why Covid-19 could place us at the brink of an economic disaster, both on a national and personal level.
Olivier J. Wouters, Ph.D., is a researcher at the London School of Economics. Dr. Wouters decided to explore the readily available information concerning political contributions. As a result, he published a seriously frightening article about the extent to which lobbying of Congress (both on federal and state levels) likely controls every aspect of your healthcare or lack thereof.
The usual suspects have their fingerprints all over this: BigPharma (far and away the largest political contributor), but also the health product industry (medical devices, testing equipment), the hospital industry, the health insurance industry, all the medical associations, etc.
The recipients of their largesse are senior legislators with the most influence on health care policies. Although donations favor Republicans, major Democrats fare quite well, too.
From 1999 to 2018 BigPharma and the health product industry (which will be responsible for producing Covid-19 test kits) spent $4.7 billion lobbying our elected lawmakers as follows:
–Federal: $233 million a year targeting the federal government (committees); $414 million a year in political contributions.
–State: $877 million a year to state candidates and committees.
Let’s look at some examples of why this is important. Did you ever wonder why it’s illegal to purchase discounted prescription drugs from Canada? Why spend $2,900 for 60 tablets of antibiotic Xifaxan in Buffalo, NY, when you can cross over into Canada and pay $900 for the same amount?
Well, it seems that Cory Booker (D-NJ) and a dozen other Democrats were instrumental in tipping the scales to Big Pharma by voting against an amendment that would have allowed the importation of less expensive prescription drugs from Canada. Booker’s home state of New Jersey has lots of BigPharma companies, and Booker himself received several hundred thousand dollars from Pharma and medical device makers to advance his career before refusing further contributions when he decided to run for president.
Here’s another question: Why is there an actual law that forbids the federal government from negotiating drug prices in Medicare D? Well, it was pushed through by a congressman you may have never heard of, Billy Tauzin (D-LA), who, when his term of office ended in 2005, went to work as a paid lobbyist for Big Pharma at a salary of $2 million a year. He received a bonus of $11 million in 2010, making him the highest paid lobbyist of them all.
Here’s Dr. Wouton’s conclusion in the JAMA piece: “Understanding the spending of the pharmaceutical and health product industry on lobbying and campaign contributions can inform discussions about how to temper the influence of industry on US healthcare policy.”
That’s British understatement for you. So if Covid-19 bankrupts you, you know who to thank.
Be well,
David Edelberg, MD