By Eagan Kemp, Melinda St. Louis, Taylor Lincoln, and Michael Tanglis
Public Citizen, May 7, 2020
Summary of Findings
The vast majority of the largest health insurers say they are offering at least some fee waivers for the treatment of COVID-19 patients, but these fee waivers contain significant restrictions and most are set to expire long before the pandemic can reasonably be expected to end.
Most of the fee waivers are set to expire soon. Of the 25 largest health insurers, 21 have announced that they are waiving all costs – such as deductibles and co-payments – for COVID-19 patients, at least for in-network care, and two are offering fee-waivers for some COVID treatment. But 15 of the 23 fee-waiver offers are set to expire by July 1, including 11 by June 1.
Few of the fee waivers appear to cover costs for out-of-network care. Only two of the 25 largest insurers affirmatively state that they will cover patients’ costs for care provided by both in-network and out-of-network providers. This distinction is important because many patients might not be able to obtain care from in-network practitioners due to the high rate of hospitalization in some locations.
Up to 60 percent of people in private insurance plans may not be covered by the fee- waivers because they are in self-insured plans. The fee waiver offers universally exclude those in self-insured plans unless the employers that underwrite the plans opt-in. About 60 percent of people who receive insurance through employers are in self-insured plans.
Some insurers are providing few, if any, expanded benefits for coronavirus treatment. Two large insurers – CareSource and WellCare – appear to be offering little beyond their normal coverage.
Descriptions of testing benefits need improvement. Although Congress has mandated free testing for COVID-19 with few restrictions, many of the large health insurers’ descriptions of testing benefits are unclear and/or appear to impose restrictions that the recent legislation did not call for.
From the Introduction
To the extent that insurers are offering increased benefits voluntarily, they are likely seeking to earn good will. But the fine print attached to the increased benefits is apt to reinforce Americans’ perception that private insurers’ benefits are incredibly difficult to navigate and are riddled with financial hazards and pitfalls.
While Americans would welcome blanket protection from costs for coronavirus treatment, this would only serve as a temporary solution to the broader problem that plagues American health care. The system is unfathomably complicated, ridiculously expensive to administer and rations care according to people’s ability to pay. This is not only morally bankrupt but, as the spread of coronavirus indicates, it is also dangerous from a public health standpoint because we are all affected by the community’s overall health and ability to obtain needed care.
Lawmakers and some insurers were right to move in the direction of free care for coronavirus, but stopping there would not make sense. There are many health conditions that, although less publicized than coronavirus, are even more deadly. If free care makes sense for COVID-19 patients, the same is true for those suffering from cancer, heart disease, complications at birth and myriad other conditions.
The most sensible way to untangle the thicket of our health care system, protect Americans from crushing costs, and create a healthier and more productive society is to implement Medicare for All, under which patients would receive the care they need for free and providers would be compensated at a fair rate for services rendered.
By Don McCanne, M.D.
The nation’s private health insurers now have a chance to prove to us that they are worthy of controlling our health expenditures. During the worst pandemic in a century, combined with a catastrophic economic downturn, what are they offering us?
Perhaps they best show their true colors by their conditional offer to waive deductibles and copayments for treatment of COVID-19 patients, but you’d better get sick and recover before the end of the month since this offer by several of the larger insurers (United Health, Anthem, CVS/Aetna, Health Care Service Corporation, Cigna, Florida Blue, Blue Shield of California, Independence Health Group, Anthem Blue Cross of California, Highmark Group) expires by June 1. That means that you have about one more week to become ill with the virus in order to qualify for this great offer.
Also, during this crisis there is a greater likelihood that care may be provided out-of-network because of the urgent nature of the disease and the strained capacity of the delivery system. Of course the insurers can’t be expected to cover those out-of-network expenses since they have no contracts with the providers. Also, the majority of employer-sponsored plans are self-insured, and the insurers provide only the administrative services, so they can’t be expected to waive the cost sharing in these plans either since it’s not their money. And the benefits for COVID testing? Just try to figure that out.
How would this compare to the single payer model of Medicare for All? All medical costs for COVID would be covered. Not only that, but all other medical problems such as heart attacks, cancer, other infectious diseases, injuries, and whatever else would be covered as well.
Besides, if we leave the private insurers in control, what are they going to do about the uninsured? Just what they’re doing now – nothing!
But ask the insurers, and they’ll tell you that they are doing something right. Look at their record profits!
And this is the private insurance that some politicians are telling us that we don’t want to have taken away from us? Medicare for All? How are we going to pay for that!? Well, the $4 trillion that we are already paying is more than enough. We just have to make it affordable for each of us through equitable, progressive funding of a universal risk pool: single payer Medicare for All.
Don’t forget, if you want the COVID deal that your insurer may be offering you, you’d better get sick this week or the deal may expire. Your ambulance service may even offer curbside pickup, but that also expires, after you do.
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