For the Uninsured, Covid Care Has Entered a New Stage of Crisis

Once the government’s supply of treatments runs out, health care providers will need to purchase them on their own, with insurers covering the costs for Americans just as they do for other treatments. People without coverage will in most instances pay for the drugs out of pocket. The same is true for coronavirus tests.

And with the prices of coronavirus vaccines expected to increase on the commercial market, the shots could eventually become less accessible to people without insurance. The federal government has purchased a large supply of the updated booster doses, but another round of shots is expected to be needed next year.

The Biden administration has proposed a new program called Vaccines for Adults that is modeled after a federal program that provides vaccines to children at no cost. If funded by Congress, the program would supply coronavirus shots and other vaccines while reimbursing providers for administration fees.

The government has also talked to manufacturers of vaccines and treatments about funding their own programs for the uninsured, Dawn O’Connell, the assistant secretary for preparedness and response at the Department of Health and Human Services, said at an event hosted by the Kaiser Family Foundation this fall.

“We’re trying to pull a few levers all at once,” she said.

In 15 states, a temporary federal provision allows Medicaid funds to be used to cover vaccine-related fees, treatments and tests for the uninsured. But that program will expire when the federal government lifts its declaration of a public health emergency for the pandemic, a move it could make as soon as next year.

The Biden administration has also experimented with a smaller program that could offer a template for future distribution methods. In September, weeks after an Eli Lilly monoclonal antibody treatment moved to the commercial market, the administration announced that it would make 60,000 doses available to health care providers. Each time a provider used a commercially purchased dose for an uninsured patient, the federal government offered to replace that dose. (The Food and Drug Administration said last week that the drug, which is not expected to work against newer coronavirus variants, was no longer authorized for emergency use.)

There were warning signs even before the federal uninsured fund lapsed of the hassles to come. Anthony Lund, a professional health insurance counselor who previously worked at a Mayo Clinic testing center in Minnesota, once offered reassurances to uninsured patients he scheduled for coronavirus tests: The federal government would pick up the cost.