U.S. Covid Care Has Entered a New Stage of Crisis for the Uninsured

The Biden administration is asking Congress to replenish its coffers, but its pleas to lawmakers this year have so far been unsuccessful. Warning about the threat of new subvariants as winter approaches, the White House asked Congress last month for more than $9 billion in additional funding for the pandemic response. Some of that money would go toward ensuring that Americans, including those without insurance, continue to have access to vaccines and treatments.

Republicans in Congress have resisted the White House’s requests. They have accused the administration of spending pandemic relief money in a wasteful manner and have shown little appetite for providing more funding, especially after President Biden declared in September that “the pandemic is over.”

Adding to the dilemma for the uninsured, the administration is planning to allow vaccines and treatments for Covid-19 to hit the commercial market by next summer — a move that could further hinder access for those without health coverage.

The result, public health experts say, is the end of the universal access that Americans have had to Covid care during the pandemic, a rare exception in the fragmented U.S. health care system. As federal funding dries up, people without insurance may be left footing the bill for tests and treatments, or they may be discouraged from seeking care altogether.

The problem is especially acute in states that have yet to expand Medicaid under the Affordable Care Act. Those areas, where Republicans partly or entirely control state government, tend to have a larger share of residents without health insurance than the states that have adopted the expansion.

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For much of the pandemic, the federal government covered the cost of vaccinating, testing and treating the uninsured through a fund run by the Department of Health and Human Services. But that program shut down in the spring because of a lack of funding, and in September, the government stopped providing free at-home tests through the Postal Service for the same reason.

Roughly 50,000 coronavirus cases — a figure that is almost certainly a significant undercount — are being reported in the United States each day, and people without insurance can face an array of costs. Bills for tests can be large and unpredictable; some people have faced charges of more than $3,000 for the routine nasal swab. For those who become seriously ill, a hospitalization can cost more than $1 million.

The government continues to offer Covid-19 treatments like Paxlovid for free to patients. But without the federal uninsured fund, Americans without health coverage can still be charged for outpatient visits needed for a diagnosis or a prescription.

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.

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