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The potential costs for the testing and treatment of coronavirus could deter some Americans from seeking medical care, public health experts worry. Several states, including New York and Washington, have moved to tackle one of those issues by ordering health insurers to waive out-of-pocket costs for COVID-19 medical tests and certain other services.
Dozens of insurers have pledged to eliminate copays and deductibles for testing to ensure that concerns about affordability don't exacerbate the outbreak. But states and health insurers' moves apply to fully insured plan members only. They leave out 100 million Americans who receive health benefits from self-funded employers, sparking concerns about whether those employees will receive similar protections.
Business groups and benefits lawyers say employers plan to cover coronavirus testing and are interested in waiving cost-sharing for the tests, though it's unclear if many employers have moved to do so.
Katy Johnson, senior counsel of health policy at the American Benefits Council, said she's received a dozen calls from employers and their consultants and lawyers with technical questions about their ability to waive cost-sharing. Cassandra Labbees, a partner in the employee benefits practice at law firm Epstein Becker & Green, said states' decisions to order insurers to cover copays for tests has put pressure on employers to do the same.
At least one health insurer is giving employers a push. A spokeswoman for national health insurer Cigna said it has signed up all of its self-insured employer clients to eliminate cost-sharing for coronavirus tests. Cigna sent letters to these "administrative services only" clients Monday and Tuesday, giving them 10 business days to opt out of the program, the spokeswoman said. Cigna served about 12.1 million people in these plans at the end of 2019, according to its quarterly earnings report.
Cigna, like other large insurers, previously committed to waiving cost-sharing for fully insured employer, Medicare Advantage, Medicaid and ACA individual and family plans.
States' mandates don't apply to self-funded employer plans, which provide benefits to 61% of people with job-based health coverage, because they are governed by a federal law known as the Employee Retirement Income Security Act of 1974, or ERISA. Likewise, health insurers that serve these employers as third-party administrators can't unilaterally waive cost-sharing for employee plan members, though they can give them an option.
Two Democratic members of Congress introduced legislation on Tuesday that aims to fill gaps left by ERISA by requiring self-insured employers—along with private health insurers—to cover the full cost of the coronavirus diagnostic test and prevent them from passing those costs on to beneficiaries in the form of higher premiums.
The legislation, introduced by Reps. Diana DeGette (D-Colo.) and Donna Shalala (D-Fla.), would add the test to the Affordable Care Act's list of preventive health services that insurers must cover at no cost. The bill would exempt the test from a one-year waiting period that new preventive health services must undergo before insurers must cover them.
"We are on the cusp of a worldwide pandemic," DeGette said in a statement. "In order to effectively curb the spread of this virus here in the U.S., we must increase testing immediately. No patient should hesitate getting a test done if a doctor thinks it's necessary because of the cost."
For now, most testing is being conducted and covered by the Centers for Disease Control and Prevention. Costs will become a greater concern when more tests become available and private labs begin billing insurers.