Treating the nation's uninsured for COVID-19 could cost hospitals as much as $42 billion, according to estimates from the Kaiser Family Foundation.
But with job losses mounting by the day, that figure could soar, further crowding out federal relief funds that hospitals say they need for other purposes, such as extra staffing, personal protective equipment, or making up for lost revenue from the pandemic.
The not-for-profit Kaiser Family Foundation on Tuesday estimated that between 670,000 and 2 million uninsured people in the U.S. could eventually be hospitalized for COVID-19, which is the respiratory illness caused by the novel coronavirus. So far, COVID-19 has killed more than 12,000 people in the U.S. and 80,000 people worldwide.
Reimbursing hospitals for those hospitalizations at Medicare rates could cost anywhere from $13.9 billion to $41.8 billion, depending on how many uninsured are infected and require hospitalization. The foundation noted the estimates are highly uncertain and calculated based on the number of uninsured people in 2018, which totaled 27.9 million.
That figure may be rising: In the last two weeks of March, 10 million people applied for unemployment benefits, according to the U.S. Labor Department. Consulting firm Health Management Associates estimated that up to 40 million people could be uninsured if job losses are severe.
The Trump administration has said the $100 billion emergency fund created by the Coronavirus Aid, Relief, and Economic Security Act, or CARES, could be tapped to reimburse hospitals for treating uninsured COVID-19 patients. HHS Secretary Alex Azar said hospitals receiving relief funds would be prohibited from balance-billing patients for treatment.
The cost of treating the uninsured could consume as much as 40% of that fund, according to the Kaiser Family Foundation analysis. Plus, the analysis noted, those funds wouldn't protect uninsured people who seek care for suspected COVID-19 and turn out to have another illness.
Hospital lobbies, including the American Hospital Association and the Federation of American Hospitals, oppose using the $100 billion relief fund to pay for the uninsured. Instead, they and the insurance industry trade organizations have pushed for the federal government to implement a national "special enrollment period" so that the uninsured could enroll in private coverage, which typically pay providers higher rates than Medicare.
To date, 11 states and the District of Columbia, which all operate their own public insurance exchanges, have responded to the COVID-19 pandemic by launching special enrollment periods in which anyone uninsured and eligible can enroll in coverage. The Trump administration has reportedly refused to create a national special sign-up period, despite initially appearing open to the idea.
That's a big mistake, according to Ceci Connolly, CEO of the Alliance of Community Health Plans, which represents not-for-profit insurers.
"There is an immediate public health risk that is exacerbated by these individuals not having coverage and probably worrying about cost right now," Connolly said, adding that people without insurance are less likely to contact a physician or get a COVID-19 diagnostic test than those with coverage.
While people who lose their health coverage qualify for special enrollment period under the Affordable Care Act, paperwork and other hurdles may delay enrollment in a plan. The federal government has the latitude to streamline a national enrollment period in which those hurdles are waived, Connolly said.
"Why the administration now is refusing to use a lever that's very easily available—it's established, there's an infrastructure, there's an agency that knows how to do this, there's an existing website, there are forms, health plans know how to process individuals who sign up on the exchanges—it's a complete mystery," she said.