Some insurers worry that the Biden administration could put them on the hook for more COVID-19 testing costs.
The Trump administration issued guidance stating that insurers' responsibility to pay for COVID-19 tests is limited to tests that are medically necessary, despite Democratic lawmakers' insistence that they intended to institute a broader requirement. However, that interpretation could change under a Democratic administration.
The Families First Coronavirus Response Act requires insurers to cover COVID-19 tests without patient cost-sharing, but the guidance, issued June 23, says that the law only applies to tests that are deemed "medically appropriate" by a healthcare provider.
Insurers are arguing for Congress and the administration to designate more federal funding for public surveillance testing. Health plans' financial performance has varied over the past year, but some large, for-profit plans have fared well under reduced volumes.
The Alliance for Community Health Plans Director of Public Policy Michael Bagel said the group of not-for-profit health plans supports the Trump administration's guidance. ACHP also wants Congress to provide more funds for public surveillance testing and codify which tests insurers should paid for.
"We strongly advise the Biden administration not to upend the apple cart," Bagel said.
All consumers should have access to affordable tests, Bagel said, but responsibility for testing shouldn't only be pinned on one group or another.
David Allen, a spokesperson for America's Health Insurance Plans said that the group is committed to ensuring access for all medically necessary COVID-19 tests.
The American Clinical Lab Association asked to delineate who is responsible for paying for which tests.
"It's critically important that federal policymakers clarify coverage requirements for private insurance and take concrete steps to ensure any COVID-19 tests that fall outside of those coverage requirements can be supported through a federal testing fund," ACLA President Julie Khani said.
Long-term care facilities represented by the American Health Care Association/National Center for Assisted Living said they support measures that prevent an "unfunded mandate" for COVID-19 testing.
Cheryl Fish-Parcham, director of access initiatives at Families USA, said the group believes insurers have money that they didn't spend on care, but that the most important thing is that consumers don't pay for tests.
"People shouldn't have to spend a lot of time figuring out how to get a free test. It should be seamless and easy for consumers," Fish-Parcham said.
Congress could provide more funds for COVID-19 testing in year-end legislation including spending bills and potentially pandemic relief funding. Government funding expires on Dec. 18.
