National COVID-19 testing plan needs to address cost concerns, experts say

Public health experts welcomed Congress’ decision to allocate billions for COVID-19 testing, but cautioned that money alone won’t solve the challenges states and providers face in expanding access.

“We remain concerned that hospitals and small communities may be left behind,” said Blair Holladay, CEO of the American Society for Clinical Pathology. “The money is there, but we will need to work tirelessly to ensure that these resources are distributed adequately to the communities that need them.”

Lawmakers allocated $25 billion to expand the country’s capacity for COVID-19 testing as part of a broader $484 billion emergency relief package  President Donald Trump signed April 24.

Nearly half the funding—$11 billion—will go toward helping states, municipalities, tribes and employers purchase more coronavirus tests and scale up their capacity to analyze results, as well as identify people who may have come in contact with someone who has been infected.

More than $4 billion has been dedicated to bolster testing capacity in harder-hit areas; another $2 billion is set for state grants from the Public Health Emergency Preparedness program, which supports public health departments.

The biggest impact is likely to be a mandate giving the Trump administration 30 days to establish a national program detailing how it will boost production, training and availability of COVID-19 tests, as well as its plans to assist states and address testing disparities.

A national testing plan has long been supported by public health experts and Democratic lawmakers, but GOP legislators and the White House have pushed for states to take the lead.

The lack of a national strategy prompted several states and municipalities to develop their own testing programs with varying standards. Subsequently some states have formed regional alliances to procure needed resources and to share data and strategies for a more coordinated COVID-19 response.

Public health experts say a national plan would help establish a more unified set of metrics to measure progress in the effort to expand testing, and address many of the problems that have led to shortages, quality issues regarding test accuracy, and delays in results.

“A national testing strategy, if fully funded and developed in collaboration with states, will maximize public safety,” said Trish Riley, executive director for the National Academy for State Health Policy. “When states reopen their economies, they need enough testing and the ground troops to conduct contact tracing.”

Since early April, more than 100,000 coronavirus tests have been conducted daily in the U.S. for a total of more than 4.5 million since the start of the outbreak, according to the COVID Tracking Project, a volunteer organization launched in April by the Atlantic magazine.

Projections indicate an average daily capacity of 500,000 to 1.5 million tests will be necessary to begin reopening the country, said John Auerbach, CEO of Trust for America’s Health.

Any national program should establish a guidance committee that includes input from state and local officials as well as hospital leaders and representatives from laboratories to ensure the administration is getting insights from all relevant voices, Auerbach added.

Resources aside, Dr. James Cardon, chief clinical integration officer at the Hartford (Conn.) HealthCare system, said a national program must also address testing for those who have lost employer-based insurance as unemployment surges. The Families First Coronavirus Response Act, enacted in March, dealt with some concerns by letting state Medicaid plans cover COVID-19 testing with no out-of-pocket costs for the uninsured.

But COVID-19 treatment costs for the uninsured aren’t covered by the law, and the threat of large medical bills may deter many low-income and uninsured individuals from being tested.

“As we think about broad-based testing, how do we ensure that we don’t put up any financial barriers for folks to test and ensure we are being totally inclusive regardless of access to insurance or whether you’re a citizen or not,” Cardon said.