The rapidly changing situation regarding the Coronavirus (COVID-19) has spurred Congress to move quickly in its response. The Families First Coronavirus Response Act, HR 6201, was passed by both the House and Senate and now awaits President Donald J. Trump’s signature as of the afternoon of March 18, 2020. Congress will likely pass additional legislation, and the White House is also devising a Coronavirus stimulus package plan.
The Office of Communications recently spoke to University of Pennsylvania Carey Law School Professor Allison Hoffman, health care law and policy expert, about HR 6201 and what it means in practical terms.
Office of Communications: Can you discuss what the Families First Coronavirus Response Act addresses in terms of health and health care?
Professor Hoffman: In terms of health, there are two main threads of efforts. The first thread focuses on food security. The second thread focuses on funding for COVID-19 testing. Notably, there is nothing with regard to payment for medical care that might be necessary if someone tests positive for COVID-19.
On food security, HR 6201 includes provisions such as a $500M increase in the WIC (The Special Supplemental Nutrition Program for Women, Infants, and Children) program funding and $400M in emergency funding for state food banks. It also includes flexibility in the SNAP (Supplemental Nutrition Assistance Program), such as freezing eligibility requirements based on work or work training requirements. There is also an additional $250M for the Senior Nutrition program, to help provide home delivery of meals to low-income seniors.
On testing, HR 6201 provides comprehensively for free COVID-19 testing. The bill requires private health plans to provide coverage for diagnostic testing, including the cost of a visit in any setting (including urgent care, emergency room, or telemedicine) to facilitate that diagnosis. It does the same for people in Medicare, Medicaid, and other public health programs (TRICARE, Veterans Health Administration, Indian Health Service). It also, remarkably, provides for $1 billion to the National Disaster Medical System to reimburse COVID-19 diagnostic testing and services to people who are uninsured.
The bill also temporarily increases the FMAP for Medicaid. The FMAP is the proportion of total Medicaid costs that the federal government pays; the states pay the rest. It’s typical to increase the FMAP in economic downturns. This increase is contingent on states not tightening eligibility standards for the program (maintaining eligibility standards in place as of January 2020).
Office of Communications: What are some of your concerns regarding the bill as it is?
Professor Hoffman: The problem and remaining gap is what happens after someone is tested. As it stands now, the medical care that someone gets to treat COVID-19 after a positive test will be reimbursed under their current health insurance plan rules. The care could cost upwards of tens of thousands of dollars and individuals could be left paying a considerable share — or for the uninsured, all — of that cost.
Even among people who are insured, Americans pay higher rates of cost-sharing than people in almost any other developed country. That means, for example, that if you have a health plan where you have a $2000 deductible, you would have to pay for the first $2000 in medical care before the health plan starts to pay for medical care. Likewise if you have a 10% copayment after that deductible, you would pay for 10% of any additional care up to the annual limit of the plan.
If you end up getting care in a facility or by a doctor who is out of network for your plan, or if you are transported by an out-of-network ambulance to a hospital, you could be stuck with a large surprise bill. This happens more often than one might think and the magnitude of an out-of-network bill for COVID-19 care could be staggering. Some states have started to pass laws prohibiting it, since Congress has failed to do so. And it’s possible that Congress would pass something on out-of-network medical bills with respect to COVID-19 medical care in particular, even without broader protections against the costs of COVID-19 care.
Even more, 10 percent of the population under age 65 in this country still lacks health insurance and could face unmanageable bills for needed medical care. The United States is the only developed country with such high rates of uninsurance, and it will make treating COVID-19 especially difficult here, or it will leave Americans, who are going to lose jobs and job-related health insurance in the face of this crisis, increasingly financially insecure.
Office of Communications: Do you have any additional concerns about the legislation?
Professor Hoffman: A question that is not specifically health care related is what Congress will do on paid sick leave for people who are sick themselves or who must leave work to care for others, either others who are sick or children who are now at home due to school closures.
These provisions have been in limbo, especially regarding which categories of caregiving would count for longer periods of paid leave. The first house bill was more comprehensive — although it still left many workers out through exemptions for large employers — and a “technical amendment” scaled back the scope, so paid leave remains a big question mark on an issue critical to many families’ well-being.