House Democrats press Trump administration on coronavirus testing affordability

A trio of House Democrats is pressing the Trump administration on the affordability of coronavirus diagnostic tests.

Reps. Rosa DeLauro (D-Conn.), Katie Porter (D-Calif.) and Lauren Underwood (D-Ill.) sent a letter Friday to the top officials at the IRS, Department of Health and Human Services and Department of Labor, asking how the agencies can make sure private insurance companies cover tests without any cost-sharing. 

“It is critical that any cost barriers or limits to COVID-19 diagnostics testing be removed, so those who may be infected do not forgo testing because of cost concerns,” the lawmakers wrote.

According to the lawmakers, the director of the Centers for Disease Control and Prevention has the authority to authorize payment for the care and treatment of patients subject to “medical examination, quarantine, isolation, and conditional release.” 

However, the Democrats said the statute fails to address payments that a patient may face if they were to go to their primary care provider, urgent care or a health clinic if they have symptoms of COVID-19.

The statute also fails to clarify whether or not diagnostic testing should be exempt from cost-sharing requirements. 

As the virus spreads across the U.S. and the federal government attempts to ramp up testing capacity, some states and health insurers are taking matters into their own hands. 

Governors in New York, Washington and California issued guidance this week prohibiting health insurers from imposing cost-sharing on individuals seeking coronavirus tests.

Insurers Cigna and Aetna and some Blue Cross plans said they will be waiving all co-pays for beneficiaries in Medicare, Medicaid and private plans who need a diagnostic test. However, the insurers did not pledge to do the same for out-of-network costs that could be incurred if a patient were to get tested at an independent lab. 

Patients who are tested for the coronavirus might also face additional costs related to visiting the doctor, emergency room or urgent care. If they test positive and require hospitalization, they would face charges for that, too. 

The insurers did not specify what would happen in those circumstances. Under Aetna’s new policy, members who are diagnosed with COVID-19 “will receive a care package containing CVS over-the-counter medications to help relieve symptoms.”

States and insurance companies are also limited in what they can require of self-funded plans typically offered by large employers. 

While the insurance companies said they hope and expect self-insured plans follow suit, there’s no guarantee that will happen, putting more than 100 million people in limbo.

Self-insured plans are regulated through ERISA, the Employee Retirement Income Security Act, which falls under the Department of Labor. Under ERISA, employers that self-insure aren’t considered insurers.