As the pandemic worsens around the country, the Trump administration has moved to place limits on who insurers are required to cover COVID-19 tests for.
The Trump administration made the move in a little-noticed guidance sheet released June 23 by the Centers for Medicare and Medicaid Services.
CMS said that insurers no longer have to cover COVID-19 testing when employers mandate a test before an employee can return to work, or when someone is tested as part of a public health surveillance program.
The move comes as the Trump administration has failed to put the weight of the federal government behind scaling up widespread COVID-19 testing, handing that task to state and local governments with minimal contributions from the feds.
Public health and insurance experts described CMS’ move to TPM as indicative of a bungled federal response to the pandemic — and, specifically, to providing testing capacity — leaving CMS to sort out questions of health insurance policy that are ill-suited to the public health needs of a national pandemic.
“The virus doesn’t care if you have insurance or not,” Dr. Dena Grayson, a doctor and researcher who worked on Ebola treatments, told TPM. “It still infects you.”
Through two laws, Congress mandated at the start of the outbreak that health insurers would fully cover COVID-19 tests — with no copays.
But the mandate came with no additional government support attached, requiring insurance companies to foot the bill for at least part of the national testing plan.
Experts in responding to pandemics argue that testing should be free, to encourage widespread usage. But neither Congress nor the Trump administration has made efforts towards answering the question of who should ultimately pay for such a program — what Grayson described as “the first step” in handling a pandemic.
Instead, the cost was shifted to insurers, with CMS issuing guidance that could be construed as limiting testing to a degree far narrower than Congress had in mind, according to Christen Linke Young, a fellow at the USC-Brookings Schaeffer Initiative for Health Policy.
“The statue says insurance companies have to pay, period — you can debate whether you think its good policy, but that’s the statute,” she added.
CMS first issued guidance in April that limited insurance coverage of testing to tests that are “medically necessary” without further defining that term, and then issued updated guidance last week which walled off tests ordered by employers or pandemic surveillance tests from insurance coverage.
“What the latest federal clarification is saying is that if you’re sick and you’ve got symptoms of COVID and you go to the doctor your plans are supposed to cover that and waive cost sharing,” Sabrina Corlette, director of Georgetown University’s Center on Health Insurance Reforms, told TPM.
“But if you have to get a test to go back to work, or are subject to community-wide testing, or you don’t have any symptoms — you want to get a test because maybe you want your kid to get a test to go to summer camp or you’re traveling and you want to get a test before you go — insurance companies would not be required to cover in those circumstances,” she said.
It remains unclear on the employer side who would end up footing the bill for tests that companies require of their employees before returning to work.
“Some employers are paying for this, but under the federal guidance released last week, the health plan is not obligated to pay for it,” Corlette told TPM.
Now, once federal and state-sponsored free testing initiatives begin to recede, Linke Young said, “people are no longer going to have that certainty.”
After publication, CMS issued a statement to TPM reiterating that insurers do not have to cover testing for surveillance or or employment.
“While a fundamental part of the United States COVID-19 surveillance plan, broader surveillance testing is a public health responsibility that should be done in coordination with federal and state public health officials,” the agency said.