Needed: A COVID backstop for uninsured

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

•••

The 27.5 million Americans lacking health insurance must not be left behind as the nation moves off war footing against COVID-19 and back toward normality as the pandemic's third year ends.

Emergency measures in place since early 2020 have made COVID tests, vaccines and therapeutics such as Paxlovid available at no cost to consumers, thanks to the federal government distributing these critical supplies. But on Jan. 30, the Biden administration announced that COVID-related emergency declarations will end on May 11.

That doesn't mean a hard stop in early May when it comes to no-cost COVID vaccines and treatment: There are existing government stockpiles. But it will mark the beginning of an important transition — shifting responsibility back to health insurers.

It's a process often referred to as "commercialization." It's important for those with a health plan and those without one to understand the implications.

For those with a health plan, the shift means that COVID prevention and medication will be covered similarly to vaccines and treatments for other conditions. What will that look like for Minnesotans who have coverage? The Minnesota Council of Health Plans (MCHP), the trade group for the state's health insurers, had this to say:

"Health plans are continuing to evaluate their approach to coverage and cost-sharing for COVID-related services, and there may be variation based on type of coverage (e.g., fully insured, self-insured or government-sponsored)," the organization said in a statement this week. But, "Cost sharing policies that are tied to the end of the [public health emergency] will revert to the standard policies applied to other acute illnesses."

For example, COVID vaccines will be covered under the Affordable Care Act's preventive services benefit, with no cost-share when obtained from a network provider, like any other vaccine, MCHP said. "COVID testing would be covered under lab benefit like any other illness and will resume traditional cost-sharing."

While this transition will undoubtedly have bumps, the critical challenge ahead is what to do about the millions of Americans who do not have health coverage. It's unrealistic to expect the uninsured to pay out-of-pocket for vaccinations, testing or treatment, given that cost is likely a key reason many don't have a plan in the first place.

Leaving so many without affordable COVID vaccines and treatments also undermines public health. COVID is still circulating and can throw what Minnesota infectious disease expert Mike Osterholm has often called "100-mile-an-hour curve balls." It's in everyone's best interest to ensure that such a sizable group of Americans — the 27.5 million uninsured — don't face hurdles to vaccination, detection and treatment.

The Biden administration is "zeroing in" on a plan to extend no-cost COVID services and treatment for the uninsured into 2024, according to a recent Politico story. The administration's communications staff did not provide further details when contacted by an editorial writer this week. But a staffer did provide a recently released fact sheet stating that "the administration is committed to ensuring that COVID-19 vaccines and treatments will be widely accessible to all who need them."

Extending no-cost COVID preventives and treatment through 2024 is the right approach. The priority should be making these services convenient for those without coverage. Community health centers, with a long tradition of serving vulnerable neighborhoods, should play a prominent role. Retail pharmacies should also be enlisted.

Details are needed sooner vs. later to help medical providers, insurers and states adjust and fill in gaps. For example, Minnesota health officials told an editorial writer that they have accessed remaining American Rescue Plan funds to supplement its Vaccine for Adults program. This will provide "a very limited supply" of COVID vaccine to community clinics and federally qualified health centers.

Congress also needs to do more to help the uninsured. The COVID wind-down's timing is appropriate three years into the pandemic, but care is needed to ensure that shots and treatments are accessible to all who need them.