Calling COVID Cure Cash Co-Pays

For some, Medicaid picks up the tab. For others, insurance, whether under private policies, Medicare or under incentive exchanges created under the Affordable Care Act (ACA) is the carrier. Co-pays and deductibles are all over the map. And having insurance doesn’t always mean full coverage. Even those with insurance can be forced to deal with co-pays and deductibles that can reach ruinous proportions. Being insured is not an automatic insulator from medical bankruptcy. Two patients, with identically severe COVID infections, identical physical descriptors and conditions and precisely the same treatment can produce wildly divergent net economic billing realities based on the nature of their coverage… assuming that they qualify for some coverage somewhere. Lacking universal healthcare in the US, where everyone is fully covered, each case must be analyzed separately. Administrative costs are thus killers too, because hospitals bill based upon a separately negotiated rates with each insurance carrier. Very different rates for the same services and treatments.

Some hospitals are savvy enough not to beat a dead horse, often waiving the co-pays and deductibles when they rise to what are clearly unmanageable levels for the relevant patients. Some hospitals don’t. Writing for the February 8th Los Angeles Times, Maria L. La Ganga drills down on what seems to be an egregious example of high billing cost but is in fact pretty ordinary these days. She starts, not with an upscale chichi Westside Los Angeles hospital… her story takes place in the working class/agricultural town of Vacaville, California at NorthBay VacaValley Hospital: “It was bad enough that Patricia Mason’s husband rushed her to the emergency room on his birthday and didn’t see her again for nearly a month.

“That she was transferred in the middle of the night to a different hospital, one that could better care for her deteriorating condition, and that her husband had no idea where she was or even how to find her… That her doctor called him two days later to break the news. His wife, the physician said, had less than a 30% chance of surviving COVID-19… Then the medical bills began to arrive. The grand total to save the 51-year-old woman’s life: $1,339,181.94… What the Vacaville couple — with five jobs and nine mostly grown children between them — are actually on the hook for: $42,184.20… The odds that they will pay it off? Zero.

“The most serious cases of COVID-19 don’t just attack a patient’s body, leading to pneumonia, respiratory failure, septic shock, blood clots, brain fog and more than 460,000 deaths in the U.S. to date. They can also damage a virus victim’s bank account… Because, while it is difficult to know who will die from the virus and who will escape with just a runny nose, it is just as hard for patients and the hospitals that care for them to figure out their COVID-19 hit, what is covered and who will actually pay for it.

“‘The deck is absolutely stacked against the consumer and the patient,’ said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University… ‘The first issue is you’ve got COVID and you’re not feeling so great,’ Corlette added. ‘Going to battle with the doctors and hospitals or health plan, there’s a huge power imbalance to begin with, let alone when you’re struggling with health issues…. Getting answers about why certain things are on the bill is almost impossible.’

“Many insurance companies have waived all out-of-pocket costs for coronavirus treatment, for some patients slashing a million- dollar-plus bill to nothing. But those waivers are entirely voluntary, and many have already expired. Medical bills for uninsured COVID-19 patients are covered by the federal government, but the rules are complex, and hospitals must apply for the money.

“During the Obama administration, the federal government capped the amount most insurance plans can require patients to pay. But not all plans have so-called out-of-pocket maximums. And even if they do, the annual limit for a family was $16,300 in 2020, the pandemic’s first painful year. This year, it rose to $17,100, although insurance companies can adopt a lower limit.” 

What’s worse, the mere thought of intrusive treatments with unknown costs holds back many from seeking treatment until symptoms get so out of control that they cannot be reversed. In minority communities, where mistrust of traditional hospitals runs deep and where tales of massive patient fatalities are viewed as a probable outcome, you have these realities in South Central Los Angeles:

“Eight out of ten of those who died at [Martin Luther King, Jr.] hospital were Hispanic, a group with the highest Covid-19 death rates in Los Angeles County, followed by Black residents. County data also showed that the most impoverished Los Angeles residents, many of them around the hospital in South Los Angeles, are dying of the disease at four times the rate of the wealthiest.

“Michelle Goldson, an I.C.U. nurse who cared for [two male Latino patients over 50], said many patients had a ‘distrust of the health care system, distrust of doctors’ and came in only when desperately ill. Severe cases, she said, weren’t limited to older people. ‘Everybody’s dying here,’ she said. As she headed home one recent evening, she waved at a 27-year-old patient who was sitting up eating dinner. When she returned the next morning, he was dead. ‘What kind of virus is this?’ she asked.” Sherry Fink, writing for the February 8th New York Times.

And for those with coverage, as I said, a small percentage of a huge number can in itself be a ruinous figure. “But while most health plans are required to follow the federal government’s out-of-pocket maximums, the pipe trades’ plan [plumbers and pipefitters union] is ‘grandfathered’ in and does not have to offer all of the same protections. Mason’s insurance does not have an out-of-pocket limit.

“Many insurance companies announced early in the pandemic that they would waive all out-of-pocket costs for their members’ COVID-19 treatment… The Blue Cross Blue Shield Assn., a network of 36 carriers, plans to waive treatment costs for its members through May. Blue Shield of California will waive such co-pays through February… Cigna’s waivers are scheduled to end Feb. 15, according to America’s Health Insurance Plans, an industry trade group also known as AHIP.

“Most waivers do not include self-funded plans, such as Mason’s, which are also known as employer-funded plans. The Kaiser Family Foundation estimates that 61% of Americans who get their insurance through their jobs are covered by these kinds of self-funded plans.

“And of the nearly 150 medical insurers listed on the AHIP website, 46% either never waived treatment costs or the waivers have already ended as of Wednesday — even though the pandemic shows no sign of abating any time soon.” LA Times. 

In the end, all of this argues for a national, uniform and universal healthcare plans, not a simply extension of the existing ACA structure. There are some serious “Cadillac” plans out there, due to aggressive collective bargaining agreements or very upscale and generous corporations – and those beneficiaries may want to keep those plans. Otherwise, for the most part, healthcare coverage in the United States is a product of the location (New York and California plans cost more than those in North Dakota for obvious reasons, but there is a larger market size).  Every developed nation in the world has universal healthcare – except the United States. For example, Germany has a uniform plan, based on a percentage of wages and salaries, that covers medical, dental, vision, hearing and prescriptions with minimal co-pays and deductible, all administered by different private insurance carriers. Why can’t the United States, where per capita medical costs are double the average for the rest of the developed world, just get it done?!

I’m Peter Dekom, and when the big questions are asked, as our economy is in shambles, is the question whether we can afford universal healthcare… or whether we can afford not to?