University of Pennsylvania Law School professor, Allison Hoffman, writes in The Hill about Congress’ failure yet to help Americans with out-of-control medical bills related to the coronavirus pandemic. To date, Congress has not stepped in to help most Americans with the cost of COVID-19 care. As medical debt soars, what will Congress do?
The relief legislation that Congress has passed addresses only a small sliver of the costs of COVID-19 medical care, primarily to remove financial barriers to testing. But, Congress has done nothing as of yet to help people with or without insurance who face huge medical bills if they need treatment for COVID-19. The cost of care could be more than $70,000. Few Americans can afford this cost; if they get treatment, they face huge medical debt.
Hoffman explains that people with Medicare have the best coverage. Still, people with traditional Medicare who do not have supplemental insurance and many people in Medicare Advantage plans can face high out-of-pocket costs. The risk of medical debt for a large number of Americans stems from four root causes with our health care financing system.
- Cost-sharing. Americans pay more out-of-pocket for care than people in virtually all other wealthy nations. Indeed, for people with employer coverage, deductibles can easily be $1,000 for an individual and $5,000 for a family. For people without employer coverage, who buy health insurance through a state health insurance exchange, deductibles alone can be around $4,000 for individuals and double that for families. And ACA plans have out-of-pocket caps at $8,150 for individuals and $16,300 for families. On top of costs for in-network care, people are often liable for costs for out-of-network care.
- Health care costs. Health care costs in the US tend to be about twice as much as the costs in other wealthy nations. So, cost-sharing tends to be higher here than elsewhere. The best coverage is through traditional Medicare with supplemental insurance, which requires little or no out-of-pocket costs. Medicare Advantage plans can charge you up to $6,700 for in-network care alone.
- Out-of-network costs. These costs can be many times more than in-network costs. Inexcusably, people using in-network hospitals are often faced with out-of-network provider charges, often called “surprise medical bills.” Nearly one in five (18 percent) people who were admitted to a hospital for pneumonia complications received surprise bills.
- Uninsurance. There are now easily 35 million uninsured Americans, between the 28 million or so people without insurance pre-novel coronavirus pandemic and the 10 million people who have lost their jobs since.
To address these issues, Hoffman proposes ending all coronavirus-related cost-sharing for people with insurance, expanding Medicaid, providing financial help to people who are uninsured, with the option of going on COBRA, opening up the state exchanges, and expanding people’s right to buy Medigap coverage to fill gaps in Medicare.
Hoffman says there’s no quick fix to the four issues she raises. But, there is a quick fix when it comes to the medical bills people face related to COVID-19. Congress should have the federal government cover all COVID-19 related care. And, it should pay for it directly through traditional Medicare with separate federal funds.
Congress can make a small tweak to the Medicare law so that any Medicare provider in the US must accept Medicare payments for COVID-19 care. This solution takes the insurers off the hook for paying for this care and should keep their premiums from going up as much in 2021. And, it ensures that doctors and hospitals will be paid for the care they deliver. Most important, it ensures cost will not be a barrier to COVID-19 care for anyone in this country.
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