Photo: Yalonda M. James / The Chronicle
The normalizing of coronavirus is happening even as the crisis grips the nation. The change arrives in big and small ways, some of them loudly, some not.
Connecticut opens up restaurants to 75 percent capacity on Thursday. That’s a high-profile normalizer.
President Donald Trump exited the Walter Reed National Military Medical Center late Monday amid a bout with COVID-19 that he’s trying desperately to portray as routine even though he’s still very ill on high-level drugs.
Now this: Starting Dec. 1, the health providers that run the state’s free COVID testing program must ask anyone seeking a free test whether they have private insurance. And if the client has coverage, they’ll pay for the tests that way.
On one level, it’s just a small adjustment, netting the state maybe a few million dollars over the next several months — at a time when federal cash for coronavirus has dried up.
No one without coverage will be turned away. Still, it’s a big step that might not be worth the small amount it will save the taxpayers in a program that has accounted for 5.5 percent of all tests in the state.
Just by asking for insurance coverage, health providers change the relationship they have with patients.
The big question is, when word spreads through low-income and immigrant communities that the free testing sites are now asking for insurance, will some hesitate to come in for a test? Will some think, incorrectly, that a service currently unfettered by a single concern about payment will cost them money they do not have?
What about people who have insurance but don’t want to use it for a COVID test, fearing the information may come back to haunt them? What about disputes that inevitably arise over coverage, tying up days of the providers’ time?
“There are a lot of hairy issues that are being raised by the change of this policy,” said Arvind Shaw, CEO of Generations Family Health Center, which operates four locations in eastern Connecticut.
“It’s much more complicated than it seems,” Shaw said, echoing queries he and other providers had on a call with the state Department of Social Services Monday. “It’s not just asking a couple of questions in a different sequence. When it was free, we could just concentrate on testing.”
He was speaking in the past tense about a service that’s still completely free and will remain free to anyone who needs it after Dec. 1. It’s a safe bet many of the people receiving tests at the sites under contract with the state do not have private insurance; they have HUSKY Medicaid coverage or maybe nothing.
As of Sept. 7, the community testing program had spent $14.5 million on 82,066 tests, Gov. Ned Lamont’s office told me. The latest figure on tests in the purely free program is about 95,000 — out of 1,724,308. Sites are run by Yale New Haven Health, Hartford Healthcare and the network of private, nonprofit federally qualified health centers that largely serve low-income residents, such as Generations.
Lamont’s office recognizes the change isn’t trivial.
“The onus is on us to keep reassuring people that the tests are still free and confidential,” spokesman Max Reiss said. “We’re going to be crystal crystal clear, no one will ever be turned away for not having insurance.”
That needs to be a formal campaign, not just loose word of mouth. Lamont’s administration has done a good job with testing so far, making sure all insurers cover 100 percent of the cost without co-pays or deductibles; exceeding the national average numbers; and sending out word that the main target groups for testing are people with symptoms, people who have been exposed to someone with COVID-19 and people in densely populated places or congregate housing.
They ask those questions at testing sites, but they don’t turn people away who aren’t in one of those groups.
The average test costs about $120, and the average payment to the providers in the free community testing program has averaged $177, covering the lab work plus other costs.
It might have saved a ton of money if, say, half the tests in the state fell under this program. But the vast majority are already under private insurance at hospitals, pop-up centers, pharmacies and walk-in centers, for example. So the savings will be muted.
Which raises the question: Why risk mucking up a crucial public health program to save a minuscule fraction of the state budget? Even if clients use insurance, the state will have to pay the providers something for their trouble.
Well, it is taxpayer dollars, so there’s that. And in the bigger picture, it’s part of the creeping normalization of COVID-19 as just another disease.
The health insurers, for their part, aren’t objecting to this cost shift. “The carriers are following the emerging science and guidance closely and will be updating and revising their policies accordingly,” said Susan Halpin, executive director of the Connecticut Association of Health Plans, a lobbying group.
In those words, and in the state’s actions, and in Trump’s claim that COVID-19 is under control, we see the seeds of this normalization. Some of it is spot on, some too early.
I don’t know whether it’s too soon to ask clients at a free testing clinic if they have insurance. But it’s not a small change at a time when any untested case of this illness can still kill multiple people.