Natalia Jarramillo spent several days trying to get a free COVID-19 test. She wasn't feeling well. She was achy, but didn't have a temperature. She was feeling under the weather, but couldn't go to a state-run COVID testing facility because of the weather.
The state shutdown its testing facilities in advance of Hurricane Isaias. Jarramillo's doctor wanted her tested so she wound up visiting a hospital emergency room. The test was free. The visit was not.
Now she's in quarantine and facing a $250 bill for the emergency room visit.
WLRN Connects spoke with people and experts about paying for healthcare during COVID-19.
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We've seen how vulnerable South Florida is to the virus with high infection rates and thousands of deaths. We're also in a tough spot because of the high cost of healthcare and how many people don't have health insurance — or lost it if they lost their job due to pandemic-related layoffs.
“I'm feeling a little bit better, but still hanging in there with some symptoms," said Jaramillo, who's recovering at home from COVID-19. "Very mild, thankfully, nothing that I can't manage at home, but still, it's draining. It's tiring.”
Two days after her first symptoms, that at first felt like a cold, she started feeling dizzy.
"I felt chills and pain in my body. I didn't even have the energy to be standing up," Jaramillo said. "And that's when we thought, 'OK, this is not just a regular cold.' We called the doctor last Saturday and he suggested that I should get tested.”
In late July, as Hurricane Isaias made its way toward Florida, the state shut down state-funded testing sites so she couldn't get tested over the weekend at Marlins Park, the Miami Beach Convention Center or Hard Rock Stadium.
Instead, Jaramillo called Memorial Hospital in Hollywood and went to get tested. That meant having to pay for the emergency room visit. Her insurance told her the money went toward her annual deductible.
She waited about 48 hours to receive her positive result.
“They let you know that the test is free, but you would still have to pay for the ER visit if your insurance doesn't cover it,” Jaramillo said. “That’s what stopped me from getting tested right away, and I had to wait a couple of days to see if I could find an alternative site on Monday. I couldn't find alternatives. Still, even if the testing sites were open, they didn't have appointments until like several days later, so that was the only option I had.”
Elizabeth Rosenthal, a doctor and journalist, is the editor in chief of Kaiser Health News and the author of “An American Sickness How Health Care Became Big Business and How You Can Take It Back.” She and her colleagues have been looking into medical bills through a Kaiser Health News and NPR partnership called the Bill of the Month series. It's a crowdsourcing project in which people share their medical bills with journalists. She said Jaramillo’s situation is common.
“We've been hearing about it a lot. And I'm sorry to say $250 out of pocket…she got off pretty easy compared to some of the patients we've heard from."
The federal government and insurers have made promises that COVID testing and treatment will be free.
“A COVID test is putting the stick up your nose or getting a throat swab, but that comes with all sorts of stuff. You don't do it at home, so you go into the ER, you get an ER fee," Rosenthal said. "The insurer will say, ‘Well, you know, the test is free, but everything else isn’t.’"
Sometimes a patient does pay for the cost of the test if insurance covers it, but the insurer is being charged by the lab and that can drive up health insurance premiums.
If one has a COVID diagnosis and receives COVID treatment, clearly covered in theory, one should not have to pay copays or deductibles for that.
“This is where I encourage patients to fight bills," Rosenthal said. "If you were in the hospital for three days for COVID treatment and they say, ‘Well, your coinsurance is $2,000.' You should say, 'No. The insurers and the federal government have told me that I don't have to pay the out-of-pocket costs for COVID treatment.' I encourage everyone to fight that fight."
Blanca Mesa, with the Florida Health Justice Project, points out that Florida is now one of 12 states that has not expanded Medicaid, “designed and created to be the nation's first responder," according to her. "When you lose your job, when you're in a difficult situation, when there's a health pandemic and you have no health insurance, Medicaid will step in if you qualify and give that health care that you need,” Mesa said.
“Before the pandemic, there were about 800,000 working poor Floridians who would qualify for Medicaid if Florida had expanded it,” she said. “The problem is Florida has Medicaid, but like the other 12 states (that haven't expanded the program), (Florida) has very strict requirements of who can qualify.
“When I talk to people now that need to go to a doctor, they think they're sick. They have COVID symptoms,” Mesa continued, “they’re afraid to go anywhere because they have no money for co-pays. They have no money, definitely, for hospital costs." She said one option for those patients is a federally qualified health clinic. Those clinics receive federal funds and that is to treat people who are uninsured.
And then there are the unknown long-term costs of having COVID.
“People are being left with debilitating conditions — lung damage, kidney damage, heart disease that they didn't have before because this is not just a flu,” Mesa said. “It's not just limited to your respiratory system. So what are the uninsured going to do? It's not just going to be about getting through this, but if they need physical therapy, they need respiratory therapy, they need ongoing medications."
Mesa pointed out many of those vulnerable to the virus are those who have limited access to economic safety nets.
“These are often workers who don't have sick pay, they're not going to be able to afford to take off time from work,” she said. “So they go to work even when they have symptoms and they can't get tested. The problems just kind of spiral.”
A person who had health insurance through their job but no longer has it after losing a job, they likely qualify to buy a plan on the federal ACA marketplace. But Floridians who have been uninsured since before the pandemic, they can’t buy health insurance on the federal marketplace at healthcare.gov until the next enrollment period begins in the fall.
President Donald Trump’s administration decided not to reopen the marketplace for a special open enrollment period during the pandemic. Other states that have their own marketplaces did reopen their exchanges for people who want to get insured at this time.
“Open enrollment starts Nov. 1,” said Louisa McQueeny, program director at Florida Voices for Health. “For Medicaid to get expanded, we need to get the Legislature to expand Medicaid. That's the simplest answer.”
Meanwhile, the federal government did set up a relief fund to reimburse providers for heath care they provide to uninsured COVID-19 patients. The federal CARES (Coronavirus Aid, Relief and Economic Security) Act set aside $175 billion to cover COVID-related medical bills, even for the uninsured. Providers need to file a claim and get reimbursed. And it means sometimes people shouldn’t get charged for care that was already paid for by federal dollars.
“You would think that that would make it easier to contest the charges, but in fact, when we at Kaiser Health News looked at where that money went, it often went to the hospitals that previously had the highest Medicare billing,” Rosenthal said. “It often didn't go to the hospitals where people who are uninsured or low income are most likely to go. It went to the wealthiest hospitals. It just shows how botched the response has been generally."
So what is the long-term effect of COVID on the cost of health care?
“A lot of hospitals are saying, ‘We're losing money because of COVID, because they've had to cancel all the elective procedures,' which are their cash cows,” Rosenthal said. “I'm worried they did get a lot of money through the CARES Act to make up for that. We're worried that we're going to see a great spurt of surprise bills and high bills as offices and hospitals try and recoup some of the money they say they've lost during COVID.”
Like a hurricane event threatening South Florida can have an effect on the next several years on home insurance costs, COVID may do the same on health insurance.
“I worry that it will,” Rosenthal said. “We see that all of the worries about surprise billing have kind of been put to the side for COVID because people say, ‘No, we can't worry about that. Now we have this crisis.'”
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“We've had a crisis of medical billing before COVID,” Rosenthal added. “I worry that many of the problems that were so pressing then have been put to the side for COVID. Then they're going to come back even worse once we're through this period.”