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Context

Profit-driven healthcare is incompatible with a robust public health response to the novel coronavirus. Containment and mitigation are only possible through widely available testing for those potentially exposed and treatment for those diagnosed, but costs imposed on patients in pursuit of profit routinely discourage millions from seeking needed care.

In February, the Miami Herald reported that a man who sought testing for the novel coronavirus at his local hospital was billed more than $3,000, even though tests revealed he had the common flu. Although he was insured, high cost-sharing meant he still owed at least $1,400, and only if he provided his insurer with extensive documentation of his medical history to prove it wasn’t related to a pre-existing condition.

Also in February, the New York Times reported that a man who’d been working in China and returned to the United States was required to undergo testing and a two-week quarantine along with his daughter, with whom he was traveling. Neither was found to be infected. After they were released, he was billed nearly $4,000, even though the testing and quarantine were mandated by the government. Although he was insured through his employer in China, his plan didn’t cover treatment in the United States.

This month, the Times has continued to report that both uninsured and underinsured Americans are delaying testing and treatment due to prohibitive costs, dramatically heightening the difficulty of containment and mitigation efforts. Because people often lack coverage due to working in low-wage, hourly jobs that offer no health benefits, they are also less likely to be able to undertake social distancing measures for fear of losing wages or employment, further exacerbating the outbreak.

By contrast, countries with generous public healthcare systems and welfare states credit them as key factors in successful response to the novel coronavirus. Taiwan’s system covers all testing and treatment for free, in addition to food and lodging for those subject to mandatory quarantine; the country has the lowest per capita incidence rate of any affected country. Economists expect public health benefits in Europe to help insulate consumer spending from shocks related to medical bills that are expected to occur in the United States, and labor protections that allow workers to self-quarantine while enjoying full pay and job security to aid containment and mitigation.

Lessons for New York

Because the current right-wing government in Washington is unwilling to undertake appropriate public health measures to halt the spread of the outbreak, our state government must fill in the gaps to protect us here in New York. We urge Governor Andrew Cuomo to take the following steps immediately:

Direct the Department of Financial Services to promulgate emergency regulations prohibiting cost-sharing on an in-network provider office visit, urgent care center visit, or emergency room visit when the purpose of the visit is to be tested or treated for COVID-19, so that care is free at point-of-service. Earlier this month, Governor Cuomo directed DFS to require New York insurers to waive cost-sharing for testing related to the novel coronavirus. But as the experience of the United States has demonstrated, potential treatment costs are discouraging people from getting tested in the first place.

During President Trump’s March 11th address to the nation, he said that insurers nationwide had agreed to waive cost-sharing for treatment as well, but the industry immediately clarified that his remark was once of several inaccuracies he conveyed that night, and that insurers planned to continue profiting off of what has become a global pandemic.

This is an opportunity for New York to become a national leader in the fight against the novel coronavirus by turning President Trump’s bluster into a reality in our state. Making treatment free will strengthen containment and mitigation efforts, ease undue financial burdens on vulnerable New Yorkers, and generate political will for similar action in other states and at the federal level.

Open a special enrollment period for uninsured New Yorkers to obtain a qualified health plan on the state’s exchange, and increase subsidies to ensure universal access. Not only does Cuomo’s directive provide minimal financial relief for cost-burdened patients, it does nothing for the uninsured. The open enrollment period for New York’s exchange closed on January 31st, 2020, meaning that most uninsured residents will be unable to obtain insurance through it for most of the year.

New York should follow the example of Washington and Massachusetts, which have announced special enrollment periods for any uninsured resident who needs to obtain insurance now. Because many residents are not able to afford plans available on state exchanges even with federal subsidies, we must also allocate whatever state funds are necessary to make subsidies sufficiently generous to ensure 100% coverage in New York state - up to and including the full cost of premiums.

Establish a state-funded Essential Plan for all New Yorkers regardless of immigration status, with the same coverage mandates and subsidy options as other qualified health plans. Undocumented immigrants are not eligible for Medicare or Medicaid and cannot purchase plans on state exchanges due to federal regulations. But the novel coronavirus does not discriminate on the basis of legal status, and neither should our healthcare system.

Conclusions

The truth is that all the same incentives that are impeding a proper response to the novel coronavirus also undermine public health outcomes in every other arena. Insurance companies and pharmaceutical manufacturers seek maximum profits, imposing prohibitive costs on patients, who in turn delay preventative care and early detection, leading to more serious health problems that require more dramatic interventions later. That is, if they don’t lead to death.

To the extent the state bears these burdens in the form of uncompensated emergency room treatments and welfare programs, they drain valuable resources that could be better spent elsewhere. But mostly, costs are borne by patients who, if they survive, stack up unpayable medical bills that lead to bankruptcy and ruined lives. Aside from the incalculable human suffering generated by such a system, it also produces economic dysfunction, as medical debt burdens lock patients out from other areas of the economy.

While we must pursue aggressive harm reduction measures in the context of our current, for-profit system, we must also work quickly to move toward a single-payer program that provides care free at point-of-service for all New Yorkers. The costs - both financial and moral - are too great to do otherwise.