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Higgins critical of Trump administration's guidance limiting COVID testing coverage & decision by WNY insurance companies to follow suit


Tue, Aug 25th 2020 03:05 pm

Congressman says limiting access to testing is short-sighted, belies congressional intent & leads to greater costs and public health risks in long-term

Congressman Brian Higgins, D-NY-26, is objecting to a decision by insurance companies to stop covering the costs of some COVID-19 testing – and what he called the administration’s loophole that allows companies to do it.

Higgins, who serves on the House Ways and Means Subcommittee on Health, is calling on the administration to make clear to insurers their responsibility to cover COVID-19 testing in all cases. Writing in a letter to the departments of Labor, Treasury and Health and Human Services, Higgins wrote, “The lack of a national testing plan from this administration has meant that states and localities have been largely left to develop testing protocols on their own and scramble for what testing supplies they can get in the absence of national leadership. It is unconscionable for your departments to now also allow private insurance companies to abdicate their fair share of responsibility to their members and our communities by explicitly declaring that coverage of COVID-19 testing is not required under certain circumstances.”

Higgins had equal criticism for insurance companies using this as an opportunity to deny their customers COVID-19 test coverage and relayed that message in a letter to Western New York insurers, writing, “Your organizations can afford to provide this coverage. …While skimping on COVID-19 testing coverage will offer you short-term financial benefits, your policy will have the net result of making Western New York a sicker place in the long run. This will result in higher costs for all payers, including for your companies and the federal government, well into the future. This is nothing short of an abdication of responsibility to your members and our communities.”

In March, Congress passed both the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. FFCRA stated private insurers “shall provide coverage, and shall not impose any cost sharing (including deductibles, copayments, and coinsurance) requirements or prior authorization or other medical management requirements” for “(i)n vitro diagnostic products … for the detection of SARS-CoV-2 or the diagnosis of the virus that causes COVID-19.” The CARES Act further clarified that such tests and their administration are to be covered by payers without cost-sharing on the part of patients.

On June 23, the Trump administration subsequently tapered the definition of what must be covered with regards to COVID-19 testing in guidance jointly issued by the U.S. departments of Labor, Health and Human Services, and Treasury. This guidance specifically exempted payers from being required to cover COVID-19 testing done for purposes of surveillance or employment.

Higgins said, “The testing positivity rate in Western New York has been at 2% – double the state average – in part because the region already lags well behind the rest of the state in testing. On any given day, about 16/100 of 1% of the population of Erie County is administered a COVID-19 test; the statewide per capita rate is double that, with 32/100 of 1% of the state population receiving a test daily. Although new cases of COVID-19 in Western New York remain low compared to most of the rest of the country, in Erie County alone several dozen new cases of COVID-19 are confirmed every day, and more than 600 Erie County residents have died from this disease. This pandemic has not ended in Western New York; it continues to impact the daily lives of your members and my constituents. It continues to cause permanent harm in our communities, particularly communities of color.”

Higgins insisted, “Testing cannot be limited just to those that show symptoms. The Centers for Disease Control and Prevention estimate that 40% of people with COVID-19 are asymptomatic. These individuals are still able to spread the virus, and the only way to identify them is with testing as part of screening and surveillance efforts. Nor can testing be limited to only those who can afford it. In the absence of insurance coverage for testing, COVID-19 tests can cost anywhere from $100 to upwards of thousands of dollars. And for too many Americans, even a $100 out-of-pocket expense is unaffordable. These types of barriers will discourage individuals from getting tested at a time when we need more testing, not less, particularly as schools across the nation attempt to reopen safely.”

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