States Seek to Ease Consumer Costs for Coronavirus Testing

(Bloomberg Law) -- A growing number of states are requiring health insurers to waive copays and other out-of-pocket expenses for coronavirus testing to make sure family budgetary challenges don’t slow efforts to control the outbreak.

“States are looking for ways to encourage people to get the care they need,” Kevin Lucia, co-director of the Center on Health Insurance Reforms at Georgetown University, said Friday. He expects more states to follow the lead of those that have already imposed coronavirus-related requirements on insurers.

The new requirements are a sign that state officials are willing to use their regulatory authority over the private health insurance market to combat the coronavirus outbreak, health-care researchers say.

Gov. Andrew Cuomo (D) made New York the first state to impose such requirements March 2, when he announced a plan to restrict copays for coronavirus testing as part of a larger package of new rules related to the virus.

Since then, at least four other states have followed suit. California Gov. Gavin Newsom (D), Nevada Gov. Steve Sisolak (D), and Washington Insurance Commissioner Mike Kreidler (D) announced new state rules Thursday requiring insurance companies to waive cost sharing for coronavirus testing. In Oregon, eight of the state’s largest insurers have agreed to similar restrictions, Gov. Kate Brown (D) announced.

States’ Reach Only Goes So Far

State authority is limited to around a third of the health-care market, making state action just one part of what must be a larger approach to removing cost barriers to coronavirus testing, according to Daniel Meuse, deputy director of the State Health and Value Strategies Program at Princeton University.

“Obviously, people are worried about what the cost will be if it turns out they need to get tested,” Meuse said Friday. “And these actions are an opportunity for the states to help ease the burden for consumers and make sure that everyone who needs to be tested will get tested.”

All of the state actions so far involve bans on cost sharing for coronavirus testing imposed by insurers in the Obamacare marketplaces.

In addition, some of the states included a variety of other new requirements, including coverage of the cost of an eventual vaccine and suspension of prior-authorization requirements in some instances.

Medicare and the self-funded health insurance market are outside state control, and authority over Medicaid is shared between the states and the federal government, Meuse said.

Around 11% of people nationwide are currently uninsured, he said.

“This is a situation where you’re trying to patch together an approach that works across all of these different silos of insurance,” Meuse said. “Each silo has its different structure and different regulators, and the states are saying, ‘This is what can we do to reach across as many as possible and ensure our residents have a good opportunity to access these services.’”

The trade group American Health Insurance Plans announced Thursday its members will begin taking steps to waive copays for coronavirus testing.

Cigna and CVS Health/Aetna have also announced that they will waive copays and coinsurance for the tests for their members.

To contact the reporter on this story: Christopher Brown in St. Louis at ChrisBrown@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.com; Peggy Aulino at maulino@bloomberglaw.com

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