End of federal program to affect Va.'s uninsured Congress allowed funds covering COVID testing and vaccines for uninsured Virginians to run out. The loss risks a critical safety net (copy)

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A federal program covering the costs of COVID-19 tests, treatment and vaccines for the country's 28 million people without insurance has run out of funding because Congress did not act in time.

If providers are unable to absorb the new costs on their own, this could strain a critical safety net for the nearly 650,000 uninsured Virginians under the age of 65 and leave them with less access to care and a greater possibility of disease spread, said Virginia Department of Health officials in a statement.

"VDH is considering how we may need to adjust our program planning to ensure access to testing, vaccines and treatment for Virginians, regardless of insurance status," said Logan Anderson, a VDH spokesperson. "It is possible that we may not be able to sustain testing or treatment capacity or be appropriately prepared for future surges if funding does not come through this federal package."

The Uninsured Program, run through the U.S. Health Resources and Services Administration, reimbursed providers for supplying these services to uninsured people throughout the pandemic. The federal agency was forced to stop accepting testing and treatment claims on Tuesday and will halt vaccine claims on April 5 at midnight.

The VDH's current testing and vaccination efforts are not impacted by the congressional standoff.

As of Friday, four of VDH's federal grants totaling almost $376 million are dedicated to COVID testing, according to the agency. An additional $387 million divided among 10 additional federal grants are geared toward vaccinations. Half of those are set to expire by July.

But Anderson said there's a chance the loss of the Uninsured Program will indirectly affect the agency if more patients begin to seek services at community clinics and local health departments. People might also head to hospital emergency rooms, which could place undue pressure on Virginia's health care system.

And although some hospitals offer charity care programs to reduce the cost of a medical bill if an uninsured person seeks COVID treatment, not all do and eligibility can vary. Some require having Social Security, which could shut out undocumented immigrants.

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<strong>Statewide, health</strong> providers have filed more than $303 million in reimbursement claims through the Uninsured Program, per federal data last updated on March 3. About 60%, or almost $182 million, was for testing.

A bulk of the claims for treatment were filed by hospitals, which are still recovering from the increased costs of the past two years, said Julian Walker, the vice president of the Virginia Hospital and Healthcare Association.

In 2020, state hospitals faced a $1.8 billion revenue loss in part because of the postponement of scheduled surgical procedures while also investing in testing supplies, ventilators and personal protective equipment for their staff.

They are also bracing for potential funding cuts to Medicare that would reduce how much money is reimbursed to providers for services, Walker added.

"Inaction in Washington that results in a discontinuation of pandemic-related support could have harmful implications for patients and health care providers who have already endured so much," Walker said. "It is important to remember the fact that COVID-19 cases and hospitalizations are declining in Virginia does not mean that the added expenses of responding to the pandemic have receded."

Cases have substantially dropped since Virginia experienced its greatest surge of cases in January, when the average number of daily infections peaked at nearly 19,000. That's about 25 times the average the state reported on Friday: 767.

Hospitalizations are at an all-time low, and deaths have declined from an average of 139 per day in early February to 20 on Friday.

The percentage of people testing positive is at 3.7%, which is below the 5% threshold estimated to indicate enough testing is being conducted to detect most infections, Anderson said.

But as cases, hospitalizations and testing have dropped, so have the number of people being vaccinated. The lower demand prompted Richmond and Henrico County's health districts to close the community vaccination site at the Arthur Ashe Center on Friday and shift toward smaller clinics.

Per the VDH, the average doses administered per day statewide has dipped below 4,000. The last time that happened was the first week of vaccinations in Virginia in December 2020.

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<strong>While nearly 73%</strong> of the state's population is fully vaccinated, that percentage varies across localities. In some cities and counties, barely half of the residents have received both doses of Pfizer and Moderna or the single shot of Johnson & Johnson.

Of the more than 6.2 million who are fully vaccinated, the majority - 54% - do not have a booster shot, which provides additional protection against hospitalization and death.

In Richmond, CrossOver Healthcare Ministry and Daily Planet Health Services - community clinics with patient populations that are predominantly uninsured, medically underserved or experiencing housing instability - were among those that filed the most claims for administering vaccines.

The safety net providers have also served as a community testing site for uninsured people, and - with the Uninsured Program funding - they were able to maintain the staffing levels needed to plan, order supplies and educate their patients.

It created more access for the uninsured to seek care at places they otherwise wouldn't - such as CVS or Walgreens - and eased the burden on resources and staff, said Dr. Patricia Cook, chief medical officer at Daily Planet.

CVS in Virginia had the most claims paid for vaccines statewide at nearly $16 million. A spokesperson told the Richmond Times-Dispatch that the pharmacy chain is working with federal and state officials to ensure that people will continue having access regardless of insurance status.

The funding limbo, if not fixed, will leave CrossOver's largely immigrant patient population at risk of increased spread, said CEO Julie Bilodeau. This group has consistently faced high COVID rates in part because of being essential workers.

The top 10 occupations uninsured workers reported being in were nearly 6 million people in essential industries such as construction, housekeeping, restaurants and retail, according to 2018 data from the Kaiser Family Foundation, which publishes analyses on health care issues.

Without more money to support further vaccination, testing and treatment efforts, it's unclear what the dwindling of funds could mean long term for the people who will most need them.

And the growing reliance on at-home tests doesn't exactly equal growing access.

In data collected from Aug. 23, 2021, to March 12, 2022, of more than 400,000 U.S. adults, the Centers for Disease Control and Prevention found respondents who were seeking an at-home COVID test were more likely to have a college degree or higher, make more than $150,000 a year, be fully vaccinated and boosted, and not be an essential worker.

But as uncertainty looms and resources are stretched, Bilodeau had a promise for CrossOver's patients: They did not once close their doors during the pandemic, and they're not starting now.

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