Limit Americans' out-of-pocket exposure for Coronavirus treatment | xpostfactoid

Limit Americans' out-of-pocket exposure for Coronavirus treatment | xpostfactoid: 
by Andrew Sprung
Proposed: a federal reinsurance program to limit individuals' out-of-pocket spending for Coronavirus treatment.
Like all emergency healthcare measures proposed to limit the ravages of the coronavirus, capping MOOP for the treatment of one disease highlights dysfunctionality in Americans'  healthcare norms.  People shouldn't be uninsured. If insured, they shouldn't be exposed to in-network costs up to about $8,000, or to unforeseeable out-of-network costs that are effectively unlimited.  Permanent fixes are in order for all of these exposures.  But crisis-specific patches may help stave off hundreds of thousands of deaths and economic paralysis.
The bill passed by the House yesterday to ease the economic impact of the coronavirus pandemic, H.R. 6201, purports to make coronavirus testing available at no cost to all Americans. That includes office visits, urgent care center visits, and emergency room visits that lead to an order for testing.* It does not, however, include treatment for those who become seriously ill.

David Anderson and Nicholas Bagley are calling for Congress to rise to the crisis by protecting Americans against balance billing -- either by passing comprehensive consumer protection that's been stalled since last fall or, at a minimum, passing a bill to limit out-of-network billing for Coronavirus treatment.

That's vital. I've worried since late February that fear of balance billing would inhibit some Americans from seeking treatment. I've also noted a closely related problem: Americans' huge exposure to out-of-pocket costs for in-network care:

In employer-sponsored insurance, the average single-person deductible in 2019 was $1,655, according to the Kaiser Family Foundation. 28% of covered workers had a single -person deductible over $2,000. The median annual maximum out-of-pocket (MOOP) limit (after which the plan pays 100% of covered expenses) was $4,000 (the maximum allowable is $8,100). About two thirds of employer plans require coinsurance for inpatient hospital stays, averaging 20%.

Meanwhile, an ICU stay with a ventilator cost an estimated $11,000 per day back in 2005. Many people with high deductibles and MOOP are afraid to seek treatment. Half of U.S. adults say they or a family member put off or skipped some sort of health care or dental care or relied on an alternative treatment in the past year because of the cost, according to 2019 polling by the Kaiser Family Foundation.

Fear of huge expense may deter people from getting tested even if the test itself is free, as well as deterring people from seeking treatment if symptoms intensify. Along with a balance billing ban, a key measure to reduce that inhibition would be to limit individuals' maximum out-of-pocket spending for coronavirus treatment to, say, $2,000, and limit insurers' exposure by providing federal reinsurance for out-of-pocket costs above that limit.  To hold insurers to their responsibilities, the reinsurance would only cover the difference between the $2,000 cap and the plan's existing MOOP. KEEP READING