Michigan’s largest insurance companies have announced they will stop free treatments for patients diagnosed with COVID-19 starting Sept. 30, joining other states across the country who have sunsetted their fee waiver programs. Vaccines and booster shots will remain free.
The announcement comes as more vaccines have been made available, but also as the state sees a new surge in COVID-19 infections and hospitalizations. As of Aug. 25, the state announced a total of 933,394 cases and 20,123 deaths due to COVID-19. More than 4,300 new cases were confirmed on Monday and Tuesday, and hospitalizations have increased by 231% since July 1.
Dr. Victoria Dooley, a family medicine physician in Novi, Michigan, anticipates this move will have a tremendous impact on residents across the state.
“Fear of medical costs is the number one obstacle to medical care,” Dooley said, noting that this will impact vaccinated people as well, since breakthrough cases persist—even those requiring hospitalization. “The one small consolation, debt-free medical care, is being taken away from everyone, not just the unvaccinated. Why should people face financial ruin because they were unfortunate enough to get a communicable illness during a global pandemic?”
Persuaded by high profits, public health concerns about the pandemic, and Affordable Care Act regulations, a number of insurers across the country took the initiative to ease the economic pressure on their subscribers. This largely came in the form of waiving out-of-pocket treatment costs, and sometimes credits or reductions toward people’s premiums. This significantly eased the financial burden. A study by the University of Michigan of COVID-19 hospitalizations from March through September 2020 found that 71% of insured people spent anywhere from $277 to $4,000 in out-of-pocket costs.
In Michigan, the state’s largest health insurance companies—like Blue Cross Blue Shield of Michigan, Priority Health and HAP—have waived costs like copays, coinsurance, and deductibles for patients needing treatment for COVID-19.
But as vaccines have become available—and the FDA approved the Pfizer-Biotech vaccine—insurers have no longer seen the need to continue the cost-waving programs.
Across 102 largest health plans in each state and the District of Columbia, 73 had ended their cost-sharing waivers by April 2021, when vaccines started to become widely available. The bulk of the programs have either already ended, or are set to expire by the end of 2021.
Some have praised this move as a way to incentivize people to get vaccinated and lower the risk of contracting severe cases of COVID-19. The Kaiser Family Foundation found that roughly 84% of hospitalizations for COVID-19 were preventable.
“We cannot emphasize this strongly enough: All of our vaccinated members need to talk with their physician about when to schedule their booster,” said James D. Grant, M.D., BCBSM senior vice president and chief medical officer in a statement. “Even more important, those who still have not gotten the vaccine need to consider getting it as soon as possible. The vaccine is saving lives.”
More than half of Michigan residents ages 16 and older have received at least one dose of a vaccine. Breakthrough cases are less likely to require hospitalization, but it’s still possible. The Henry Ford Hospital system, which services the Detroit area, said that 15-20% of patients hospitalized with COVID-19 are vaccinated.
Dooley doesn’t believe this decision by insurers is the answer to increasing vaccination rates.
“Vaccine hesitancy exists for many reasons,” Dooley said, explaining that passing on the costs of COVID-19 treatment to patients is not an effective way to incentivize people to get vaccinated as it doesn’t address the broad and complex reasons people might be avoiding vaccination. Dooley is especially doubtful this will convince people who don’t believe in COVID-19 or doesn’t believe they are at risk for complications. Instead, this move can stand to leave patients at risk.
“Insurance company profits soared during the pandemic and with a profit-driven healthcare system, they will never prioritize patients over profits. This action is not for anyone’s greater good except their own,” Dooley said.
Dooley says she finds that financial roadblocks are the number one obstacle her patients face in obtaining proper care. Whether it comes to treatment in her practice or when she has to refer patients to outside care or emergency treatment, the first question is always “How much will this cost?”
“To be under- or uninsured is a death sentence for many people,” Dooley said. “Our healthcare system is not caring. It doesn’t prioritize staying healthy. It doesn’t even cover the whole body from teeth to feet to mental health and dental under one comprehensive plan. People are literally dying for lack of healthcare affordability. It is abhorrent and makes my job a lot harder.”