The cuts at the nonprofit clinic, which serves about 11,000 patients, are just one example of how Covid-19 programs across the country have shrunk over the past month as a result of Congress not allocating new funding to fight the pandemic.

Curative, a major private testing company, no longer offers its services to uninsured people at more than 10,000 testing sites nationwide. In New York, a pharmacist who administered thousands of doses of the vaccine a week to low-income communities has stopped his information work. In Maine, the community health center, which serves one of the state’s poorest areas, is suspending plans to expand dental and mental health services to pay for Covid care.

Dried-up dollars make it difficult for low-income people to rely on those who rely on these providers for testing and vaccines, threatening to increase disparities in health across the country. Less access could also prolong the pandemic by allowing the virus to circulate and possibly become a haven for new, more dangerous options.

“From my point of view, it’s crazy,” said Neil Smoler, a pharmacist in Woodstock, New York, who led the information operation. From September to March, he traveled to neighboring areas to make several thousand injections a week. When federal compensation, which covered the administrative costs of these vaccinations, ended, he had to stop, although he continues to give free vaccines to people who come to his pharmacy.

“At the moment when we are a little ahead of this problem, they cancel any protection,” Smoler said. “I know people are tired, but this virus is more tolerant than we are.”

The cuts are happening amid new growth in both infections and hospitalizations. According to the Centers for Disease Control and Prevention, on average in 7 days on April 25 there were 44,416 cases, which is more than 20 percent more than the previous week. Compared to the previous week, the number of hospitalizations increased by 6.6 percent.

In March, the White House requested $ 22.5 billion from Congress to help Covid, including $ 1.5 billion that would hold money to vendors offering testing, treatment and vaccines to uninsured and underinsured Americans. But Republicans abandoned the price tag, and that tranche of money was set aside from an agreement now being considered by lawmakers.

The $ 10 billion two-party deal fell apart earlier this month when Republicans demanded a vote on an amendment that would preserve the Trump-era policies that restricted immigration because of the pandemic.

But even if Congress approves this smaller package, more money to compensate suppliers for their services to uninsured Americans is unlikely to happen.

“Ensuring access for uninsured people is very important,” White House Response Coordinator for COVID-19 Ashish Jah said at a briefing on Tuesday. “If Congress continues not to fund these immediate priorities, it will be harder and harder for people to access aid.”

Lack of federal funding could reduce significant progress in reducing racial disparities in Covid-19 and country back until the early days of the pandemic, when colored people became ill and died from the virus more often than their white counterparts. In 2021, uninsured rates were highest among adult Latinos and black Americans CDC data.

Reimbursing providers to help uninsured Covid Americans reach these groups has been a key element of the federal government’s response to the pandemic since April 2020, when the Health Resources and Services Administration began paying providers for testing and treatment.

Since then, the agency has paid more than $ 20 billion in claims to more than 50,000 providers for testing, treatment and vaccination through the HRSA Covid-19 program. Through a separate fund, more than 3,800 suppliers received compensation for another $ 13 million for claims to vaccinate the uninsured. Funding for these programs ended on March 22 and April 5.

“It’s really irresponsible on the part of the government to take away funding for Covid when Covid is far from over and health systems are already strained,” said Colin Elias, CEO of Community Clinical Services in Lewiston, Maine. “We have to pay a living wage to our employees who work extremely hard.”

The clinic, which began filing claims with HRSA for Covid-19 testing in May 2020, was already operating at a loss. Now that she will have to pay the Covid treatment bill for uninsured patients, Elias said the clinic is postponing a new recruitment and postponing plans to expand dental, primary care and mental health services this year.

Both federally funded medical centers known as the FQHC and vaccine providers receiving doses from the CDC are required to treat patients regardless of their insured status, leaving groups struggling with how to provide care without receiving reimbursement of overheads, including provider time and paperwork.

The CDC warned vaccine providers last week that it could stop giving free vaccines if agencies find that providers charge patients for vaccination, deny people that they are not insured, or bill to visit the office to get vaccinated, according to with the received email. by POLITICO. The CDC did not respond to a request for comment.

Curative, a testing company that received nearly $ 600 million in compensation for testing and was the largest beneficiary of the uninsured HRSA program, said it was now looking for other ways to continue to provide testing to all patients. The company did not say how many tests it was reimbursed for, but noted that “less than a quarter” of the tests were filed with HRSA when the program was still accepting claims. The company says it has conducted more than 31 million tests in 40 states.

“We are deeply concerned about this recent event and the impact it will have on uninsured patients,” the company said in a statement. “Our real-time data shows that the pandemic is not over and indicates a potential outbreak of cases on the horizon.”

At the moment, many medical centers that operate as a safety net for uninsured Americans are trying to find a place in their budget to cover the cost of continuing to provide Covid care. Some are cutting back on public immunization activities. Others are cutting back on their workforce development efforts.

“We’re really the last game in town in many, many communities. The county broke out. Hospitals have decided, “Okay, we just need to focus on our operations,” said Jana Yubank, executive director of the Texas Association of Public Health Centers. “If the centers are unable to do this work, I am really concerned about what will happen to a large number of our marginalized populations and individuals at the forefront who are most vulnerable to Covid infection.”

Many medical centers can still provide services only because the demand for testing and vaccination remains relatively low. A wave like Delta or Omicron may see that health centers are again stretched to their limits, and there is not enough time to intensify the response to Covid.

“We are doing well now, but if there is another wave in two months, we cannot guarantee whether there will be enough dollars,” said Vacheria Keys, director of regulations for the National Public Health Association. Centers. “I don’t know if we have the resources to keep building up again and again and again.”

Not all medical centers are in a difficult position. Those who serve the majority of the Medicaid population say they are in a better financial position than their affiliates, who serve predominantly uninsured patients because much of their income is stable.

Laura Owens, director general of Carolina’s family medical centers in North Carolina, said federal uninsured dollars made it easier for medical centers to serve their community because they didn’t even have to think about someone’s insurance status when providing care.

“The main advantage of this program, beyond budgets, plans and work processes, is that it definitely lowers barriers to personal care,” Owens said. “People didn’t have to make decisions about vaccinations or testing if they didn’t have an insurance card in their wallet.”

Free testing is also still available to uninsured individuals elsewhere, including pharmacies such as CVS and Walgreens, and some health departments, although the latter seems to have slowed or stopped in some parts of the country.

But declining access threatens to reopen a gap in health care that many have tried to close since the pandemic began. Health professionals working with migrant workers in rural areas say their patients have difficulty accessing urban facilities and enrolling in tests or vaccines without either documentation or language skills to navigate the health care system.

“The workers we serve do not have the transport, the means or the documentation to present [government-run] testing grounds, ”said Isabel Garcia, executive director of RCMA, a migrant advocacy group in Florida. “Before completing the program (HRSA) it was still difficult – many clinics and tests are in town or in town – but it was more accessible.” Now, she says, people just don’t get surveyed.

When working with vulnerable populations, getting help should be as simple as possible, said Marilyn Summerford, executive director of Access Family Health Services in northeastern Mississippi.

“Any barrier, no matter how big, that prevents people from getting the services they need,” Sumerford said, “our health care system will pay for it for years to come.”

https://www.politico.com/news/2022/04/27/providers-end-covid-care-uninsured-congression-inaction-00027988

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