Trump’s plan to reimburse hospitals is a recipe for disaster

With millions of Americans losing their jobs and health insurance during this pandemic, President Trump has touted a potential fix for their newfound lack of insurance: the government could reimburse hospitals for COVID-19 treatment when patients aren’t covered. Unfortunately, as an emergency physician treating many coronavirus patients, I’m seeing first hand why this so-called solution is a recipe for disaster. 

A few days ago, I had to take a few extra minutes with a patient before discharging her and sending her home. In 20 years as an emergency physician, I don’t always have that luxury, as the next patient may be having a stroke or losing their airway. This time was different. I was sending a patient who surely had COVID-19, out of my rural hospital and back out into the world.

The patient had all the telltale symptoms of COVID-19: fever, body aches, cough and trouble breathing. She said she had lost her sense of taste and smell over the last few days, a peculiar finding before the coronavirus began raging across America, now commonly reported among patients. This symptom clearly tilted the odds in favor of likely COVID-19. 

Still, despite the signs, I couldn’t test the patient. Her oxygen saturation wasn’t ideal, but it was acceptable, therefore she did not require admission to the hospital. Because tests are still limited nationwide, I couldn’t test her. In other words, because of America’s lack of resources and equipment, I couldn’t formally “prove” she had the virus. So would the government cover her treatment?

I spent the extra time because she had an underlying condition that put her at greater risk of a severe coronavirus infection. Patients with comorbidities like the one in front of me were the ones who would be fine one minute and in respiratory failure a day or two later. 

This patient had diabetes, one of the chronic conditions along with heart and lung disease, that increased her risk of severe complications from COVID-19. Like many of the people I serve in my rural Michigan community, the patient had cobbled together low-wage part-time jobs to make ends meet. In a headshaking irony of modern American health care, this patient — hardworking, responsible and independent — had no health insurance because she earned too much to qualify for Medicaid, even though its qualifying criteria was expanded in Michigan. With income above 138 percent of the federal poverty level, or more  than $18,000 per year, she could only get insurance through the health exchange. Because she couldn’t find a plan with monthly premiums or deductibles she could afford, she went without health insurance. Her chronic illnesses went untreated and unmanaged and likely got worse over time.  

I told her she needed to get follow-up care and health insurance that could cover at the very least her medications. I gave her a card for discounted prescription drugs. I told her that if she felt any shortness of breath, that meant the coronavirus had spread to her lungs and she needed to come back to the emergency department immediately. Then, with instructions to isolate herself within her house, she was discharged.

COVID-19 may be new. My patient’s predicament, however, was not. 

Like millions of Americans — including many of the newly unemployed thanks to the pandemic — she struggles to meet basic health care needs because she can’t afford it. Deprived of health care, these patients’ chronic conditions tend to worsen. Their overall health declines. When a pandemic strikes, they are left more vulnerable. 

Fortunately, there exists a potential fix that’s better than the president’s proposed band-aid.

States that expanded Medicaid through the Affordable Care Act helped address real blind spots in American health care. In my state of Michigan, 670,000 people who were once uninsured now have health care through the Medicaid expansion. Patients benefited because people who never had a primary care provider can now see doctors, get their medications and better manage their health. States benefited too: The 90 percent of federal reimbursement for expanded Medicaid recipients was more generous than the 50 to 78 percent paid for previous recipients.  

Now, amid a public health crisis, massive unemployment and a looming recession, Congress and President Trump should expand Medicaid again.  

As more people lose their jobs, they will lose their employer-provided health insurance. While the ACA lets people sign up within 60 days of losing a job, even “affordable” plans carry outrageous deductibles often reaching $5,000. People who have these high deductible plans are effectively uninsured: nearly half of all Americans can’t afford a $400 ER bill, let alone a $5,000 deductible.

As more people get COVID-19, medical bills will pile up, creating more sick and bankrupt Americans.  

Against this backdrop, President Trump’s plan to pay hospitals for caring for uninsured COVID-19 patients raises questions.

If my patient wasn’t tested, would she still qualify for care? Would the federal government act like a for-profit insurance company, denying claims and giving patients and hospitals the run-around to avoid paying the bill? How many people will avoid the hospital altogether because they don’t trust the government to pay the bill? How many will die in their homes because they did not want to bankrupt their loved ones?

Expanding Medicaid to all unemployed individuals and those who don’t get health care through their jobs, with 100 percent federal funding, is the best step to take now. 

Americans can’t afford to be distracted by political sideshows. This pandemic is a public health disaster that demands we put people first. Our priority must focus on averting unnecessary deaths and helping those devastated by job loss. 

Those of us on the front lines are doing our part. Now Washington must act swiftly and decisively on this front, so we can see our way out of this pandemic that could define a generation.

Dr. Rob Davidson is an emergency room physician in West Michigan and executive director of the Committee to Protect Medicare, a coalition of doctors devoted to protecting Medicare and advocating for health care for all.