Biden plan for free at-home tests faces hurdles

President Biden announced a plan with much fanfare on Thursday for free at-home COVID-19 tests as part of his effort to tame the pandemic this winter.

But the catch is that people will still have to pay the cost up front for the tests, which can be over $20 for a pack of two at the local CVS, and then submit receipts to their health insurer to get reimbursed. 

That process has raised concerns among experts that the upfront cost and added hassle of reimbursement will still cause barriers to testing, a contrast to European countries where tests are free or just a couple of dollars up front. 

Larry Levitt, a health policy expert at the Kaiser Family Foundation, said Biden’s announcement would “certainly make at home testing more accessible,” but added that “it’s still going to be cumbersome for people.”

Advocates have been pushing for greater access to rapid at-home tests for over a year, saying that frequent and cheap rapid tests can help limit spread of the virus without resorting to business closures by giving people the ability to know when they are infectious and need to isolate, and when they are not. 

Some progress has been made, as the administration says the supply of at-home tests is set to quadruple compared to late summer. 

“When I came into office, none of these tests were on the market,” Biden said Thursday at the National Institutes of Health. “Thanks to our actions and the work of all of you, we now have at least eight at-home testing options and prices for those tests are coming down.  

“But it still isn’t good enough, in my view,” he added. “That’s why I am announcing that health insurers must cover the cost of at-home testing.  So that if you’re one of the 150 million Americans with private health insurance, next month your plan will cover at-home tests.”

Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, said that the upfront cost would act as “barriers” for some people, or at least make them think twice about getting a test at a time when frequent testing should be encouraged. 

“The answer to ‘do I really need this?’ is always yes,” Nuzzo said. 

“The most preferable option would be to make these goddamn things free or close to free and make them widely available so people can just pick them up,” she added. 

White House Press Secretary Jen Psaki was asked Thursday why the administration is not directly subsidizing the tests as some other countries are doing. 

She replied that the reimbursement through insurance setup “was implementable and possible to do now, and we will continue to build on it.”

Craig Spencer, director of global health in emergency medicine at Columbia University Medical Center, pointed to other countries with better rapid test access. 

“I just did a BBC interview,” he tweeted. “The host said that in the U.K. you can just walk into a pharmacy and pick up free tests. I informed him that at-home tests in the US cost $8-$10 each—if you can find them—and I’m not sure but I think maybe his head exploded.”

“But don’t worry, next month in the U.S., if you’re lucky enough to have private health insurance, you MIGHT have the opportunity to submit the costs of SOME at-home tests to an insurance company whose only motive is profit,” he added. 

The Biden administration proposal allows the roughly 150 million people with private health insurance to get reimbursed for the at-home tests. For people without private insurance, the administration says it will be distributing 50 million tests to sites like health centers and rural clinics. 

Levitt, of the Kaiser Family Foundation, noted that insurers could also seek to restrict how many tests they will reimburse for. 

“I have no doubt that insurers will put up roadblocks,” he said. 

Further guidance to lay out the details of the policy is coming by Jan. 15, the administration says. 

Kristine Grow, a spokeswoman for America’s Health Insurance Plans, the insurer trade group, said it is “not opposing” the proposal, and noted that at-home tests are an “important tool.”

She also noted some concerns to be worked out as the guidance develops, such as ensuring that test makers cannot implement “price gouging” on their at-home tests. 

On the state level, New Hampshire has pushed forward with a new program to provide free rapid tests for its residents, shipped to their homes. But highlighting the mismatch between demand and supply, the almost one million tests ran out within 24 hours of the website for ordering going live this week, the Concord Monitor reported.

A spokesman for New Hampshire Gov. Chris Sununu (R) said the state is “working with our federal partners to determine the possibility of replenishing supply.”

In neighboring Maine, Nirav Shah, director of the state’s CDC, told reporters on a call Thursday that he has concerns that if the national program is not structured properly, it could cause barriers. 

“A pay and chase model where individuals have to have an expenditure up front and then get reimbursed for it, that introduces an access challenge for a lot of folks,” he said.