Trump’s decision to cover the uninsured through a new hospital bailout fund came days after he ruled out reopening Obamacare’s marketplaces during the pandemic. That refusal, which surprised some of his own health officials, sparked a scramble to reassure tens of millions of uninsured Americans they wouldn’t have to fear financial devastation if they got sick with the disease.

The administration also still hasn’t explained how the federal government will pay out a separate funding pot covering diagnostic testing for uninsured Americans. That funding was approved a month ago by Congress, about two weeks before the administration also promised to cover treatment for the uninsured.

Nervous patients are increasingly questioning whether they’ll be on the hook for potentially massive costs, according to the legions of advocates who help patients navigate America’s byzantine health care system. They say they don’t yet have answers.

Some hospitals said they’re holding off on sending bills to uninsured patients and others are offering financial assistance, even as they face new financial strain from the health crisis. Some uninsured Covid-19 patients have already seen sky high bills from testing and hospital costs.

“The thing that is totally missing is any explanation for patients,” said Sara Rosenbaum, a health law professor at George Washington University. “If you don’t have to worry about getting care because the hospital is supposed to care for you, and the hospital bills you, what then? There has been absolutely no communication to the public.”

A federal official involved in designing the uninsured treatment pool said the administration recognizes there ultimately needs to be a robust messaging campaign to let uninsured people know they can get free care.

“We have an eye to actual individuals, and don’t want them to be afraid to seek care,” said the official, who requested anonymity.

HHS Secretary Alex Azar. | Andrew Harnik/AP Photo

But that work can’t begin until the administration finalizes plans for the uninsured treatment pool.

A Department of Health and Human Services spokesperson said the administration is “finalizing” plans for covering the uninsured but didn’t specify a timeline other than in "the very near future." An administration source said, of the $100 billion hospital bailout, that officials are "working as hard as we can to get the money out as fast as possible."

The internal discussions are dragging on as hospitals, doctors and health clinics urge health officials to rush out the remaining emergency dollars from the same bailout fund Trump said he’ll use to cover the uninsured. Some clinics have temporarily shuttered and hospitals have furloughed workers after halting lucrative elective procedures during the crisis to preserve resources and minimize infection risk.

Scott Christensen, administrator of the Delta Regional Medical Center in Mississippi, said his safety net hospital hasn’t billed anyone for coronavirus testing or treatment while it awaits further guidance from the Trump administration. These are especially challenging times for the hospital — revenues are down 50 to 60 percent, he said, and it spent heavily to set up drive-through testing and a new respiratory intensive care unit. But he said hospital officials are sensitive to patients’ cost concerns.

“I don’t want our community to avoid care during a time like this if they are afraid of getting a big bill,” Christensen said.

When the administration announced its plan for the uninsured, HHS Secretary Alex Azar insisted it would be better than Obamacare, because it would fully cover costs without co-pays or deductibles that insured patients may face. But Obamacare advocates said the move did little to address the uninsured population’s broader health needs, including follow-up treatment that can be intense for recovered coronavirus patients.

Nearly 30 million people lacked health insurance before the last month of economic devastation, and millions more have since joined their ranks. The cost of coronavirus treatment for this group could be staggering — the nonpartisan Kaiser Family Foundation earlier this month estimated the bill could total between nearly $14 billion and $42 billion.

That could eat significantly into the $100 billion fund Congress approved to help doctors, health clinics and hospitals cover the cost of protective gear for workers and life-saving medical equipment like ventilators and fill in lost revenue from the cancellation of elective procedures.

President Donald Trump during the bill signing ceremony for CARES Act in the Oval Office on March 27. | Erin Schaff-Pool/Getty Images

Last month’s $2.2 trillion CARES Act, which included the industry bailout fund, gave the Trump administration wide latitude to distribute those dollars. Hospital lobbyists were caught off-guard by Trump’s decision to use the fund for the uninsured, and they have demanded that lawmakers replenish the fund. Some health care analysts have argued, however, that targeting the fund to cover the uninsured in hard-hit hospitals would be a more efficient way to spend the money where it's most needed.

HHS sent out an initial $30 billion tranche of funds to health care providers over a week ago. Hospitals and Democratic lawmakers have pushed the administration to distribute additional funds quickly. However, Azar told House appropriators Wednesday that the next funding round won’t go out until later this week, according to a letter from the subcommittee's health appropriations chairwoman, Rep. Rosa DeLauro (D-Conn.).

At least one Medicaid expansion holdout state, Tennessee, has meanwhile sought additional Medicaid funds to directly cover coronavirus treatment costs for uninsured patients. However, Tennessee Gov. Bill Lee, a Republican, said CMS Administrator Seema Verma indicated his request would likely be denied, citing the massive stimulus bill already approved by Congress. CMS didn’t respond to a request for comment.

Meanwhile, health care providers said they’re still looking for clarity on promises to cover diagnostic testing costs for uninsured patients.

An emergency coronavirus package approved by Congress a month ago, before passage of the CARES Act, included a $1 billion fund the Trump administration could use to reimburse providers for those tests. Hospitals said they haven’t gotten details on how they could get paid from that fund. HHS did not respond to questions about that fund.

Separately, that rescue package also allowed states to expand their Medicaid programs just to cover diagnostic testing for the uninsured. Those waivers could be especially helpful in the 14 states that have refused Obamacare’s expansion of the program to poor adults.