The coronavirus outbreak and ensuing economic fallout is resulting in widespread financial hardship, as entire industries come to a standstill, workers get laid off, and the stock market tanks. As more and more Americans contract the coronavirus, another major source of financial anxiety for many will be health care costs, as serious cases of COVID-19 could result in massive hospital and physician bills. For those who are going into the global pandemic uninsured, however, the Trump administration is offering little relief. Politico reports that President Donald Trump and senior officials rejected plans this week to reopen the federal health care exchange at Healthcare.gov for a special enrollment period in response to the coronavirus, despite the idea being previously under consideration.

Trump’s decision not to have a special enrollment period came even as the federal government faced widespread calls to do so from Democratic lawmakers, health care groups, and the health insurance industry. “Given the risk posed by COVID-19, it is more important than ever for people to have health coverage,” the CEOs of America’s Health Insurance Plans and Blue Cross Blue Shield Association wrote to congressional lawmakers on March 19. “This will give people the opportunity to get the security and peace of mind that health care coverage provides.” (Congress declined to include the enrollment period in their recent stimulus package, throwing the matter into the Trump administration’s hands.) The Trump administration had reportedly strongly considered the enrollment period, and insurers told the New York Times that they “had been hopeful just a few days ago” the administration would announce the move—until the situation abruptly became “fluid,” one executive told the Times. (A White House official told Politico the administration was “exploring other options,” though what those are remains unclear.) While the administration’s decision applies to the 38 states that use the federal health care exchange, 11 states that operate their own exchanges have announced special enrollment periods of their own: California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington, along with the District of Columbia.

The lack of a special enrollment period will not prevent laid-off workers who have lost their employer-based health insurance from getting re-insured, as the Affordable Care Act allows those who lose job-based insurance to obtain health care through the federal marketplace outside of the regular enrollment period. The special enrollment period would have enabled Americans who have lost their jobs to obtain new health insurance more easily and with less paperwork at an urgent time, however, as well as give those who have already been uninsured another chance to purchase insurance as the pandemic ramps up. And the price for contracting a serious case of the coronavirus without insurance is likely to be costly. Though lawmakers have mandated that testing be free for patients with or without insurance—which, in practice, has not always been the case—a hospital visit or stay to treat the coronavirus could be financially catastrophic. The Kaiser Family Foundation projects that the total cost for coronavirus-based hospital admissions with employer insurance could range between $9,763 and $20,292, depending on any complications or comorbidities. Those numbers, however, could even be higher, as Time reported that an uninsured woman who went to the emergency room multiple times for COVID-19 received a hospital bill for $34,927.43.

When asked Wednesday at the White House briefing about what now-uninsured Americans should do about getting insured, Vice President Mike Pence said he'd “continue to bring opportunities to the president.” But the vice president largely avoided answering the question substantively, instead touting the health insurance industry while failing to say how currently-uninsured Americans could take advantage of its coverage. “I think what we're seeing health insurance companies do today...is really inspiring,” Pence said. “One of the things that has animated and characterized the president's approach is the way he's engaged American businesses to step up and do their part.” (“I think that's one of the greatest answers I've ever heard, because Mike was able to speak for five minutes and not even touch your question,” Trump commented about Pence’s response.) The president noted, however, that the question was a “fair” one, and “it's something we're looking at,” though he did not offer any further details.

The Trump administration’s refusal to allow more Americans to easily sign up for ACA insurance isn't the GOP’s only attack on the health care program in the midst of the global pandemic, as Republican-led states and the Trump administration have resolved to keep moving forward with their lawsuit to kill the ACA despite the coronavirus. “It’s always been a question of legality, not health care policy,” Samantha Fisher, a spokesperson for the Tennessee Attorney General, argued to the Daily Beast. Trump himself has repeatedly decried the ACA amid his coronavirus response, saying at a recent press briefing that he wants to “get rid of the bad healthcare and put in a great healthcare.” “What we’d like to do is totally kill it,” Trump said at a Fox News town hall. The Supreme Court’s decision on the lawsuit is likely to come as the U.S. still grapples with and recovers from COVID-19: Arguments are set to take place in the fall, with a decision coming as soon as spring 2021, potentially before a vaccine for the coronavirus is readily available. If the court overturns the law and kicks millions off of their health care plan—the country’s health care problem in the wake of COVID-19 could soon get exponentially worse. “The only thing worse than a public health pandemic is a public health pandemic without health care,” Democratic strategist Jesse Ferguson told the Daily Beast. “It's like watching the Chernobyl disaster and deciding to bulldoze the fallout shelters.”

More Great Stories From Vanity Fair

— Trump Awakens to the COVID-19 Danger

— Could Wall Street’s Coronavirus Tsunami Get Worse?

— Jared Kushner Told Trump the Coronavirus Was Fake News

— Tucker Carlson on How He Brought His Coronavirus Message to Mar-a-Lago

— The 12 Most Insane Moments From Trump’s National Emergency Presser

— How a QAnon Coronavirus Conspiracy About Oprah Went Viral

— From the Archive: Inside the Week of Hurricane Katrina, Revealing the Foolishness, Fear, and Politics That Turned a Natural Disaster Into a Man-Made Catastrophe

Looking for more? Sign up for our daily Hive newsletter and never miss a story.