Clinical support technician Douglas Condie extracts viruses from swab samples so that the genetic structure of a virus can be analysed and identified in the coronavirus testing laboratory at Glasgow Royal Infirmary, Glasgow, on February 19, 2020.

Public health officials have been clamoring for greater testing capacity to help them combat the spread of the new coronavirus in their communities. Now, as testing is poised to become more widely available from commercial labs, the cost of those diagnostic tests could become a factor in the effort to control the virus.

Lab Corp. announced Thursday it was immediately offering testing for COVID-19, while Quest Diagnostics said it will start testing specimens next week, increasing the options for hospitals, physicians offices and urgent care clinics.

On Wednesday, the Trump administration designated the new test as an essential health benefit, saying Medicaid and Medicare plans would cover the cost of the screening. Under the Affordable Care Act, large-employer health plans must cover the cost of essential health benefits, such as preventive testing. But the administration's designation does not require plans to provide the tests to patients free of charge.

Only a few labs approved by the Centers for Disease Control and Prevention, including the one at its headquarters in Atlanta, were allowed to run the testing until about a week ago. Under pressure from state and local governments, the CDC expanded their testing guidelines on Thursday.

While the CDC tests were free, the new commercial ones won't be, resulting in bills for health insurance plans, along with higher medical costs as the virus spreads and people seek treatment.

Most Americans have not yet met their out-of-pocket deductibles this early in the year, so the timing of the outbreak could leave many patients footing much of the bill, if their employer or private Medicare Advantage plan doesn't make an exception to waive co-pays or deductibles for the commercial tests.

A spokesman for UnitedHealth Group said the company's "first priority is to ensure our members have access to the diagnostic and treatment care they need," but did not specify whether the company would waive co-pays.

Health insurer Aetna, owned by CVS Health, will cover the testing with no out-of-pocket costs or cost sharing.

The board of America's Health Insurance Plans pledged that its members, which include most of the major publicly traded insurers and the majority of nonprofit Blue Cross plans, will take proactive steps to make sure people can get care.

"We will cover needed diagnostic testing when ordered by a physician. We will take action to ease network, referral, and prior authorization requirements and/or waive patient cost sharing," the group said in a statement.

Washington state regulators ordered health insurance plans there to waive all cost-sharing and co-pays on coronovirus testing through May 4, as the state grapples with one the nation's largest coronavirus outbreaks.

Late Thursday, Cigna announced that it will waive all cost-sharing nationally for COVID-19 tests on all of its Medicare Advantage and Obamacare exchange health plans, as well as the health plans it manages for large employers and state Medicaid programs.

"We are advising our clients to put the care of our patients first. So, making sure they have access to testing and treatment – and they should be confident that care is covered," said Dr. Steve Miller, Cigna chief clinical officer, adding "no one should be discouraged from seeking care right now."

Cigna has already been working with large employers and state health officials in Washington state to prioritize access for patients.

"We are working really closely with our patients and our plans, and we have case managers helping the families to make sure they have access and they can concentrate on recovering from illness, and not on the stresses of paying for healthcare," Miller said.

It's not clear yet how the new commercial tests will be priced, and what kind of costs that will mean for patients.

Democratic leaders on the House Oversight Committee expressed concern that patient costs could impact access to testing for Americans whose plans have high deductibles, if those plans don't waive cost-sharing, and for those who are uninsured.

In a letter to the department of Health and Human Services, committee members wrote that testing and treatment costs "will cause many uninsured and underinsured individuals to avoid care for coronavirus-like symptoms. That will not only hurt those who go untreated, but it will also hasten the spread of COVID-19."

More than 27 million Americans had no health insurance coverage in 2018, according to the most recent Census data.

The Trump administration is considering using emergency health measures to cover the costs of coronavirus testing and treatment for the uninsured, according to Dr. Robert Kadlec, assistant secretary at the Health and Human Services department.

The administration has discussed whether the National Disaster Medical System reimbursement program, which is generally used in hurricanes and natural disasters, could be sued to pay hospitals and physicians for treating patients for the coronavirus.

"National Disaster System medical system patients get reimbursed or providers get reimbursed at 110% of Medicare rates," Dr. Kadlec explained during congressional testimony on Tuesday.

The stakes are high for the health-care industry and for political leaders to make sure health costs don't become an aggravating factor in the coronavirus outbreak.

High health-care costs are already one of the top issues for voters in this year's election. If the virus spreads in the weeks and months ahead, how Americans experience access to care during the outbreak could play a big role next November.



Correction: The Trump administration's essential health benefits designation does not require private health insurers to offer COVID-19 testing free of charge.