The United States is probably testing about 400,000 to 500,000 people per day for the virus that causes COVID-19, and it probably needs to increase that number to 1 million to 5 million per day to get the outbreak fully under control.
Dr. Ashish Jha, director of the Harvard Global Health Institute, delivered that message Wednesday to attendees at the America’s Health Insurance Plans (AHIP) annual meeting, AHIP Institute.
The kinds of commercial health insurance plans AHIP represents are responsible for paying for COVID-19 testing, or getting an employer or the government to pay for testing, for about 268 million U.S. residents, according to data from Mark Farrah Associates.
Up till recently, Jha said, even people with mild to moderate COVID-19 symptoms have been told to skip testing, because of a lack of testing resources.
Now, U.S. testing capacity has increased dramatically, but, even today, because of the testing shortage history, “we are largely testing people for symptoms,” Jha said. “One of the major problems with this virus is that there is a good amount of asymptomatic spread…. People without symptoms can spread the virus.”
Because somehow without symptoms can spread the virus that causes COVID-19 to large numbers of other people, the country needs to be testing large samples of all kinds of people, to detect symptom-free “super spreaders” before those people make many other people sick, Jha said.
About 100,000 people enter U.S. hospitals every day, and hospitals should be testing all of them, to keep symptom-free or low-symptom super spreaders from making doctors, nurses and other patients sick in the hospital, Jha said.
The United States should also do aggressive testing of nursing home workers and residents, workers in many kinds of workplaces, and people who’ve come into contact with patients who have tested positive for the virus that causes COVID-19, Jha said.
Jha said one key question is why the United States is not already testing 5 million people per day.
“In my mind, the single biggest reason is that we have not made this a priority for the federal government,” Jha said. “We’re not going to get the level of testing we need by having all 50 states competing with each other. We really need a coordinated national effort.”
Preexisting National Conditions
Dr. Patrice Harris, the immediate past president of the American Medical Association, said COVID-19 has brought into stark relief many “preexisting conditions of this country.”
“The first was a woefully underfunded mental health system,” Harris said. “This system has been so underresourced for decades.”
COVID-19 has also highlighted health inequalities in the United States, Harris said.
One reason for social distancing-related social isolation is that many Americans lack access to broad band internet services, Harris said.
Another concern, Harris said, is that some jurisdictions provided much better telephone access to mental health professionals than others did. The country needs to make sure everyone, in every jurisdiction, has comparable levels of access to crisis support, Harris said.
The meeting panelists spoke, via an online videoconferencing system, to attendees who were originally supposed to convening in Miami Beach, Florida.
In the past, AHIP annual meetings have attracted thousands of attendees.
The attendee list for the online meeting appeared to show about 900 attendees.
AHIP member companies have been rushing to try provide rich COVID-19 testing and treatment benefits, often far in excess of what plan terms provided, and then facing bitter criticism when errors or gaps in emergency coverage have led to some patients getting large bills.
Larry Merlo, chief executive officer of CVS Health, which now owns Aetna, said in a session moderated by Matt Eyles, AHIP’s president, that he thinks health insurers have done a good job of responding to the crisis.
“We have to get a ‘A,’ if somebody was going to grade us here,” Merlo said. “As an industry, we’ve broken down the competitive wall. We’ve communicated, we’ve shared learnings with one another. We’re bringing our forms of innovation into the market.”
The government defines the playing field, but an entire group of companies has worked together to make change happen, Merlo said.
“I’ve never been more proud of our industry,’ Eyles said. “It really has been a remarkable couple of months.”
Many speakers at many sessions talked about increased use of telehealth being a permanent feature of the U.S. health care system.
They agreed that Congress and the U.S. Department of Health and Human Services (HHS) need to make many emergency regulations that have facilitated increased use of telehealth services permanent.
Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, issued a statement about the need to make some of the temporary federal telehealth changes permanent as AHIP members were meeting.
Some of the temporary HHS telehealth policy changes have involved easing of the usual Health Insurance Portability and Accountability Act (HIPAA) personal health information privacy and data security rules. HIPAA offered emergency exceptions to help providers offer telehealth services through any services that providers and patients could figure out how to use.
Elizabeth Goodman, executive vice president of government affairs and innovation at AHIP, said in a session featuring AHIP executives that she believes those HIPAA exceptions will expire, and that providers may have to shift some new telehealth services onto platforms that meet HIPAA standards.
Goodman said she believes the COVID-19 crisis will also lead to enormous growth in home-based care, both because of the high incidence of COVID-19 illness in nursing homes and assisted living facilities and because of home care providers’ impressive response to a crisis-related increase demand for home care.
Even before COVID-19 came along, “there has been a large shift from care in nursing homes to care in the home and the community,” Goodman said.
But Medicaid has traditionally favored reimbursement for nursing home care over reimbursement for home care, and the program has been slower to update the reimbursement rules for some types of care than others, Goodman said.
Now, since the COVID-19 crisis started, home care providers have shown that they can deliver advanced services, such as delivering drugs through catheters, and that they have the ability to provide those kinds of services for large numbers of patients, Goodman said.
David Merritt, AHIP’s executive vice president for public affairs, and Goodman, also talked about government financial support for health care.
Goodman said she thinks the enormous budget impact of the crisis has slowed adoption and implementation of new programs, such as Washington state’s new public health plan option program.
But Merritt said he sees broad, bipartisan public support for public health spending.
Goodman said, in response to a question about the possibility that Affordable Care Act opponents could try to roll back the ACA Medicaid expansion program, “nothing is off the table, depending on how bad the budgets get.”
“However,” Goodman added, “I don’t see, from a political standpoint, the politics of denying people health insurance in the middle of a pandemic.”
— Read Health Insurers Look Inward at AHIP Annual Meeting, on ThinkAdvisor.