Arkansas health care providers are worried after news that a federal program that covers the costs of covid-19 treatments for uninsured patients will be ending within the next couple of weeks.
Such providers, including pharmacists, primary care physicians and hospitals, received notice last week from the Health Resources and Services Administration that its Covid-19 Uninsured Program is running out of funds after Congress declined to approve an additional $15 billion in pandemic relief spending sought by the Biden administration.
That means the program will stop accepting claims for covid testing and treatment for uninsured patients Tuesday. Vaccination claims for the uninsured will not be accepted after April 5, the announcement said. The Health Resources and Services Administration also said it could not guarantee there would be enough money to cover claims submitted before those deadlines.
Health care providers in Arkansas say the closure of the program raises several concerns. Without funding to reimburse costs for administering vaccines, covid-19 tests and treatments -- such as monoclonal antibodies and antiviral medications -- some providers will stop offering such services to people who do not have insurance.
"If this money runs out right now, we are going to have a lot of people in the state in a bind," said David Wroten, Arkansas Medical Society executive vice president. "If we want physicians to be able to test and treat patients who do not have insurance, this money is critical to be able to do that."
About 8.5% of Arkansans, or roughly 254,000, are not insured, according to the Kaiser Family Foundation's most recent data compiled last year.
"There are only two options," Wroten said. "Providers either absorb the cost or don't provide the service."
An increase in cases in Europe and China has led to concerns that limiting access to treatments that significantly lower the risk of severe illness and death could be catastrophic for Arkansans without insurance.
Should another wave hit the state, those people could become sicker and once again overwhelm emergency departments and intensive care units in hospitals already facing staffing shortages and exhausted nurses and doctors.
"Anytime the government pays for something and then takes it away, the problem with that is always limited access," said Jodiane Tritt, Arkansas Hospital Association executive vice president, adding that many hospitals in Arkansas, particularly in rural areas, are under financial distress because of the prolonged periods during the pandemic when elective procedures were halted.
Tritt said that she hopes hospitals "will still be able to absorb the costs" of offering covid-19 tests and other treatments, but that "it's possible in some parts of the state, public health infrastructure will have to pick up those access points that hospitals have been trying to augment."
"The last thing hospitals need is more infections with hospitalization that would have been prevented with vaccine use," she said.
Baptist Health is "currently assessing how this lack of funding will impact us in the future and our ability to broadly provide these services," Cara Wade, a spokesperson for the hospital system, said via email. "Like all health systems, we continue to navigate covid-19 community needs and funding for these functions is critical for our ability to continue to provide these services to all who need them."
The University of Arkansas for Medical Sciences has not "received guidance information from CMS [Centers for Medicare and Medicaid Services] or any other agency as to whether or not there will be another way for UAMS to recoup its costs for vaccinating uninsured patients," Leslie Taylor, a UAMS spokesperson, said via email.
UAMS has given more than 24,000 vaccine doses and performed more than 66,000 covid-19 tests on uninsured patients, Taylor said.
For vaccine administration, UAMS bills insurance providers, including the Health Resources and Services Administration, at $46 per dose, meaning the hospital and its clinics should be reimbursed about $1.1 million for those given to patients without health insurance. That money "allows us to try to recoup some of our costs for staffing and supplies," Taylor said.
Pharmacies, particularly independent ones -- which became key cogs in the health system during the pandemic, offering testing, vaccinations, antivirals and monoclonal antibody treatments -- will also have to limit services should funding not continue for the uninsured.
Like hospitals, pharmacies offering covid treatments have been stretched, with many hiring extra staffers, renting additional space for vaccine administration, traveling across the state to hold vaccine clinics and ordering extra supplies needed to treat patients.
"Moving forward, if this is what you can expect from the federal program, there will be providers who drop out if they can't count on being paid for the services rendered," said John Vinson, head of the Arkansas Pharmacists Association. "Why would they continue the service?"
The process to file a claim with the Health Resources and Services Administration program is cumbersome, Vinson said, meaning that the abrupt notice of the program's end left many independent pharmacies that operate with few employees scrambling to submit claims before the deadlines. Some pharmacies have tens of thousands, if not hundreds of thousands, of unpaid claims from the program, he said.
"It is a very difficult system to navigate," Vinson said. "We have members with tens of thousands of dollars at risk because of the announcement that came out."
To administer covid vaccines at his Doctor's Orders Pharmacy location in Pine Bluff, owner and pharmacist Lelan Stice hired additional employees, rented more space, paid out-of-pocket costs to set up vaccination clinics in rural areas and ordered supplies that the business would not usually carry, like intravenous poles and blood pressure cuffs to administer monoclonal antibody treatments.
Stice said the pharmacy's payroll increased by almost half a million dollars in 2021, compared with 2020. As of last Thursday, Doctor's Orders had 4,000 vaccine claims left to file by the April 5 deadline.
"We are at risk at a small pharmacy in Jefferson County for $40,000 in lost revenue for a mammoth amount of work that we did," Stice said. "That is just for vaccines. I have not looked at what we have for uninsured on monoclonal [antibodies] or the oral antivirals."
With ongoing expenses of additional employees, whom Stice is reluctant to let go out of fear that another coronavirus variant might hit the state, the pharmacist said he may have no choice but to stop offering covid treatments to those without insurance.
"Ethically you have to treat them, but legally you are not required to as a for-profit," he said. "So we will probably refer them to a hospital, and it will become a burden the hospital has to absorb."
"We can't provide these services for free and stay open," Stice said. "Insurance companies are barely covering our costs already."
Blake Torres, a pharmacist and owner of West Side Pharmacy in Benton, said that upon learning of the end of the program last week, he immediately stopped offering covid treatments to uninsured patients -- not only in Benton but at several other locations in Arkansas.
"We are having to turn people away," Torres said.
West Side Pharmacy alone has about $125,000 in outstanding claims for vaccines and monoclonal antibody treatments for uninsured patients, Torres said, adding that he knows of other pharmacies with outstanding claims exceeding $1 million.
"I feel betrayed and almost lied to by the government that I trust, that I took its word on, has now turned its back on me and other providers across the state and more importantly patients across the state," he said.
In an email sent last Wednesday to the offices of several lawmakers, including U.S. Rep. French Hill, R-Ark., and Sen. Tom Cotton, R-Ark., Torres urged Congress to extend the deadlines to submit claims to the program before it closes.
"We were told, 'thank you for stepping up to the plate, use your time and resources and your staffing to care for the uninsured and you will be reimbursed," Torres wrote. "Yet, here we are experiencing the opposite."
Cotton's office did not respond to the Arkansas Democrat-Gazette's request for comment on Thursday about the closure of the Covid-19 Uninsured Program.
U.S. Sen. John Boozman, R-Ark., said in an emailed statement that the "federal government has spent more than $6 trillion in covid-19 relief to fund investments in vaccines, treatments and testing," adding that he applauds "frontline workers whose efforts have helped save countless lives and mitigate the pandemic's effects."
"At this stage, taxpayers deserve a thorough accounting of how previous funds have been spent before more money is distributed," Boozman said. "Any additional covid-19 spending must be necessary, effective and paid for."
Similarly, Hill said in an emailed statement that "very little information exists as to how much money remains in existing programs" from the initial $6 trillion in federal covid relief funds.
"Before any further money is considered, Congress should have some idea of how the first $6 trillion was spent and any additional funding should not even be considered unless it is targeted and paid for."