WASHINGTON -- With an urgent funding request stuck in Congress, a federal agency said it can no longer cover covid tests and treatment bills for uninsured people, forcing it to stop taking claims at midnight Tuesday.
"The lack of funding for COVID-19 needs is having real consequences," Martin Kramer, a spokesman for the Health Resources and Services Administration, said in a statement. "We have begun an orderly shutdown of the program."
The Uninsured Program is an early casualty of the impasse between Congress and the White House over the Biden administration's request for an additional $22.5 billion for ongoing covid response.
In operation since the Trump administration, the program reimburses hospitals, clinics, doctors and other service providers for covid care for uninsured people, whose numbers total about 28 million. Kramer said the program will next have to stop accepting claims for vaccination-related costs, after April 5.
Shutting off the spigot of federal money could create access problems for uninsured people, as well as consequences for the rest of society.
"Covid is a highly infectious disease, so we want people who think they might be sick to get tested and treated, not only for their health but for the community as well," said Larry Levitt, a health policy expert with the Kaiser Family Foundation. "If uninsured people now hesitate to get care because of the cost, we'll see more cases and greater inequity."
Levitt said he also worries that vaccine providers could dial back their outreach efforts to uninsured people.
The Health Resources and Services Administration, the agency running the Uninsured Program, is a unit of the Department of Health and Human Services. Officials said it receives about 1 million claims a day and has reimbursed for care for millions of people during the pandemic.
The program pays out about $500 million a week in claims, and more than 50,000 service providers have taken advantage of it.
Health and Human Services Secretary Xavier Becerra told The Associated Press last week that other initiatives could be blunted if the standoff with Congress persists.
He singled out "Test to Treat," a newly launched program through which patients who test positive can quickly get a supply of antiviral medications. They can take those medicines at home, reducing their chances of hospitalization.
"If you don't have the dollars to let it fly, you're stuck," Becerra said.
The administration's request for more money got snagged in a push and pull between Republicans and Democrats in the House and Senate.
The biggest obstacle is in the evenly divided Senate, where Democrats would need 10 Republican votes to avoid a filibuster and approve the money. But Republican senators say that savings should be found from the trillions of dollars that Congress has already provided since the pandemic began two years ago.
House Speaker Nancy Pelosi, D-Calif., tried to find a compromise by agreeing to cuts with GOP leaders, but she ran into problems with fellow Democrats.
Unless the money flows, more Americans will feel the fallout, the Biden administration says.
A White House fact sheet says the government will not have enough money for boosters, or for vaccines targeting specific variants, to provide them to all Americans. The supply of monoclonal antibody treatments will run out by late May.
Additionally, health authorities will be unable to procure enough quantities of certain treatments needed by patients with immune system problems. Sustaining a robust capacity for testing will again become a challenge, repeating a cycle that has been a source of frustration from the beginning of the pandemic.
VARIANT CONCERNS
With coronavirus cases rising in parts of Europe and Asia, scientists worry that an extra-contagious version of the omicron variant may soon push cases up in the United States, too.
Experts are also keeping their eyes on another mutant: a rare delta-omicron hybrid that they say doesn't pose much of a threat right now but shows how wily the coronavirus can be.
The U.S. will likely see an uptick in cases caused by the omicron descendant BA.2 starting in the next few weeks, according to Dr. Eric Topol, head of the Scripps Research Translational Institute.
"It's inevitable we will see a BA.2 wave here," he said.
One reason is that, after about two months of falling covid-19 cases, pandemic restrictions have been lifted across the U.S. Many people are taking off their masks and returning to indoor spaces like restaurants and theaters.
And the latest data from the Centers for Disease Control and Prevention shows the share caused by BA.2 is up significantly. The CDC reported Tuesday that the variant accounted for about 35% of new infections last week. In the Northeast, it was about 50%.
Dr. Anthony Fauci, the U.S. government's top infectious disease expert, said on ABC's "This Week" that he also thinks the U.S. will likely face an "uptick" similar to what's happening in Europe, particularly the United Kingdom, where BA.2 is the dominant strain. He said he doesn't think it will be a "surge."
The U.K. has "had the same situation as we've had now," Fauci said. "They have BA.2. They have a relaxation of some restrictions such as indoor masking, and there's a waning of immunity" from vaccines and past infections.
Keri Althoff, a researcher at the Johns Hopkins Bloomberg School of Public Health, cautioned that CDC case counts underestimate the true numbers because some people are no longer getting tested and others are testing at home and not reporting the results. Also, she said, not every specimen is genetically sequenced to determine the variant.
It's clear, she said, that "BA.2 is coming onto the scene."
One reason the variant has gained ground, scientists say, is that it's about 30% more contagious than the original omicron. In rare cases, research shows it can sicken people even if they've already had an omicron infection -- although it doesn't seem to cause more severe disease.
Vaccines appear just as effective against both types of omicron, but breakthrough infections are possible. And experts point out that vaccination rates are lower in the U.S. than the U.K. About 74% of those 12 and older are fully vaccinated in the U.S., compared with 86% in the U.K.
"We need to emphasize that we're not protected in this country compared to peer countries," Topol said.
Still, not all experts are equally concerned about a BA.2-related rise in U.S. cases. Dr. James Musser, head of genomic medicine and infectious diseases at Houston Methodist, said the variant has so far only caused about 1% to 3% of cases in his medical system. Cases there have usually tracked closely with what's happening in Britain.
He called BA.2 "something we're keeping an eye on" but said, "I'm not losing sleep" over it.
That's how many scientists view the other variant that some in the public are calling "deltacron," a hybrid containing genetic information from both delta and omicron.
Earlier this month, Maria Van Kerkhove of the World Health Organization said the hybrid has been detected at "very low levels" in France, the Netherlands and Denmark. And two recent studies, which have not yet been peer-reviewed, point to a tiny number of cases in the U.S.
Much remains unknown about the hybrid. There's no evidence it causes more severe disease, and it doesn't look like it's infecting many people.
CDC researchers identified nine samples, seven from the mid-Atlantic region in a study released Monday that hasn't yet been peer-reviewed. Topol, who was not involved in the research, said there's no evidence it has the potential to spread.
It's common for coronaviruses to shuffle gene segments, said Dr. Stuart Campbell Ray, an infectious disease expert at Johns Hopkins University. With two variants circulating at the same time, people may get double infections, and a "progeny virus" could emerge.
Given the virus's ability to spawn new mutants -- and the rise of BA.2 -- experts say people should get vaccinated and keep their masks handy.
"Keep your guard up," Topol said. "This is not over."
Information for this article was contributed by Ricardo Alonso-Zaldivar and Laura Ungar of The Associated Press.