DeGette, Shalala introduce legislation to make coronavirus tests free for most Americans

Mar 10, 2020
Press Release

Measure would add the test to list of preventive health services insurers are required to cover

WASHINGTON, D.C. – U.S. Reps. Diana DeGette (D-CO) and Donna Shalala (D-FL) introduced legislation today that would require health insurers to cover the full cost of coronavirus tests for any American who has health insurance through their employer, or who has purchased a health plan through the ACA exchange.

Specifically, the legislation would add the coronavirus test to the Affordable Care Act’s list of “preventive health services” that health insurers are required to cover at no cost to patients. Not only would the legislation require that health insurers provide coverage for the tests, it would also prevent them from passing on any portion of the cost to beneficiaries.

“We are on the cusp of a worldwide pandemic,” DeGette said. “In order to effectively curb the spread of this virus here in the U.S., we must increase testing immediately. No patient should hesitate getting a test done if a doctor thinks it’s necessary because of the cost. This legislation will ensure that anyone who has health insurance through their employer, or through of the ACA exchanges, can get the test done at no cost to them.”

“Our government has a responsibility to do everything it can to manage this crisis,” Shalala said. “One of the biggest barriers to addressing this emergency is figuring out how many people have been infected by COVID-19. By reassuring the public that they will not bear any out of pocket costs for testing for the virus, this bill will help us get true sense of the scale and rate of infection in the U.S. and allow the government to deploy the right measures to keep the American people safe.”

Under the terms of the Affordable Care Act, private health insurers, and those who offer health care plans through one of the ACA exchanges, are required to cover the full cost of any “preventive health service” provided to their beneficiaries. The law specifies a list of such services that insurers must cover at no cost to patients – such as annual flu shots and mammograms.

As hospitals across the country are starting to use their own tests to help ramp up the nation’s overall screening efforts, many of them will likely start billing insurers for the procedure.

By adding the coronavirus test to ACA’s list of “preventive health services,” DeGette and Shalala’s legislation will require that insurers cover the full cost of those tests.

In response to concerns about the cost of the tests, Vice President Mike Pence recently announced that the administration would seek to have the coronavirus tests deemed an “essential health benefit” under the terms of the Affordable Care Act, a move that would require insurers to provide coverage for the test but would not prevent them from passing on a portion of the cost to patients.

By deeming the test a “preventive health service”— as DeGette and Shalala’s legislation would do — insurers would be required to cover the full cost of the test and would be prohibited from passing any portion of the procedure on to consumers through cost-sharing.

DeGette, who serves as chair of the House Energy and Commerce Committee’s Oversight and Investigations panel – which oversees most of the nation’s health care system – and Shalala, who served as secretary of HHS under President Clinton, began working on the legislation after hearing from constituents who said they were concerned about how they would afford to pay for the test if they were advised to do so by a physician.

If approved, the legislation would ensure that the nearly 178 million Americans who currently have health insurance through their employer, and an additional 11 million Americans who purchased health insurance through the ACA exchange, can get tested for the virus at no cost to them, if the need were to arise.

To enable the legislation to take effect immediately upon being signed into law, the measure includes a provision that would exempt the coronavirus test from the one-year waiting period that new preventive health services must undergo before insurers are required to cover them under the ACA. Instead, the legislation would require that health insurers cover the full cost of any tests performed after the bill is enacted.

While more than half of all Americans have health insurance either through their employer or through one of the ACA’s health exchanges, millions more do not – including those who are covered under one of the government-run health care plans – such as Medicare or Medicaid – and those who don’t have any coverage at all.

Medicare, which provides health care coverage for Americans 65 year of age and older, announced recently that it will cover the cost of any coronavirus test ordered by a physician.

The decision on whether to cover the cost of the test provided to patients on Medicaid, the government-run health care plan for low-income Americans, will be up to each individual state.

While the Centers for Medicare and Medicaid recently created a new billing code for hospitals to use to bill for the coronavirus tests, the agency has not yet set a price for the procedure.

The lawmakers said Tuesday that now that the measure has been introduced, they are working to have it included in any future coronavirus-related legislation Congress takes up in the coming weeks.

A copy of the legislation is available here.