Editor’s note: This commentary is by Deb Richter, M.D., who is president of Vermont Health Care for All. It was written before the discovery of a coronavirus case in Vermont.
Dear Gov. Scott:
As you know, cases of novel coronavirus have now been confirmed in nearby New York, Rhode Island and New Hampshire. We all recognize that the rapid spread of this virus constitutes an immediate public health emergency for which the state of Vermont must be ready. We commend you for your efforts in preparing for a possible outbreak in Vermont.
In thinking about the risk of this disease, it becomes apparent that the ability to care for people who become sick, and to contain the spread of the virus, cannot be adequately accomplished without attention to social and financial factors affecting Vermonters and their access to health care services. It is troubling to imagine people with symptoms of coronavirus delaying access to care because of lack of insurance or high deductibles and co-pays. Delayed diagnosis could mean poorer outcomes for those individuals, and if infected people continue going to work and performing their daily activities, it almost certainly will result in an accelerated spread of the virus.
To address some of these important social and financial factors, we urge you to ask for an emergency legislative appropriation of funds to safeguard the public health. This appropriation would be used to:
• Waive all costs or cost sharing for primary care office visits for individuals with suspected symptoms of the coronavirus, to include anyone with flu-like symptoms.
• Waive all costs or cost sharing for diagnostic testing needed to confirm or rule out coronavirus infection for all patients with flu like symptoms, and for those who have been in contact with persons suspected of having the coronavirus.
• Waive all costs or cost sharing for uncovered, medically necessary evaluation and treatment of individuals infected with the disease, including all uncovered expenses related to hospital care or rehabilitative treatment for these patients.
• Provide income replacement and other social support for persons who are quarantined in health care facilities or who are quarantined at home.
• Provide income replacement to parents or other caregivers who cannot go to work because their children must stay home because of school or child care closures.
We envision a portion of this appropriation being used to pay providers who would otherwise charge patients directly for services not covered by insurance. Alternatively, hospitals with significant financial reserves could be required through legislation to provide charity care to coronavirus patients.
The availability of these services to all Vermonters without cost to them should be widely publicized as soon as the state implements its coronavirus action plan, so that all residents know what is available and are therefore not deterred from seeking care and complying with quarantine orders. Unless the state can assure Vermonters they will not incur significant and unsustainable expense, the best efforts to minimize the spread of coronavirus may prove inadequate.
