Biden's plan for free at-home Covid test could be ineffective, experts warn

WASHINGTON — President Joe Biden’s new plan to require private insurance companies to cover the cost of rapid at-home Covid-19 tests could do little to make testing more widespread, experts warn, because it is so complicated to get reimbursed.

The administration has renewed its push for access to testing as part of its preparation for a possible winter Covid surge and the unknown impact of the new omicron variant of the coronavirus.

Health experts have warned that a number of pitfalls in the proposed plan could keep people from getting tested regularly for Covid, which, along with vaccines, many say is essential to get control of the pandemic.

Biden's plan would require people with private health insurance to buy the tests first and then submit reimbursement claims to get coverage. That means people would have to pay up front, save the receipts and navigate the opaque and complicated process of submitting reimbursement claims to their health care providers.

"It could provide some relief, but it also provides barriers in order to get that relief," said Lindsey Dawson, an associate director at the Kaiser Family Foundation. "This policy alone is not going to necessarily make testing a widespread practice for everybody in the United States."

Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy, said not all families will be able to pay up front for at-home tests, which can cost more than $20. Even for people who can afford it, part of the challenge for the Biden administration will be to make people aware of the reimbursements.

Private insurance holders "may not know how to save their receipt or that their health plan will even cover it," Corlette said. "So that's almost the first step, is just making sure people know that they can now do this."

It is also unclear whether the plan will limit the number of tests people can be reimbursed for and whether there will be certain restrictions on who qualifies for reimbursement. Some experts, for example, worry that insurance providers might reimburse only tests for people who have underlying conditions or who were directly exposed to someone with Covid.

An administration official said getting a free test at one of the more than 20,000 federally supported testing sites across the U.S. is also an option.

The Biden administration has said it plans to release more details about the new policy by Jan. 15.

"All those details need to be determined, and I am not yet convinced that, at best, we will get more than one test per person," said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. "In order to reduce the number of cases we're seeing, we need to have widespread, easy and free — or near-free — access to these tests. And I'm not at all convinced that what they're proposing is going to achieve that."

The Biden administration has said the new rule will cover tests for the estimated 150 million people in the U.S. who have private insurance. The administration said it would provide 50 million free at-home tests to community health clinics and rural health care centers for those without private coverage.

Some experts have questioned why the administration would not buy tests and provide them free to everyone, as many European countries have done. Ideally, Corlette said, people in the U.S. would be able to have a handful of at-home tests available and could use them regularly to make better decisions about how they interact with their communities.

"For that to work, people need to be able to afford the tests, they need to be accessible," she said. "Ideally, you just have a stack of them sitting in your bathroom cupboard and ready to pull out any time you feel a sniffle."

Asked Monday why the White House was not pursuing a strategy that would be less complicated, press secretary Jen Psaki suggested that an alternative plan was not feasible.

"Should we just send one to every American?" Psaki said. "Then what happens if you — if every American has one test? How much does that cost, and then what happens after that?"

Nuzzo said she found Psaki's response troubling.

"If you're dismissing the idea that every American gets a test as too expensive, what is this insurance policy actually going to amount to?" she asked. "It just made me feel like this policy was window dressing."

Psaki later tweeted that the administration's objective was to make Covid tests "less expensive and more accessible," adding that "we absolutely recognize that this is a key component of fighting the virus."