<figure>
 <img src="https://media.eaglewebservices.com/public/2020/4/1587758501245.png" alt="Face masks that Derby resident Melissa Dodge uses to protect herself at her grocery store job. Dodge has no health insurance. Melissa Dodge / Submitted" />
 <figcaption>Face masks that Derby resident Melissa Dodge uses to protect herself at her grocery store job. Dodge has no health insurance. Melissa Dodge / Submitted</figcaption>
 </figure>By CELIA LLOPIS-JEPSEN <a href="https://www.kcur.org/news/2020-04-24/new-federal-laws-may-not-protect-uninsured-coronavirus-patients-as-hoped">Kansas News Service</a>The small crew of health care workers at Guadalupe Clinic in Wichita —
 aided by dozens more who volunteer there — sees nearly 2,000 people a 
year.Every one of them is uninsured, and all visits are free.<a href="https://guadalupeclinic.org/" target="_blank">Guadalupe</a>
 can’t yet check patients for COVID-19. But emergency federal 
legislation might help the nonprofit roll out that service to the 
low-income neighborhoods it serves.“Our patients live in small 
apartments, small houses,” where COVID-19 can spread quickly, executive 
director J.V. Johnston said. “So testing would be important for us.”Stimulus funds promise to cover coronavirus testing and treatment for the uninsured.Still, benefits for the <a href="https://www.khi.org/assets/uploads/news/14956/khi-health-insurance-info-2018-web.pdf" target="_blank">250,000 people</a> without health insurance in Kansas remain unclear. Experts see potential <a href="http://chirblog.org/expanded-coverage-for-covid-19-testing/" target="_blank">loopholes</a>
 in the new federal laws and policies that could risk leaving people on 
the hook for hundreds, even tens of thousands, of dollars for hospital 
stays.And while the Trump administration says the offer to help 
will stop when funding runs out, it has yet to say how much money it’ll 
spend.The confusion could keep many sick people from seeking care. At the same time, the uninsured often work essential jobs that don’t give them the luxury of hiding from the virus at home.“This
 crisis is exposing big gaping holes in our health care system,” said 
Sabrina Corlette, a professor at the Georgetown University Center on 
Health Insurance Reforms. “When we have a public health crisis like this
 … the last thing you want is someone to hesitate to get tested and 
treated.”<h2>Help on the way</h2>The <a href="https://www.kff.org/uninsured/issue-brief/estimated-cost-of-treating-the-uninsured-hospitalized-with-covid-19/?utm_campaign=KFF-2020-Uninsured&amp;utm_source=hs_email&amp;utm_medium=email&amp;utm_content=2&amp;_hsenc=p2ANqtz-_a29TEiXmBg8w1NSN1RHzrL0AkB3b_c4oM2hMy5UgzCOCHSGxOjD-D1JifL7SXWGLjLy73365xrpw86-gHFg1k_gKuWw&amp;_hsmi=2" target="_blank">Kaiser Family Foundation</a> estimates coronavirus could put between 670,000 and 2 million uninsured people in the hospital nationwide.The uninsured may <a href="https://www.kff.org/uninsured/fact-sheet/what-issues-will-uninsured-people-face-with-testing-and-treatment-for-covid-19/" target="_blank">face a higher risk</a> of contracting the novel coronavirus because so many work face-to-face jobs, such as cashiering and housekeeping.Two stimulus bills passed by Congress in March should benefit people without health coverage.The Families First Coronavirus Response Act gives states the option of covering <a href="https://www.healthaffairs.org/do/10.1377/hblog20200413.783118/full/" target="_blank">COVID-19 testing</a> for the uninsured through Medicaid. That would include both the lab work and the office visit for the patient.But it wouldn’t help with coronavirus treatment,
 which can total daunting sums. Kaiser and the Peterson Center on 
Healthcare estimate inpatient bills for a serious case of COVID-19 <a href="https://www.healthsystemtracker.org/brief/potential-costs-of-coronavirus-treatment-for-people-with-employer-coverage/" target="_blank">could top $20,000</a> even when people do have job-based health plans that negotiate down the prices.The
 Trump administration came under fire to act. It has declined to reopen 
access to the Obamacare exchange but vowed instead to use money in 
another stimulus bill, the CARES Act, to reimburse hospitals at Medicare
 rates for treating the uninsured.Kaiser initially estimated that could use up <a href="https://www.kff.org/uninsured/issue-brief/estimated-cost-of-treating-the-uninsured-hospitalized-with-covid-19/?utm_campaign=KFF-2020-Uninsured&amp;utm_source=hs_email&amp;utm_medium=email&amp;utm_content=2&amp;_hsenc=p2ANqtz-_a29TEiXmBg8w1NSN1RHzrL0AkB3b_c4oM2hMy5UgzCOCHSGxOjD-D1JifL7SXWGLjLy73365xrpw86-gHFg1k_gKuWw&amp;_hsmi=2" target="_blank">between $13.9 billion and $41.8 billion</a>
 of a $100 billion portion of the CARES Act meant to help hospitals cope
 with the pandemic. Now that the Trump administration has said the money
 would also go for care beyond hospital admissions, Kaiser says the plan
 could use up <a href="https://www.kff.org/coronavirus-policy-watch/update-on-covid-19-funding-for-hospitals-and-other-providers/" target="_blank">even more funds</a>.This
 has sparked some controversy among health care providers worried the 
dollars won’t stretch, Kaiser senior fellow Karyn Schwartz says.“That’s less money that’s available to help them buy protective equipment for their staff,” she said.The
 White House and Congress have since agreed to add $75 billion for 
health care providers to weather the storm. But the administration has 
yet to say how much CARES money it will set aside for the uninsured — 
while making clear that help will stop if that unspecified amount of 
money runs out.<h2>Waiting to hear more</h2>The typical 
patient at Guadalupe cobbles together paychecks from various part-time 
jobs that don’t offer health coverage, said Johnston, the clinic’s 
executive director.As the pandemic costs people their jobs, he expects more will likely need help.“If they have no income,” he said, “they're going to buy food and pay their rent before they pay their health insurance.”Johnston
 is eager to learn how reimbursement for testing will work, and whether 
Guadalupe can participate. The money will flow through state Medicaid 
programs, and his donation-funded clinic has never billed Medicaid 
before because it only sees the uninsured.“So it’s (up) in the air now,” he said, “but hopefully that’s the case.”Like other states, Kansas is still working out the kinks of this unprecedented use of its Medicaid program.As
 of late April, the Centers for Medicare and Medicaid Services said it 
had only approved two states to cover coronavirus testing for the 
uninsured.Once Kansas clears that same hurdle, CMS said in an 
email, Medicaid could kick in retroactively, for tests conducted no 
earlier than March 18 (when the new law <a href="https://www.congress.gov/bill/116th-congress/house-bill/6201/text" target="_blank">took effect</a>).<h2>Risk for surprise bills</h2>Even bigger questions remain about how billing will work for the far costlier treatment of COVID-19.The CARES Act contains provisions meant to <a href="https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html" target="_blank">prevent “surprise bills”</a> — when a hospital or a doctor charges patients for more money directly beyond what health plans pay.But
 several health insurance experts studying the act expressed concern 
that it shields uninsured patients from hospital charges without 
protecting them against independent billers under the same roof, such as
 anesthetists or emergency department staff.They have similar 
concerns about how billing will shake out when someone tests negative 
after treatment has begun. And what if, they wonder, the patient can’t 
get a coronavirus test at all and is given one for the flu instead?“We
 know due to the lack of testing capacity,” Georgetown’s Corlette said, 
“that many, if not a majority, of people who present with covid-19 
symptoms are turned away without a test. But they’re still charged for 
the visit.”<figure>
 <img src="https://media.eaglewebservices.com/public/2020/4/1587758579320.png" alt="Derby resident Melissa Dodge doesn't qualify for Medicaid, but the program does cover her children's health care." />
 <figcaption>Derby resident Melissa Dodge doesn't qualify for Medicaid, but the program does cover her children's health care.</figcaption>
 </figure>The complexity of it all — and lack of clarity — doesn’t surprise 
Katherine Hempstead, a health insurance expert at the Robert Wood 
Johnson Foundation.“We have a very complicated, highly segmented 
health care system,” she said, and now a pandemic has sent the country 
scrambling for fixes to help millions of Americans get testing and 
treatment. “You can kind of see all these little patches that we’re 
trying to erect.”In Kansas, if those patches don’t work well — 
hampering efforts to control the coronavirus or leaving patients saddled
 with the kind of massive medical bills that drive mounting public 
frustration with American health care — it could fuel the political push
 to extend full Medicaid coverage to more low-income adults.<h2>‘A lifesaver’</h2>That includes Derby resident Melissa Dodge.She fears what <a href="https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html" target="_blank">the novel coronavirus</a>
 would mean for her 9-year-old daughter with heart and lung problems. Or
 the danger it could pose for her mother, who is over 60.But she has another worry: As a single mother caring for her four children while working part-time, she has no health insurance.“My
 anxiety was always high because I knew the financial risks” of being 
uninsured, Dodge said. “Add a new global pandemic on top of that, and 
it’s terrifying.”Dodge takes every precaution she can. When the 
pandemic hit, her employer agreed to move her shift later in the 
evenings and let her spend more of it stocking shelves — two things that
 reduce her exposure to other people.When she gets home past 
midnight, she peels off a face mask, scrubs her hands and changes 
clothes before so much as sitting down.Though she doesn’t qualify
 for Medicaid, her children do. She has driven to Topeka before to beg 
lawmakers to give people like her the same benefit.“It's a 
lifesaver for my family,” Dodge said. Her 9-year-old has had multiple 
heart surgeries. Another of her children is autistic.But if she needs care for herself, Dodge struggles with what that debt would do to her family.“The financial aspect of COVID,” she said, “is probably one of the most unspoken scary parts of it.”Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter <a href="https://twitter.com/Celia_LJ" target="_blank">@celia_LJ</a>
 or email her at celia@kcur.org. The Kansas News Service is a
 collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public
 Radio focused on health, the social determinants of health and their 
connection to public policy.

New laws may not protect uninsured coronavirus patients as hoped