Deployment of Biden administration’s rapid tests not easily reaching those who need them most

Last week, the Biden administration launched two programs aimed at putting rapid COVID tests in the hands of every American. But the design of the two efforts disadvantages people who already face the biggest hurdles in testing.

From the limit on test orders to the languages ​​available on websites, the programs miss out on many people who don’t speak English or have no internet access, as well as those who live in multi-family households. All of these obstacles are more common for non-white Americans, who have also been hit the hardest by COVID. The White House told KHN it would address those issues, but did not elaborate.

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He launched a federally run website on January 18 where people can order free tests sent directly to their homes. But there is a limit of four tests per household. Many homes could quickly exceed their allowances — more than a third of Hispanic Americans and about a quarter of Asian and Black Americans live in households with at least five residents, according to an analysis of Census Bureau data by KFF. Only 17% of white Americans live in these large groups.

“There are challenges they have to work on for sure,” said Dr. George Benjamin, executive director of the American Public Health Association.

In addition, since January 15, the federal government has required private insurers to reimburse consumers who purchase rapid tests.

When the federal website – with orders fulfilled and shipped through the United States Postal Service – went live this week, the first wave of registrations revealed serious problems.

Some people who live in multi-family residences, such as condos, dorms and houses divided into apartments, have reported on social media that if a resident has already ordered tests to their address, the website does not allow a second person to place an order.

“They are going to have to figure out how to solve it when several families live in the same accommodation and each member of the family needs at least one test. I don’t know the answer to that question yet,” Benjamin said.

USPS spokesman David Partenheimer said that while this only appears to be an issue for a small portion of orders, people experiencing the issue should file a complaint. service request or contact support at 1-800-ASK-USPS.

A White House official said 20% of shipments will be directed to people living in vulnerable ZIP codes each day, as determined by the Centers for Disease Control and Prevention. social vulnerability index, which identifies the communities most in need of resources.

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Another potential hurdle: Currently, only those with internet access can order the free rapid tests directly to their homes. Although some people can access the website on smartphones, online-only access could still exclude millions of Americans: 27% of Native American households and 20% of black households do not have an Internet subscription, according to a Census Bureau KHN analysis. The data.

The federal website is currently only available in English, Spanish and Chinese.

According to the White House, a hotline is also being launched to alleviate these types of issues. An assistant said it should be operational by January 21. But details are pending on hours of operation and whether translators will be available for non-English speakers.

However, the website reaches a group left behind in the initial rollout of the vaccine: blind and visually impaired Americans who use screen-reading technology. Jared Smith, associate director of WebAIM, a nonprofit web accessibility organization, said the federal site “is very accessible. I see very few finicky little things that I could change. »

The Biden administration has stressed that people have options beyond the rapid test website. There are free federal testing locations, for example, as well as testing capabilities at homeless shelters and other gathering places.

Many Americans with private health plans could get help with the cost of testing from the Biden administration’s reimbursement directive. In the days following its unveiling, insurers said they moved quickly to implement the federal requirements. But the new systems have proven difficult to navigate.

Consumers can get rapid tests – up to eight per month are covered – at retail stores and pharmacies. If the store is part of their health plan’s rapid testing network, the test is free. Otherwise, they can buy it and ask for a refund.

The program does not cover the 61 million beneficiaries who receive health care through Medicare, nor the estimated 31 million people who are uninsured. Medicaid and the Children’s Health Insurance Program are required to cover rapid home tests, but the rules for these programs vary by state.

And the steps involved are complicated.

First, consumers must determine which retailers partner with their health plans, then pick up the tests at the pharmacy counter. As of January 19, however, only a few insurance companies had implemented this direct purchase option – and almost all major participating pharmacies had sold eligible rapid tests.

Instead, Americans must research and purchase rapid tests themselves, then send receipts to their insurers.

Many of the nation’s largest insurance companies provide paper forms that customers must print, complete, and mail in along with a receipt and a copy of the box’s product code. Only a few, including UnitedHealthcare and Anthem, offer online submission options. Highmark, one of the largest subsidiaries of Blue Cross and Blue Shield, for example, has 16 step instructions for its online submission process which involves printing a PDF form, signing it, scanning it and uploading it to its portal.

Nearly one in four households does not own a desktop or laptop computer, according to the Census Bureau. Half of American households where no adult speaks English have no computers.

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A KHN reporter checked the websites of several large private insurers and found no information from any of them about alternatives for customers who don’t have a computer, don’t speak English or don’t cannot access the forms due to a disability.

Spokespersons for UnitedHealthcare and CareFirst said members can call their customer service lines for help with translating or submitting receipts. Several other major insurance companies did not respond to questions.

Once people go through the submission process, the wait begins. A month or more after a claim is processed, most insurers send a check in the mail covering the costs.

And that leads to another wrinkle. Not everyone can easily deposit a check. About 1 in 7 black households and 1 in 8 Hispanic households do not have a checking or savings account, compared to 1 in 40 white households, according to a federal report. Americans with disabilities are also particularly likely to be “unbanked.” They would have to pay high fees at check cashing stores to claim their money.

“It’s extremely important that we do the testing, but this program has limitations,” said Dr Utibe Essein, assistant professor of medicine at the University of Pittsburgh School of Medicine. “These challenges in getting tested for people with language barriers or who are homeless are unfortunately the same disparities we see with other health conditions.”

KHN Midwest correspondent Lauren Weber contributed to this report.

This article was originally published by Kaiser Health News on January 20, 2022.

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