As COVID-19 maintenance grows more individualistic, the uninsured find themselves in a familiar situation
It might seem like COVID-19 is over in Wyoming. It's true that transmission and hospitalizations have dropped, but people are still getting sick. Vaccines and tests are still a vital part of dealing with this public health problem. In Wyoming, it's still possible to get tests for free, but COVID maintenance could be getting pricier for many people.
The entirety of COVID-related healthcare - from testing to treatment to vaccines - has been offered free of charge to most Americans since the beginning of the pandemic.
But now, the way we handle COVID could start to look more like the way we handle the flu - with less government support for testing and treatment, and a focus on "personal responsibility."
That means there will be differences between the healthcare available to people with insurance, and the healthcare available to people without insurance.
Krutika Amin with the Kaiser Family Foundation said COVID will be treated like every other health issue in America. The pandemic, she said, has been hard on everyone and often unpredictable.
"One of the things that has helped is that people have been able to get tests for free, and also get vaccines for free so they can keep themselves and their community members safe," Amin said. "So, as the public health emergency winds down, some of these gaps in our healthcare system that have not been addressed pop up again."
Since the early days of the pandemic, the federal government has required insurance companies to cover COVID testing for their members. Meanwhile, uninsured people were covered directly by the federal government. That meant that no one - insured or uninsured - was paying for personal COVID testing.
Now, that pool of money has run out. Uninsured people will no longer automatically be covered by the federal government if they go to a clinic or hospital for testing.
People with insurance, on the other hand, can still get COVID tests for free, but Amin said that might not last.
"The requirement that insurance companies cover COVID tests is tied to the public health emergency," Amin said. "So, when the public health emergency ends, the insurers could begin charging cost-sharing for COVID tests or otherwise limiting access to COVID tests."
The federal government also requires insurance companies to cover vaccines recommended by the CDC, like the flu and MMR vaccines, and now COVID vaccines. So insured people will continue to receive free vaccines and boosters, as long as they go to in-network providers.
But Amin said the federal government has run out of funds to cover uninsured people.
"It's unlikely that the federal government would be able to take on the cost of COVID-19 vaccines for uninsured people - so they might get charged for those," Amin said.
That's grim news for the uninsured. But at least when it comes to testing, there are still some free options.
"The Vault tests are saliva tests and they are still currently available," said Wyoming State Health Officer Alexia Harrist. "Individuals can go to our website and order them for free. They're shipped to your house and then they are taken with a provider over Zoom and then they're shipped back to the Vault laboratory for testing."
The Vault tests are offered through the state. You can also order free at-home rapid tests through the federal government - a total of eight per household.
Harrist suggests ordering those now.
"I would encourage everyone to do that and have those tests at your house, to be available if you do feel sick, so you don't have to wait until you are symptomatic to then order them and wait for them to be shipped," Harrist said. "For the Vault test, that's certainly not a bad idea to have a couple on hand. I would pay attention - for both of these types of tests - to expiration dates. If they are expired then the test will not be valid."
While these state and federal programs last, insured and uninsured alike will be able to test for free at home. Harrist and other health authorities suggest testing when you feel sick, and of course following vaccine recommendations from the CDC for your age and risk categories.
But being COVID-safe will definitely be more expensive for uninsured individuals, and probably more expensive for individuals with insurance once insurance companies are freed up to introduce cost-sharing.
University of Wyoming public health expert Christine Porter said this approach leads to worse health outcomes. If we as a society want people to be safe, Porter said, we shouldn't put up financial barriers.
"The reason the U.S. has the highest death rate from COVID in the developed world is our individualistic approach," she said. "We've individualized health, which of course health is not. Each individual has their own health, but what maintains it or harms it we think of as being in the individual's control, but it is far from that."
The nation's response to COVID always relied, at least in part, on calls for "personal responsibility" - when it came to masking, for example. But as the federal government stops funding tests and vaccines for uninsured people, "personal responsibility" will be the name of the game.
Porter said that's not a good way to handle a pandemic or to mitigate any other threat to public health.
"We have the worst public health - period - among well-off nations," Porter said. "We have by far the highest infant mortality rate, by far the highest maternal mortality rate - even though we spend double per person on healthcare compared to the average of other rich countries."
And soon, COVID will be treated a lot more like every other health issue in the American healthcare system - something you manage and monitor yourself, with medical care you might be charged for.