For example, a box of 100 gloves that cost $239 in February 2020 is now $30. Dr. Judee Tippett-Whyte, president of the California Dental Association, has a private dentist practice in Stockton. Her practice relies on dental and medical supply, which cost 20 cents each but can be upgraded to N95 masks for $2.50 each. Treating patients in Virginia was expensive during the pandemic, but doctors and dentists are not responsible for those costs.
Tippett-Whyte’s argument raises the fundamental question of who should pay for pandemic costs. California dentists and doctors are lobbying insurance companies that are lavished with premium money during the pandemic to settle claims on the usual footing, and the California Medical Association representing doctors has sponsored legislation that would require insurers to reimburse medical and dental practices for related expenses such as personal protective equipment, disinfectants and staff time needed to screen patients for symptoms before and after appointments. “We bear a lot of financial costs,” she says, “and we should not bear the costs of dental and medical supply ourselves.
Insurance companies oppose the measure. Applications from doctors for Medicaid and Medicare coverage and pandemic-related costs have failed at the federal level. The Washington law, backed by the physician lobby, would require private health insurers to reimburse some of those costs. According to Mary Ellen Grant, spokeswoman for the California Association of Health Plans, reimbursement of non-medical costs is not the responsibility of insurers.
In April 2020, the Department of Health distributed $9.9 billion to 50,000 California medical providers through the Provider Relief Fund, including $1.78 billion. The insurance industry has warned that doctors and dentists cannot fend off the costs of PSA and pandemics alone. In a letter, insurance groups objected to California’s Point of Assistance, which provides payments from federal insurance claims to insurance plans, as well as state grants and loan programs that distribute free PSA to practices. More than 900,000 companies in the health care social assistance category, including doctors’ offices, dentists, and paycheck protection programs, have been loaned by the Small Business Administration since March 2020. Treatment centers have stabilized to pre-pandemic levels.
They will have enough feds to cover the costs, Grant said. Allison Hoffman, a professor of research and health policy at the University of Pennsylvania School of Law, sympathizes with health insurance companies that make a fortune each year collecting premiums to pay for a typical number of treatments and doctor visits. Health insurance margins and profits soared during the pandemic, driving up premiums for non-urgent medical care from patients.
In the late years, the American Medical Association lobbied the federal Centers for Medicare and Medicaid Services to approve codes of practice for physicians under the Public Insurance Program (PSA) for disinfecting materials, refurbishing offices, and instructing patients and staff to treat and verify symptoms. Admitting doctors without following infection control protocols would reduce revenue, the AMA wrote to federal agencies. Starting with a broad definition of what health insurance pays to keep people healthy, Hoffman sheds light on the fact that it is prescription drugs and surgical procedures that improve health in a public-health emergency.
The CMS declined a request to consider paying the cost for the rest of the appointment, according to an agency spokesman. In the wake of that decision, so did the medical profession itself.
California’s legislative debate has been more open than Washington’s. SB 242 is not about dollars, but about requiring private health plans that are regulated to reimburse dental offices and doctor’s offices for necessary business expenses during a public health emergency. The Washington Medical Association supported the law on April 16 after health care providers and government-regulated private insurers provided 657 patients and personal billing services to cover the cost of additional PPE, staffing time, and materials to conduct and transport COVID tests. Before the bill, doctors’ unions sat on both sides of the bargaining table but were uncontroversial when Sen. David Frockt (D-Seattle) introduced the bill.
Revenue from California physician associations “practices fell by a third, and PSA costs increased by 14% through October 2020, according to a membership survey in the month before the pandemic. Record profits for listed companies, even if shown to shareholders, are “a drop in the ocean” for health insurers, association spokesman Anthony York said. Dental and medical supply are a large chunk of expenses for individual practices and whole hospital systems.
We are surprised that the plan does not pay for the fight we are waging in the legislature. Conceived by Sen. Josh Newman (D-Fullerton) for small and medium-sized practices that are closing their doors in the face of rising costs. Mr. Newman called on lawmakers to offset burdensome costs and not lose doctors and practices, as he did because that would be a disgrace to communities that lose access to health care.