You are using an outdated browser.
Please upgrade your browser
and improve your visit to our site.
Skip Navigation

Covid Patients Are Receiving Eye-Popping Bills. It’s Not All Trump’s Fault.

His plan to help with hospital charges is poorly designed. But even a well-crafted plan would have been no match for our inept health care system.

Mandel Ngan/Getty Images

Stop the presses: A Trump administration program is being badly run and failing to do what it promised. It may be shocking, but it’s true; collect yourself from the floor and steel yourself to read about this unforeseeable turn of events, courtesy of a New York Times article on the administration’s bungled program to pay for the hospital bills of uninsured coronavirus patients. According to the Times, the program has not prevented uninsured Americans from receiving massive bills for their care, either because they don’t qualify for the program or because of those ever-present mistakes in hospital billing. Beyond that, many patients simply don’t know that this program even exists. But for all the real and unnecessary failures of this scheme, it bears noting that no hastily developed program of this nature would have successfully guided needy patients over the cracks in our health care system. It was destined to fail—no matter who was president.

All the same, let’s be clear about Trump’s hospital repayment plan, which was awkwardly rolled out in early April: The program is terrible, cruelly managed, and poorly thought-out, on top of all the underlying problems of our health care system. As the Times noted, patients had to have Covid-19 as their “primary diagnosis” to qualify, leaving out many patients with the kinds of comorbidities that made them more likely to be hospitalized in the first place; the program also doesn’t cover the cost of treating those preexisting conditions. The American Hospital Association told the paper it estimates that up to 70 percent of uninsured patients don’t qualify because of this wrinkle. This could have been done differently, and wasn’t.

But many of the biggest problems with this program were simply the inevitable consequences of our health care system, working as intended. Scratch a little at every aspect of how Trump’s program works, and it reveals yet another inefficient, cruel, or just plain stupid facet of how America provides care to its citizens. The basic fact that it was even necessary to create a program to cover uninsured people in the first place is the biggest possible indictment of our system.

The fact that hospitals, in addition to patients, have to eat the cost of treating their uninsured patients was a routine problem with our system long before the need for a Covid-19 stopgap became necessary; that many hospitals have chosen to bill their patients for amounts they’ll never be able to pay is even worse. Other health care providers have even entirely shunned participation in the program, instead charging the uninsured full price for coronavirus testing. According to the Times, most of the $115 billion spent so far by the Provider Relief Fund has instead been used to replace lost revenue from the decline in patients seeking care during the pandemic, not to pay for the cost of Covid-19 treatment. Again, it does not need to be this way: In other countries, hospitals do not go out of business because not enough patients get sick. Hospitals should not need to try to attract patients the way a Denny’s attracts diners with its “Signature Slams.”

The true horror of this failed Covid-19 coverage program is that all of its failures and gaps just leave the American health care system working in its normal, inept state. The frightening stories relayed by patients to the Times of their experience with this coronavirus program are exactly the kind of conversations that have happened every day for uninsured patients with other conditions for decades. One patient, whose Covid-19 bill totaled $85,000, told the paper that the hospital’s financial aid office “wanted me to go back to work, like, tomorrow, so I can start paying them.” In this case, seemingly thanks to the Times’ intervention, the hospital acknowledged the bill was sent “in error” and will be covered by the program. But what if the patient in question was one of many whose primary diagnosis wasn’t Covid-19, or who simply had an entirely different illness? If the patient had been hospitalized for a stroke instead, the government wouldn’t be there to save him, and he would be alone with his bill and a voice on the other end of the phone telling him to suck it up and get back to work.

Hospitals make mistakes in billing every day, and it’s often the patients who end up paying for them. This is a natural consequence of a system with so many confusing layers and moving parts, and it was undoubtedly inevitable that this would affect uninsured Covid-19 patients, however this program was managed. There are thousands of different insurance plans, with different benefit levels, and each will pay the hospital different amounts. Large hospitals might have literally hundreds of millions of different price points for all the insurance plans they accept. For patients to receive the correct bill that only reflects the money they actually owe requires many people to do their jobs right. And even a “correct” bill might include charges that are essentially fraudulent, yet entirely legal. If mistakes are made, the patient has to understand the bill and have the knowledge, resources, and time to challenge it. And imagine having to fight over a hospital bill while recuperating from Covid-19—or any similar lingering, debilitating illness, for that matter.

As an example: At the beginning of 2018, I switched insurance plans from one with a deductible to one without (and with higher premiums; I have no idea whether that decision really saved me money). When I went to the neurologist for a routine appointment, I was told I had to pay several hundred dollars on the spot, because the hospital didn’t know my benefit levels had changed and it thought I owed money for the deductible. It took weeks and several calls to the hospital and my insurance company to get the money back. If I didn’t have a credit card to put that charge on or money in my bank account to cover it—if I was like millions of Americans, in other words—I would have had little choice but to leave, and not receive the care I needed. There are undoubtedly thousands of worse instances of this every day; this is just one example of how even financially comfortable people with fancy, employer-provided insurance can get unexpectedly buffeted by this patchwork system.

Being poor in America requires constant negotiation with dumb, hostile bureaucracies. You are expected to have all your documents, to never miss a piece of mail at an address you might have left or a phone call to a disconnected number. You must have everything at your disposal to fight for the benefits that the government owes you. If they make a mistake, you pay, not them—in time spent rectifying it, in debts and interest incurred, in stress and anxiety. The more money you have, the less time and effort you have to devote to these nightmarish exercises, and the more options you have to fight them. This is routine, daily, expected in America: It was never going to be any other way for the nation’s uninsured. We were never going to do anything other than let them down, pandemic or no.

The failures of this program are unsurprising, not just because it was the Trump administration running it, and not just because it was poorly designed in the first place: The system to which it was haphazardly appended was already so broken and so prone to cruelty that its absorption into the larger failures of our health care system was inevitable. American health care is working as intended when it sends uninsured patients bills for the crime of surviving Covid-19; not because anyone designed our system this way on purpose, but because each tiny part of this system has been engineered to deliver profit-raking, above all else. No one has shown the will to rectify this situation yet, and in all likelihood the one good thing about Trump’s program—the way it has clearly illuminated these larger problems—will never benefit anyone. We have chosen this situation, with all the cruelty and stupidity it entails.