By Hannah Recht and Victoria Knight -
KHN
The Biden Administration has just launched two programs that aim to put rapid COVID-19 tests in the hands of all Americans.
But the design of both efforts disadvantages people who already face the biggest barriers to getting them.
From the cap on trial orders to the languages available on web pages, the programs can leave out many people who don't speak English or don't have access to the internet, as well as those who live in multi-generational households.
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All of these barriers are more common for non-Caucasian Americans, who have also been hit the hardest by COVID-19.
The White House told KHN that it will address these issues, but did not elaborate.
On Jan. 18, it launched a federally run website where people can order free tests delivered directly to their homes.
But there is a limit of four tests per household.
Many households could quickly outgrow that need: More than a third of Hispanic Americans, and more than a quarter of Asian and African Americans live in households with at least five residents, according to a KFF analysis of Census Bureau data.
Only 17% of non-Hispanic white Americans live in large groups.
"There are challenges that they have to work on for sure," said Dr. Georges Benjamin, executive director of the American Public Health Association.
Also, as of January 15, the federal government requires private insurers to reimburse consumers who purchase rapid tests.
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When the federal website, with orders placed and shipped through the United States Postal Service, went live, the first wave of requests exposed serious problems.
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Some people who live in multi-family residences, such as condos, college dorms, and split-apartment houses, reported on social media that if a resident had already ordered tests at their address, the website wouldn't allow a second person to order tests. .
“They will have to figure out how to solve it when there are multiple families living in the same house and each member of the family needs at least one test.
I still don't know the answer to that," Benjamin said.
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USPS spokesman David Partenheimer said that while this appears to be an issue for only a small portion of orders, people who encounter this issue should file a service request or call 1-800-ASK-USPS.
A White House official said 20% of shipments will reach people living in vulnerable ZIP codes each day, as determined by the Centers for Disease Control and Prevention's Social Vulnerability Index. acronym in English), which identifies communities that need more resources.
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 from their cell phones, 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 KHN analysis of Census Bureau data.
Currently, the federal website is only available in English, Spanish, and Chinese.
According to the White House, a hotline is also being launched to alleviate these types of problems.
An attendee said it is expected to be up and running on January 21.
But it is not yet known whether translators will be available for non-English speakers.
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However, the website is reaching a group that was left behind in the initial rollout of the vaccine: blind and low-vision Americans who use screen-reading technology.
Jared Smith, associate director of WebAIM, a nonprofit organization that promotes Internet access, said the federal site “is very accessible.
I only see a few small things that I could modify.”
City of Youngstown Health Department worker Faith Terreri grabs two COVID-19 test kits to hand out during a distribution event, Dec. 30, 2021, in Youngstown, Ohio.David Dermer/AP
The Biden Administration emphasized that people have options beyond the website to receive rapid tests.
There are free federal testing sites, for example, as well as testing capacity at homeless shelters and other community settings.
Many Americans with private health plans could get help with the cost of testing because of the Biden Administration's reimbursement directive.
In the days since its filing, insurers said they have moved quickly to implement the federal requirements.
But the new systems have proven difficult to navigate.
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Consumers can get rapid tests (up to eight per month are covered) at retail stores and pharmacies.
If the store is part of your health plan's rapid testing network, it will be free.
If not, they can buy it and request 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 those programs vary by state.
And the steps to follow are complicated.
First, consumers should find out which retailers partner with their health plans, and then pick up the evidence from the pharmacy.
However, as of January 19, only a few insurers had established that direct purchase option, and rapid tests were sold out at almost all major participating pharmacies.
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Instead, Americans are left to track down and purchase rapid tests on their own, then submit receipts to their insurance providers.
Many of the nation's largest insurers provide paper forms that customers must print, complete, and mail in along with a receipt and a copy of the product code from the box.
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Only a few, including UnitedHealthcare and Anthem, have online shipping options.
For example, Highmark, one of the largest Blue Cross and Blue Shield affiliates, has 16-step instructions for their online submission process, which involves printing a PDF form, signing it, scanning it, and uploading it to their portal.
Nearly one in 4 households does not have a desktop or laptop computer, according to the Census Bureau.
Half of American households where no adult speaks English do not have computers.
A KHN reporter checked the websites of several major private insurers and found no information from any of them about alternatives for customers who don't have computers, don't speak English, or can't access forms because of a disability.
Spokespeople for UnitedHealthcare and CareFirst said members can call their customer service lines for help translating or mailing receipts.
Several other large insurance companies did not respond to questions.
Once people go through the introduction process, the wait begins.
A month or more after a claim is processed, most insurers mail a check that covers the costs.
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And that leads to another barrier.
Not everyone can easily deposit a check.
About one in 7 black and one in 8 Hispanic households do not have checking or savings accounts, compared to one in 40 white households, according to a federal report.
Americans with disabilities are also especially likely to be unbanked.
They would have to pay high fees at check cashing stores to claim their money.
“It is critically important that we test ourselves, but this program has limitations,” said Dr. Utibe Essein, an assistant professor of medicine at the University of Pittsburgh School of Medicine.
"These challenges around testing people with language barriers or who are homeless are unfortunately the same drivers of disparities that we see with other health conditions."
KHN Midwest correspondent Lauren Weber contributed to this article.
KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth journalism on health issues. Along with Policy Analysis and Surveys, KHN is one of the three main programs of KFF. KFF is a nonprofit organization that provides health information to the nation.