Dr. Adam Gaffney is worried.
Massachusetts is shutting most of its free COVID-19 testing sites in the coming days and the federal government will no longer pay for COVID care and vaccinations for the uninsured.
While the winter’s blizzard of Omicron cases may be a fading memory for those who have peeled off their masks and moved on with their lives, the risk of COVID infection and serious complications for others remains all too real. There are still hundreds of new infections reported every day in Massachusetts, with those with chronic health problems, a weakened immune system, or not fully vaccinated or boosted most vulnerable to serious illness.
Now, Gaffney fears the new cuts will mean that many lower-income patients here and around the country who fall seriously ill with COVID may face huge bills they cannot afford. Or worse, they may just forgo care.
“These measures did a lot and made it more equitable for so many,” said Gaffney, a critical care physician and assistant professor at Harvard Medical School. “The pandemic is not over yet as much as we want it to be. And until it is, we need to maintain these types of supports and coverage.”
Or as he summed up his frustrations recently on Twitter: “The rationing of COVID-care by ability to pay begins.”
Gaffney’s concerns are echoed by other medical, public health, and community leaders, who say state and federal cuts to COVID-19 testing, treatment, and vaccination initiatives will widen already yawning gaps between haves and have nots. Higher infection and death rates among Black and brown communities, already a hallmark of the pandemic, will grow larger, they say, in the event of another surge.
The Baker administration, citing a sharp decline in reported infections, said on March 4 that it will shutter three-quarters of the state’s free Stop the Spread testing sites at the end of the month. That will leave 11 of 41 operating, including just two in Western Massachusetts. The sites were opened in communities hit hardest with infections and deaths through much of the pandemic.
Additionally, the Biden administration, blaming a lack of COVID funding from Congress, as of March 22 stopped paying for testing and treatments for millions of uninsured patients, including more than 200,000 in Massachusetts.
And come April 5, the federal government will cease reimbursing providers who administer vaccines to the uninsured. Federal rules prohibit providers from passing COVID vaccination costs on to patients, forcing those who care for the uninsured, typically community health centers, to find other ways to cover those costs.
“It feels like we are going to go back in time and pretending we haven’t learned what we learned in the last two years about what inequity means,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association.
“It’s not just saying there isn’t the same level of access and care. It means people will die at different rates,” Pavlos said. “It’s so disheartening.”
The cuts are being carried out as COVID cases rise in the United Kingdom and several other European countries, often a bellwether for what’s to come in the United States. At the same time, the steep decline in new cases in Massachusetts has bottomed out.
A Baker administration spokeswoman said that regardless of the cutbacks, any resident, no matter their insurance status, will still be able to get a vaccine for free at any of the eight remaining state-sponsored vaccination sites, which are located in Lynn, Danvers, Boston, Brockton, Taunton, Lowell, Barnstable, and Springfield, as well as at local health departments.
While the Baker administration is closing most of its free COVID testing sites, it said it has recently distributed 10 million free at-home COVID tests to schools, day cares, shelters, immigration-focused community organizations, and other settings.
The traffic through Massachusetts free Stop the Spread COVID testing sites continues to decline, and the 11 sites that will remain open now account for more than 70 percent of traffic at the state-funded free sites, the administration said.
There are still hundreds of other sites that perform COVID tests in Massachusetts, but most require an appointment, often a hurdle for people in low-wage jobs who can’t easily schedule time off from work.
“The Baker-Polito Administration is analyzing the impacts of this lapse in federal funding, but regardless, the people of Massachusetts have tools to keep themselves and their loved ones safe from COVID-19 including therapeutics, vaccines, and widely available testing,” the administration said in a statement.
But what’s considered widely available to some is not to others.
“While rapid tests are available widely, it’s not as easy for people to understand how to use them, and I’m worried that we won’t have an infrastructure for [traditional] PCR testing to scale back up in an upcoming surge in the fall,” said Phoebe Walker, director of Franklin County’s Cooperative Public Health Service, which includes 16 communities.
A new study from a team of Boston researchers and the US Centers for Disease Control and Prevention backs up growing concerns about equity and the use of rapid COVID-19 at-home tests.
In online surveys of more than 400,000 adults nationwide between last August and mid-March, the researchers found that white people were approximately twice as likely to report using the at-home tests as those who are Black. The gap was smaller but still measurable when comparing white respondents with those who are Hispanic, Asian, or a member of other minority groups.
The researchers also found that people in households making $150,000 or more were more than twice as likely to report using the tests as those making half that amount. Similarly, those with a postgraduate degree were more than twice as likely to have used at-home tests, compared to those who said they had a high school degree or less.
Dinanyili Paulino, chief operating officer of La Colaborativa, a social services agency in Chelsea, said many people who seek help from her organization have not yet received free at-home tests.
“These are people working under the table ... and for $15 or $20, do you think they are going to buy a test and wait to be reimbursed, or buy rice and beans,” she asked. “Or they don’t have insurance, or they don’t have access to technology to get the reimbursement.”
Paulino said it’s not uncommon for people in the largely Hispanic community to be bewildered by the complex instructions that come with the tests, even though they often are written in English and Spanish.
“People come into La Colaborativa with the instructions and see if we can do it for them,” she said. “And they want us to wait with them for the results.”
Jessica Collins, executive director of the Public Health Institute of Western Massachusetts, said people aren’t clamoring for tests as much as they were during the recent Omicron surge, prompting her social service agencies to focus their attention on getting more people vaccinated.
State data show that more than three-quarters of residents are fully vaccinated, but disparities still exist among different racial and ethnic groups in many communities. In particular, those gaps are significant for booster shots. The latest data show that 60 percent of white residents have received a booster, but just 38 percent of Hispanic and 42 percent of Black people have.
Collins is concerned the state and federal cutbacks in COVID services and funding will leave Massachusetts and the country flat-footed, should there be another surge in infections and hospitalizations.
“What’s the plan for ramping back up? Will they be using an equity-based model, with people welcome to come in, no questions asked and no insurance needed?” she said. “Don’t make us refight that equity conversation.”
Community health centers are the safety net for many lower-income people, communities of color, and those without insurance who are more likely to feel the impact of the state and federal cutbacks.
Data show the centers have administered more than 900,000 COVID tests during the pandemic; nearly three-quarters of those tests were to people of color.
And of the 1 million doses of vaccines administered by the centers, two-thirds were to people of color.
Michael Curry, chief executive of the Massachusetts League of Community Health Centers, said the state has designated about $5 million in COVID reserve funds to health centers for future testing and vaccinations.
He said the centers also recently distributed 271,000 at-home test kits to patients, but developed simplified instructions in eight languages to go with them.
“As a person who is very vigilant about how we address health equity, I know if we are not prepared, we will see higher rates of hospitalization and deaths [again] in certain pockets and that absolutely concerns me,” he said
He said the growing chorus of medical and health leaders expressing concerns about the cuts to COVID services and funding is vital.
“It makes all the rest of us recalibrate and think about, are we doing the right thing?” Curry said. “I am thankful they are beating the drums about testing and access and I am listening to the drums.”