BY RENUKA RAYASAM
Presented by AT&T
Covid-19 rapid at-home test kits rest on a table at a free distribution event for those who received vaccination shots or booster shots at Union Station in Los Angeles. | Mario Tama/Getty Images
A NEW KIND OF MEDI-GAP — With Covid daily case counts three times higher than the country’s previous peak last January, the Biden administration has made testing a larger part of its pandemic strategy.
The hyped website that offers free tests directly to the door of every American is actually a small part of the administration’s plan, limited to just four tests per household. The bigger part of the testing plan includes new guidance that, starting this week, private insurers must cover the costs of eight over-the-counter rapid tests per person every month — another 32 free tests for a family of four.
But there’s a giant loophole: The at-home tests won’t be reimbursed by Medicare, which covers about 64 million people who are either 65 and older or have long-term disabilities.
About 42 percent of Medicare beneficiaries are in what’s called an Advantage plan — run by private insurers with generally broader coverage that Medicare beneficiaries can buy into — and some of them will be covered. But the Advantage plans aren’t required to cover the tests.
And if you’re one of the 58 percent of Medicare beneficiaries without an Advantage plan? You can get a test through the new website or at a clinic or doctor’s office, but you can’t get reimbursed for buying the rapid, at-home tests over the counter.
These are the Americans who are in the demographic cohort that is most vulnerable to Covid complications. This is the group with the highest Covid risk factors . People 65 and older have made up almost three-quarters of all Covid deaths during the pandemic, according to the CDC.
Medicare, including the part with the Advantage plans, is not designed to cover things that people can get over the counter, without a prescription, said Tricia Neuman, a Medicare expert at the Kaiser Family Foundation, who was recently nominated by Biden to serve on Medicare’s board of trustees. The rules-heavy program bills enrolled providers like hospitals, doctors, labs and pharmacies directly for expenses. It doesn’t reimburse patients the way a flexible spending account or a commercial insurer sometimes does.
“There is not a structure in place that is ready made for reimbursement,” she said.
The Centers for Medicare & Medicaid Services, the agency responsible for running the program, told Nightly that people in the program can get tested for free through their health care provider or one of 20,000 testing sites. Medicare covers Covid tests that are done by a lab. A doctor can order a test, making them free to Medicare patients. Some clinics are also distributing free rapid, at-home tests.
CMS is also encouraging Medicare Advantage plans to voluntarily cover the tests. But it can’t require the plans to pay for them. It’s unclear right now how many of the Advantage plans are planning to reimburse people who buy the at-home tests.
Those measures aren’t enough, some advocates and lawmakers say. Rep. Anna Eshoo (D-Calif.), chair of the Energy and Commerce Health Subcommittee, urged the Biden administration, in a letter sent Wednesday, to expand the coverage of at-home tests to Medicare beneficiaries.
“There is a bigger question about how long it will take to adopt a fix and whether it would require a change of law or whether CMS could do this on its own,” Neuman said.
No one seems to know the answer to Neuman’s question. The agency didn’t get back to Nightly about whether it could fix the issue under the Medicare statute, without new legislation.
Nor has CMS told AARP how or whether it will address the issue, said Andrew Scholnick, AARP’s senior legislative representative in government affairs.
Going to a doctor or pharmacy or another site to get a lab-based test that Medicare will pay for is a huge barrier, Scholnick said. A supply of rapid, at-home tests laying around the house would help seniors more easily figure out whether they can gather with friends and relatives or go to a crowded setting.
“To say that they shouldn’t have the same level of access to at home tests is ridiculous,” he said. “This is unfair and bad policy.”
Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author at rrayasam@politico.com, or on Twitter at @RenuRayasam.
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— Some Democrats not ready to give up on child credit: They’re balking at suggestions by the White House to drop their bid to revive their signature Child Tax Credit plan . One day after President Joe Biden appeared ready to concede it may fall by the wayside, some lawmakers said they are not giving up on the proposal, which is included in a sweeping package stalled in the Senate.
— Georgia DA asks for special grand jury in election probe: The Georgia prosecutor looking into possible attempts to interfere in the 2020 general election by former President Donald Trump and others has asked for a special grand jury to aid the investigation . Fulton County District Attorney Fani Willis sent a letter to Fulton County Superior Court Chief Judge Christopher Brasher asking him to impanel a special grand jury. She wrote in the letter that her office “has received information indicating a reasonable probability that the State of Georgia’s administration of elections in 2020, including the State’s election of the President of the United States, was subject to possible criminal disruptions.”
— Jan. 6 panel will target Ivanka Trump for questioning: Jan. 6 investigators revealed today they’re going after Ivanka Trump, whom senior White House aides viewed as a last-ditch resort to convince Donald Trump to address rioters during the Capitol attack , according to evidence and testimony released today. “He didn’t say yes to Mark Meadows, Kayleigh McEnanay or Keith Kellogg, but he might say yes to his daughter?” a committee investigator asked of Kellogg, a top Trump White House official, during a recent interview, according to a testimony transcript published by the panel.
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— U.S. drops case against MIT professor accused of ties to China: The Justice Department dropped its case today against a Massachusetts Institute of Technology professor charged last year with concealing research ties to the Chinese government , saying it could “no longer meet its burden of proof at trial.” The department revealed its decision in the case against Gang Chen in a single-page filing in federal court in Boston.
— SEC blocks Anthony Scaramucci’s Bitcoin fund: The Securities and Exchange Commission rejected Anthony Scaramucci’s proposal to launch a Bitcoin-based investment fund, saying it would be too risky for investors. The proposal by Scaramucci — a financier best known for his 10 days as former President Donald Trump’s communications director in 2017 — would have let investors on the New York Stock Exchange buy shares in a fund backed by the Bitcoin digital currency. It’s just one of several exchange-traded funds being pitched as a way to let individuals speculate on the price of Bitcoin without having to buy it directly.
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President Joe Biden meets with members of his Infrastructure Implementation Task Force. | Chip Somodevilla/Getty Images
BIDEN CLARIFIES ‘INCURSION’ REMARK — Biden personally sought to clarify his remarks about a potential “minor incursion” by Russian forces into Ukraine , which top Ukrainian government officials condemned as needlessly provocative amid a broader White House effort to clean up the president’s statements.
Speaking ahead of a White House infrastructure meeting, Biden said he has been “absolutely clear” with Russian President Vladimir Putin and that his Kremlin counterpart “has no misunderstanding: Any — any — assembled Russian units move across the Ukrainian border, that is an invasion.”
Such an invasion would be met with a “severe and coordinated economic response” by the United States and its European allies, which has already been “laid out very clearly” for Putin, Biden said.
“Let there be no doubt at all,” Biden added. “If Putin makes this choice, Russia will pay a heavy price.”
Biden’s latest remarks today represented a slight revision of his comments at a White House news conference Wednesday, during which he predicted Putin’s forces will “move in” on Ukraine and outlined his thinking surrounding potential responses to such aggression.
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‘PLEASE DADDY, NO MORE ZOOM SCHOOL’ — The Omicron surge is depleting California teachers and keeping students home in unprecedented numbers, but political leaders aren’t yet willing to broach the alternative: distance learning.
Gov. Gavin Newsom and Democratic leaders who allowed school shutdowns early in the pandemic are holding firm on keeping classrooms open, Alexander Nieves writes. They’ve had support from the California Teachers Association despite some educators on the ground saying that working conditions are untenable due to staff shortages. And school districts are going to extreme lengths to keep students in classrooms, pulling retired teachers off the sidelines and recruiting office staff — at times even superintendents — to teach lessons.
It’s a dramatic turn for a state that once had the nation’s longest pandemic closures.
“I’m very, very sensitive to this, the learning opportunities that are lost because kids are not safely in school, the challenges of going online,” Newsom said when asked this month about distance learning. “My son, we had fits and starts, he’s in and out of school, said, ‘Please, Daddy, no more Zoom school.’”
The Sacramento City Unified School District released a statement Friday calling on local residents to “Sub-in and be a hero” by getting an emergency substitute teacher credential. Palo Alto schools have turned to parent volunteers for food service, office assistance and other on-campus jobs.
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