As federal funding for the pandemic response dries up, Americans without health insurance risk being left footing the bill for coronavirus tests and treatments.WASHINGTON — When Mandy Alderman caught the coronavirus in June for a second time, she hoped her usual primary care physician could prescribe a monoclonal antibody treatment or Paxlovid, the antiviral pill that has been shown to reduce the severity of an infection. But without health insurance, she could not afford a visit.Ms. Alderman, 44, a former medical assistant in Lawrenceville, Ga., found a doctor willing to prescribe a cocktail of other drugs, but not the proven Covid-19 medications she wanted. She took what she could get. She had to lean on her aunt for the $85 it cost to retrieve the drugs from a Publix grocery store pharmacy near her home.“I felt like I was irrelevant,” Ms. Alderman said, recounting the ordeal. “I felt like I didn’t matter.”Difficulty getting care for Covid-19 has become an increasingly common problem for poor, uninsured Americans. After paying about $25 billion to health care providers over the course of the pandemic to reimburse them for vaccinating, testing and treating people without insurance, the federal government is running low on funds for Covid care for the nearly 30 million Americans who are uninsured.The Biden administration is asking Congress to replenish its coffers, but its pleas to lawmakers this year have so far been unsuccessful. Warning about the threat of new subvariants as winter approaches, the White House asked Congress last month for more than $9 billion in additional funding for the pandemic response. Some of that money would go toward ensuring that Americans, including those without insurance, continue to have access to vaccines and treatments.Republicans in Congress have resisted the White House’s requests. They have accused the administration of spending pandemic relief money in a wasteful manner and have shown little appetite for providing more funding, especially after President Biden declared in September that “the pandemic is over.”Adding to the dilemma for the uninsured, the administration is planning to allow vaccines and treatments for Covid-19 to hit the commercial market by next summer — a move that could further hinder access for those without health coverage.The result, public health experts say, is the end of the universal access that Americans have had to Covid care during the pandemic, a rare exception in the fragmented U.S. health care system. As federal funding dries up, people without insurance may be left footing the bill for tests and treatments, or they may be discouraged from seeking care altogether.Over the course of the pandemic, the federal government has paid about $25 billion to health care providers to reimburse them for vaccinating, testing and treating the uninsured.Scott Olson/Getty ImagesThe problem is especially acute in states that have yet to expand Medicaid under the Affordable Care Act. Those areas, where Republicans partly or entirely control state government, tend to have a larger share of residents without health insurance than the states that have adopted the expansion.“Because of Covid, we’ve been able to temporarily create a bright spot for care,” said Kody H. Kinsley, the top health official in North Carolina, one of the states that has not expanded Medicaid. He added, “That island is slowly vanishing.”The Biden PresidencyHere’s where the president stands after the midterm elections.A Defining Issue: The shape of Russia’s war in Ukraine — and its effects on global markets —  in the months and years to come could determine President Biden’s political fate.Beating the Odds: Mr. Biden had the best midterms of any president in 20 years, but he still faces the sobering reality of a Republican-controlled House for the next two years.2024 Questions: Mr. Biden feels buoyant after the better-than-expected midterms, but as he turns 80, he confronts a decision on whether to run again that has some Democrats uncomfortable.Legislative Agenda: The Times analyzed every detail of Mr. Biden’s major legislative victories and his foiled ambitions. Here’s what we found.Michele Johnson, the executive director of the Tennessee Justice Center, a legal aid group that helps poor residents in the state, which is one of those that has not adopted the expansion, warned that people without coverage were facing a new risk of Covid-induced medical debt.“We’re back to the old ways,” Ms. Johnson said, adding, “People are going without vitally important services, and/or they’re going into debt for the rest of their lives.”For much of the pandemic, the federal government covered the cost of vaccinating, testing and treating the uninsured through a fund run by the Department of Health and Human Services. But that program shut down in the spring because of a lack of funding, and in September, the government stopped providing free at-home tests through the Postal Service for the same reason.Roughly 50,000 coronavirus cases — a figure that is almost certainly a significant undercount — are being reported in the United States each day, and people without insurance can face an array of costs. Bills for tests can be large and unpredictable; some people have faced charges of more than $3,000 for the routine nasal swab. For those who become seriously ill, a hospitalization can cost more than $1 million.The government continues to offer Covid-19 treatments like Paxlovid for free to patients. But without the federal uninsured fund, Americans without health coverage can still be charged for outpatient visits needed for a diagnosis or a prescription.Once the government’s supply of treatments runs out, health care providers will need to purchase them on their own, with insurers covering the costs for Americans just as they do for other treatments. People without coverage will in most instances pay for the drugs out of pocket. The same is true for coronavirus tests.And with the prices of coronavirus vaccines expected to increase on the commercial market, the shots could eventually become less accessible to people without insurance. The federal government has purchased a large supply of the updated booster doses, but another round of shots is expected to be needed next year.The Biden administration has proposed a new program called Vaccines for Adults that is modeled after a federal program that provides vaccines to children at no cost. If funded by Congress, the program would supply coronavirus shots and other vaccines while reimbursing providers for administration fees.The government has also talked to manufacturers of vaccines and treatments about funding their own programs for the uninsured, Dawn O’Connell, the assistant secretary for preparedness and response at the Department of Health and Human Services, said at an event hosted by the Kaiser Family Foundation this fall.“We’re trying to pull a few levers all at once,” she said.In 15 states, a temporary federal provision allows Medicaid funds to be used to cover vaccine-related fees, treatments and tests for the uninsured. But that program will expire when the federal government lifts its declaration of a public health emergency for the pandemic, a move it could make as soon as next year.The Biden administration has also experimented with a smaller program that could offer a template for future distribution methods. In September, weeks after an Eli Lilly monoclonal antibody treatment moved to the commercial market, the administration announced that it would make 60,000 doses available to health care providers. Each time a provider used a commercially purchased dose for an uninsured patient, the federal government offered to replace that dose. (The Food and Drug Administration said last week that the drug, which is not expected to work against newer coronavirus variants, was no longer authorized for emergency use.)There were warning signs even before the federal uninsured fund lapsed of the hassles to come. Anthony Lund, a professional health insurance counselor who previously worked at a Mayo Clinic testing center in Minnesota, once offered reassurances to uninsured patients he scheduled for coronavirus tests: The federal government would pick up the cost.During a gap without health coverage, Anthony Lund was charged $520 for a coronavirus test. He later got the bill dropped.Jenn Ackerman for The New York TimesBut then Mr. Lund lost his own health insurance when he switched jobs and had to wait for his new benefits to kick in. With a fever and a runny nose in January, he suddenly needed a test at Mayo. A surprise bill arrived in May: $520 for the nasal swab.“If we knew it was going to be charged, I wouldn’t have gone in for testing,” he said, recounting his shock.Mr. Lund’s saga ended with persistence. After corresponding with the Mayo Clinic for weeks and citing the policies he had previously counseled others about, Mr. Lund got the testing bill dropped. A spokeswoman for the clinic said it had reversed the charge as a courtesy to the patient.The end of the uninsured fund has already led to a shrinking of the nation’s Covid infrastructure. In North Carolina, some privately run testing sites have closed in part because contractors could no longer bill the government for tests given to people without insurance, said Mr. Kinsley, the top state health official.Providers in the state that relied on the fund are now left with few options. Resourceful Clinical Laboratory, which oversaw testing and vaccination sites in rural eastern North Carolina that predominantly served the uninsured, leaned heavily on federal reimbursement. The company no longer operates the sites, said Stephanie Tyson, its chief executive.The end of the fund has also added to the financial pressures on hospitals. Beth Feldpush, the senior vice president for policy and advocacy at America’s Essential Hospitals, which represents safety-net hospitals, said that hospitals that care for the uninsured had been left to balance the costs of treating those patients with rising salaries for nurses and administrative staff members.As federal funding dwindles, Mr. Kinsley said the consequences were clear: Covid-19 was heading the way of illnesses such as diabetes or high blood pressure.“We’re going to be back in a place that unfortunately we know really well,” he said. “We’ll have people showing up in emergency departments that could have been handled with more access to prevention.”

The Biden administration announced the new guidelines as it continued to work to get coronavirus tests to people regardless of their insurance status.WASHINGTON — Private insurers will soon have to cover the cost of eight at-home coronavirus tests per member per month, the Biden administration said Monday.People will be able to get the tests at their health plan’s “preferred” pharmacies and other retailers with no out-of-pocket costs, according to the Department of Health and Human Services. They can also buy the tests elsewhere and file claims for reimbursement, just as they often do for medical care.“Today’s action further removes financial barriers and expands access to Covid-19 tests for millions of people,” Chiquita Brooks-LaSure, the Biden administration’s Medicare and Medicaid chief, said in a statement about the new guidelines.Roughly 150 million Americans, or about 45 percent of the population, are privately insured, mostly through their employers. Each enrolled dependent of the primary insurance holder counts as a member.At out-of-network facilities, insurers’ responsibility would be capped at $12 per test, meaning people could be responsible for any additional costs.But if a health plan does not establish a network of “preferred” retailers where patients can get tests covered upfront, it will be responsible for whatever claims its patients submit for their eight monthly rapid tests, with no limit on the price.Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, said the policy could save families hundreds of dollars a month.“I would love to see a more comprehensive national testing policy where these tests are free for everybody, regardless of insurance status,” she said. “Will it help everybody? No. It is definitely not the ideal way to lower barriers to Covid testing. But it is helpful.”Rapid at-home tests are typically sold in packs of two, ranging in cost from about $14 to $34. That can be prohibitively expensive, especially when tests are purchased in bulk.Other countries have spent more heavily on rapid testing. In Britain, citizens can use a government website to order free rapid tests for home use. Germany invested hundreds of millions of dollars to create a network of 15,000 rapid testing sites. The United States has instead focused public purchasing on vaccines, and efforts to encourage their uptake.Some local governments in the United States have invested heavily in rapid testing to counter the latest wave of cases. Washington, D.C., which has experienced a substantial surge in virus cases, now allows residents to pick up four free rapid tests daily at libraries across the city.The new Biden policy will not apply retroactively to at-home tests that Americans have already purchased. Tests ordered or administered by health providers will continue to be covered by insurance without any co-payment or deductible under a law requiring insurers to fully cover tests at doctor’s offices, public sites and other facilities.The administration is working on other efforts to get coronavirus tests to people regardless of their insurance status, including a plan to deliver 500 million free rapid tests to the homes of Americans who order them, starting later this month.That plan, along with the new rules for insurers announced Monday, is part of a broader effort by the Biden administration in recent weeks to catch up to skyrocketing demand for rapid tests, as virus cases have exploded around the nation with the arrival of the highly contagious Omicron variant.The administration has also announced plans to make tens of millions of free tests available for uninsured Americans at health clinics and other sites in underserved communities. And it has recently opened federally run test sites in hard-hit regions of the country.Matt Eyles, president of the health insurer trade group America’s Health Insurance Plans, said in a statement that insurance companies would “work as quickly as possible to implement this guidance.”“While there will likely be some hiccups in early days, we will work with the administration to swiftly address issues as they arise,” he said.Supplies of the tests at pharmacies and grocery stores all but dried up last month as Omicron descended, and manufacturers are racing to restock shelves, a scramble that has prompted some experts to criticize the administration for being caught flat-footed.The low availability could hinder the rollout of the reimbursement policy, said Lindsey Dawson, a policy analyst at the Kaiser Family Foundation who has researched the availability of rapid tests.“If reimbursement exists but there aren’t tests to purchase,” she said, “that doesn’t help an individual consumer.”She added, “The policy could certainly drive demand, and could exacerbate the problem.”Ms. Dawson said prices have begun climbing at some major retailers, such as Walmart. That could mean significant upfront costs for families who have to file claims for reimbursement, she said.The Coronavirus Pandemic: Key Things to KnowCard 1 of 3The latest Covid data in the U.S.