Antigen testing and administrative burden

The Biden Administration now requires insurers for fully insured plans to reimburse individuals for up to eight tests per month.  Dr. Valerie Lewis of UNC makes an excellent point last night:


Reimbursement is an administrative burden nightmare. Receipts will be required. There may be requirements for prescriptions. Cash needs to be fronted and then payments will be received via check or direct deposit several weeks to months later.

This is an obstacle course that will lead to predictable and disparate fall-off from people either trying and failing to get reimbursed or looking at the obstacle course and saying “fuck it.” We know that administrative burden is most heavily borne by individuals with low incomes, complex lives, low education and likely to be heavily minoritized (in an international and American contexts). People like my wife and I who are overly educated professionals who are good at navigating complex bureaucracies because this is what we do for a living and have been trained to do for our entire lives will figure out how to get reimbursed. People earning $20,423 and have a kid at home because school is closed because seventy percent of the teachers are either sick, in isolation or on quarantine and whose boss is demanding that they come in for an extra overnight shift tomorrow are far more likely to not succeed in getting a $50 or $100 reimbursement check approved — if they could ever afford to front the $50 or $100 to buy a few boxes of tests.

Antigen testing is primarily intended to provide public externalities. There are a few treatments which are reliant upon early identification where the gains of an early positive test can be captured by the individual taking the test. However, the primary purpose for antigen testing is to identify people without symptoms early enough so that future chains of infection can be broken before other people are infected.

Reimbursement is an attempt by the government to pay for some of the externalities that we want and need to generate. However given the administrative burden, take-up will be fairly light and non-uniform.

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