Who Will Pay Ebola Patients' Medical Bills in the U.S.?

Ebola patient Craig Spencer leaves the hospital where he was treated in New York. Ebola patient Craig Spencer leaves the hospital where he was treated in New York. Richard Drew/AP

The arrival of Ebola in the United States this year led to an unprecedented medical response involving experimental drugs, round-the-clock care, and layers upon layers of protective gear. And none of it has been cheap.

Nine people have been treated for the virus in the U.S. since August. Seven recovered. The National Institutes of Health Clinical Center, which treated one of them, estimates treatment for patients diagnosed with Ebola costs $50,000 a day. Officials at the University of Nebraska Medical Center, which cared for two patients, put the daily cost at $30,000, and the total at $1.16 million for a single patient. Most patients have been hospitalized for more than two weeks.

The U.S. has shown it can beat Ebola. But who will pay for the expensive care it takes to do it?

It's a tough question, and one that the people holding the bills seem reluctant to answer. Hospitals that have treated patients in Georgia, Nebraska, New York, and Texas did not respond to requests for comment, nor did the governors' offices of these states. NIH was forthcoming about cost of care, but the feds pick up the tab for treatment there.

The topic of payment came up during a Senate Appropriations Committee hearing earlier this month but only briefly. The Obama administration had requested $6.18 billion in emergency funding for Ebola response efforts in the U.S. Missing from the request, said Sen. Mike Johanns, was funding that would cover treatment of patients with Ebola on American soil. The federal government should cover the University of Nebraska Medical Center's costs, he said, because it had asked the medical facility to take in patients.

"We were glad to do it," said the Republican lawmaker from Nebraska. "But it seems at this point some assistance in terms of reimbursement would be appropriate, because treating an Ebola patient is worlds different than treating Mike Johanns who walks in with a severe case of the flu."

Health and Human Services Secretary Sylvia Mathews Burwell said that conversations about payment have so far remained between hospitals and private insurers. "To date, it has not been an issue that has come to us," she said. "If this is something that [Congress] wants to discuss as part of this funding, we're happy to entertain that."

Sen. Barbara Mikulski, D-Md., the Senate Appropriations Committee chair, agreed with Johanns about exploring federal reimbursement options. "It is costly," she said at the hearing, referring to Ebola treatments. But neither the committee nor the panelists had a real solution. "Let's talk about this. Let's keep working on it."

Some hospitals, faced with these costs, are tentatively looking to the feds to foot the bill. New York City health officials said earlier this month that Bellevue Hospital's treatment of one patient with Ebola was expected to be so expensive that they would seek federal funding to help pay the bills. Emory University Hospital in Atlanta, which treated four patients, has asked Congress to approve funding for full reimbursement for Ebola cases. One case, they said, can cost up to $1 million.

"Caring for patients with Ebola virus disease effectively and safely is enormously resource-consuming, far above and beyond usual care," the hospital wrote in a letter to the Senate Appropriations Committee on Nov. 7. Emory officials said payment should be a collaborative effort, using both federal and private sources.

At the time of this writing, there are no reported cases of Ebola in the U.S. But federal health officials have said that as long as the Ebola outbreak in West Africa—which has infected more than 15,300 people and killed 5,459 of them—rages on, there could be more patients. And those patients most likely won't be able to cover hundreds of thousands of dollars in medical bills on their own.

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