Widespread testing is one of the best ways to prevent outbreaks of Covid-19. It doesn’t work if uninsured employees have to pay their own way.
In April, as meatpacking plants across the country continued to stay open despite emerging Covid-19 outbreaks among their employees, JBS USA made an announcement: It would secure free Covid-19 tests for all of the workers in its Greeley, Colorado plant—one of the largest in the country at 3,000 employees. At the time, just 36 employees at that facility had contracted the virus. In the next six months, another 258 would follow. Six would die.
Now, a former contractor-turned-whistleblower has accused the Colorado facility of charging its uninsured employees $100 in cash for those tests. As first reported by The Greeley Tribune, an affidavit filed by the former contractor said she was hired to conduct Covid-19 screenings on site, and alleged that she was instructed to tell employees who were experiencing coughs to continue working. She also accused the company of neglecting to fix broken temperature-screening devices. In a separate affidavit, a second whistleblower corroborated many of her claims.
Essential workers like the employees at the JBS Greeley plant are among the most vulnerable to contracting Covid-19 at work. In order to prevent widespread outbreaks of the kind that sickened thousands at meatpacking plants during the spring and summer, one of the best tools at companies’ disposal is widespread diagnostic testing. There’s just one problem: No one agrees on how to pay for those.
Congress made it clear that health insurance companies should foot the bill for Covid-19 tests in its Families First Coronavirus Response Act (FFCRA), which required most insurers to fully fund testing and treatment without imposing co-pays or other forms of cost-sharing. But the policy can leave behind huge swaths of uninsured workers in the food industry. According to an analysis published in Health Affairs, 14 percent of workers in meatpacking plants don’t have health insurance. A similar proportion of grocery store employees lack coverage. And in the agriculture sector, where much of the workforce is undocumented or working on seasonal visas, an estimated 29 percent of workers are uninsured.
“For most of the last nine months, there was not enough capacity. But since then there’s been a paradigm shift and we now have the ability to screen in a cost-effective way.”
At JBS USA in Greeley, the whistleblowers said that, initially, the company had paid for all employee tests. But it appears that at some point the policy stopped applying to uninsured workers. “JBS put it on us to explain to employees the tests would not be paid any longer,” Sarah-Jean Buck, one of the contractors who turned whistleblower, told the Tribune. “These are employees who are saying they do not feel well—and then they changed their mind once they hear they need to pay, saying some excuse like it is just my sinuses acting up.”
In theory, uninsured employees who are required to get tested at work should not have to pay out of pocket, even if Congressional relief bills have failed to provide an alternative for those without coverage. It should be up to an employer to foot the bill if it plans to require tests at work, according to Jon Hyman, a partner at the law firm Meyers, Roman, Friedberg & Lewis in Cleveland, Ohio. That’s because of the way the Equal Employment Opportunity Commission has interpreted a provision in the Americans with Disabilities Act. The agency has issued guidance saying that employers are allowed to test people at work because contagious workers represent a “direct threat” to their peers.
According to the affidavit filed by the whistleblowers, JBS Greeley employees who felt sick were only sent home if they tested positive for Covid-19. But when those who did have symptoms were confronted with a $100 testing fee to confirm a diagnosis, many opted out of getting tested and continued to work.
And even those who did go home sick with Covid-19 may not have been eligible for paid sick leave, Hyman said. The FFRA guarantees sick pay only for employees at companies with less than 500 workers, and the Greeley plant employs more than 3,000. JBS USA promised sick pay for any employeee infected with Covid-19, but media reports suggest that follow-through has been spotty.
“Why are we testing? We’re testing to reduce transmission, and not just to count numbers. We’re testing to find the contagious, isolate, and reduce the number of people with the disease, period. That’s the issue.”
A spokesperson for JBS denied the allegations that employees had been charged for tests, writing in an email that “uninsured team members have not been charged for COVID tests at any point during the pandemic.” She also said that the company conducts routine surveillance of asymptomatic workers and everyone who enters the company’s facilities goes through a temperature-testing process and is given a mask.
Hyman pointed out that decisions about whether to stay on site or go shouldn’t be left up to employees who have a financial stake in the outcome. “It’s just a terrible H.R. practice,” he said. “If somebody is symptomatic, best practices say you want them out of your workplace as quickly as possible so they can’t spread. You don’t want someone to make the choice of continuing working because they need the paycheck, even though they have a fever and a cough.”
According to a CDC analysis released in mid-October, mass testing in meat and poultry facilities has gone a long way toward identifying outbreaks of Covid-19 and catching asymptomatic or pre-symptomatic infections. But even though the benefits are obvious, screening is far from universal. “These findings support the need for comprehensive testing strategies … for high-density critical infrastructure workplaces to aid in identifying infections and reducing transmission within the workplace,” the researchers concluded. Despite these recommendations, employers in most states are not required to provide Covid-19 testing at all.
In the absence of a comprehensive federal testing mandate, some states have issued requirements for specific, high-risk industries. In California, Washington, Michigan, Colorado, and Virginia, farmers are required to provide testing for their workers, according to an analysis by the Environmental Working Group. Some state-level guidelines were implemented after reports surfaced that a handful of orchard owners in Washington had refused to allow officials to conduct on-site testing, and another facility in California had offered tests only to employees “chosen by the company.”
“Bottom line, pay for the testing if the employee lacks health insurance to cover it, and pay the employee for the time spent related to the testing.”
Elsewhere, officials have focused on making testing available for uninsured people free of charge through local hospitals and clinics. Earlier this month, New York City issued recommendations urging anyone who works outside of their home and around other people to get tested once a month. The city has set up several free testing sites to make this possible.
In an ideal world, local officials could roll out testing plans according to a risk assessment based on local infection levels. Higher community spread would require more tests, and lower-level spread might mean easing up. The Rockefeller Foundation released a report outlining such a testing strategy last month. It called for 200 million tests each month for then-current infection rates, which hovered at around 30,000 Americans each day. The U.S. is now clocking an average of nearly 70,000 cases per day.
Of course, the success of a Rockefeller plan hinges on the availability of fast and cheap tests, which could be purchased in bulk by employers who plan to screen people on site. That hasn’t come to fruition yet, but there’s hope on the horizon as rapid testing quickly becomes more available and costs plummet.
“You can debate when this is going to happen, but I’ll say starting with the beginning of 2021, I believe that we’ll see a distinct increase in testing at the workplace,” said Mara Aspinall, a professor at Arizona State University and an advisor on the Rockefeller project. She added that rapid antigen tests—which can deliver results while you wait, instead of a day or two later —already cost far less than the slower $100-a-pop tests, ranging from $5 to $25 per test. By early 2021, they’ll be far more available.
“For most of the last nine months, there was not enough capacity. But since then there’s been a paradigm shift and we now have the ability to screen in a cost-effective way,” Aspinall said. Whereas 35 million antigen tests were available in September, that number may swell to 200 million a month in the first quarter of 2021, and even higher after that. Employers who have ordered antigen-testing systems that are currently back-ordered will get up and running.
Other forms of cheap testing also show promise. On farms, where workers live in shared housing, local regulators or farmers might be able to test sewage water to screen for indicators of Covid-19, Aspinall said. It’s not a precise tool, but it can function as an early warning sign.
“I think the most important issue is: Why are we testing? We’re testing to reduce transmission, and not just to count numbers. We’re testing to find the contagious, isolate, and reduce the number of people with the disease, period. That’s the issue,” Aspinall said. “That’s why I think doing this broadly and nationally will have an impact on transmissibility—and therefore start the beginning of the end of the pandemic.”
It may feel like a long wait, but the future in which fast, cheap tests are plentiful may not be too far away. In the meantime, Hyman said, employers should foot the bill for testing their employees. “Bottom line, pay for the testing if the employee lacks health insurance to cover it, and pay the employee for the time spent related to the testing,” he wrote in a blog post for Workforce magazine. ”It’s not only the law, but it’s also just the right thing to do.”