With the COVID-19 pandemic getting worse than ever, health insurers are facing an uncertain level of exposure to testing costs. That’s because payers and plan sponsors are on the hook for the entire cost of coronavirus tests — which can vary widely — and they could be required to pay for even more testing depending on the strategy that the Biden administration plans to pursue.

The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act require plan sponsors to pay all in- and out-of-network claims for diagnostic and antibody testing services. The CARES Act says those claims must be paid at a listed “cash price,” which essentially allows labs to name a price for test processing.

Reinsurance programs can help lower premiums in the individual insurance market, but they’re not enough by themselves — states will need to experiment with broader measures to impact underlying health care costs, particularly for unsubsidized individual market enrollees, a report from The Commonwealth Fund concludes.

However, such programs could be a tough sell as states tighten their budgets because of the COVID-19 pandemic, says study author Justin Giovannelli, an associate research professor and project director at Georgetown University’s Center on Health Insurance Reforms.