What happens if you're uninsured and get coronavirus?

A hospital stay to treat COVID-19 will likely cost more than $20,000, according to estimates from the Kaiser Family Foundation.

So what's going to happen to people who just lost their jobs, and maybe their insurance, if they get sick?

Hospitals have to treat patients whether they can pay or not, so what happens if they get slammed with people who can't?

In these still-early days of a global pandemic, it's hard to say. Major insurance companies have said they'll cover COVID-19 treatments, often on more generous terms than other illnesses. There are also options for people without insurance, but each has its caveats, and the rules aren't clear for the newest ones.

Those who had insurance through their job, but got laid off, can purchase COBRA insurance. It can be expensive, but you don't have to decide on the purchase for 60 days after your separation, so people can take a wait-and-see approach.

People may also be able to get on a spouse's insurance plan.

Those who lost insurance when they lost their jobs can also sign up for federally subsidized Affordable Care Act policy plans – Obamacare. The loss of insurance counts as a life-changing event, opening the federal health exchange even if President Donald Trump declines to open it more broadly and let anyone buy a policy, as some have asked him to do.

The filing process can be complex, though. Among other things, applicants need to estimate their 2020 income and document that their estimate is reasonable.

It's possible the federal government will simply pick up the costs for uninsured COVID-19 care. The president essentially promised that Friday, and there are billions of dollars for hospitals in the federal stimulus bills Congress has passed. But it's not yet clear how this will work.

Among other things, it may take approval from the General Assembly to stand that process up in North Carolina.

"We're just unpacking all of it," said Pat Ryan, spokesman for Senate President Pro Tem Phil Berger.

"What the president has described, I think, has left a lot of people wondering how that's going to work," said Brendan Riley, policy director for the N.C. Community Health Center Association.

Which brings us to Medicaid. North Carolina's version of the program requires very low income levels for people with children to get on it, and it's essentially impossible for an able-bodied adult without children to qualify.

The state's legislative session came to a near standstill last year as Gov. Roy Cooper and the Generla Assembly's GOP majority faced off over expanding Medicaid to cover North Carolina's working poor.

COVID-19 doesn't seem to have changed the legislative math so far.

State Rep. Donny Lambeth, who backed a compromise bill in recent years, said he doesn't see the measure getting revived in the near term. The federal courts struck down a potential work requirement for Medicaid expansion and without work requirements, "I do not believe there is an interest in Medicaid expansion even now," Lambeth said in an email.

"This is a major policy decision that has multiple years of a funding commitment that will not be made in the short term," said Lambeth, R-Forsyth.

Cooper's administration has also asked the federal government for a waiver that would allow it to cover COVID-19 treatment costs through Medicaid for people who make as much as 200 percent of the federal poverty level. That's a smaller population than expansion, but a significant increase. The federal government has not yet approved that waiver and, if it does, implementation will require legislative approval.

It wasn't clear Monday whether it would get it. Joseph Kyzer, spokesman for Speaker of the House Tim Moore, said a House working group meeting this week will study this issue and others as lawmakers prepare for a General Assembly session on COVID-19 issues, which is likely to open later this month.

Major insurance companies are waiving out-of-pocket costs for many customers when it comes to coronavirus care for the insured, but there may be downstream costs. It is too soon, experts said, to predict what this pandemic will do to future premiums.

The impact for hospitals could be significant. They are required to treat people whether they can pay or not, and they've largely suspended elective surgeries to clear up bed space for the expected rush of COVID-19 patients.

Primary care doctors are seeing fewer patients altogether due to social distancing. This all leads to lost cash flow.

"We're seeing a big drop in patient volume ... and of course that costs a lot of money," said Riley, whose association represents 42 organizations around the state in medically underserved areas.

Federal funding already approved in this crisis, and state dollars that may flow later, will take up some of the slack. But if it's not enough and hospitals are left with uncollectible treatment costs "providers that have been in a fragile financial position may not survive," said Lambeth, who is also the former president of Wake Forest Baptist Hospital.

Lambeth said this may mean more closures in rural areas, more consolidation and people driving further to see a doctor or be admitted to a hospital. It will likely boost telemedicine, which is a good thing, Lambeth said. Social distancing has led insurance companies to cover more virtual visits to the doctor.

David Anderson, who follows health markets closely as a researcher at the Robert J. Margolis Center for Health Policy at Duke University, said he thinks its important for the president to fully re-open ACA healthcare exchanges. There are a lot of healthy young people who are more likely right now to buy insurance policies.

That influx "would help bring stability to insurers and the hospitals," he said.