Covid-19 cases, predictably, have climbed as the weather turned cold in much of the country. As of mid-December, cases had jumped more than 50 percent, while deaths were up 40 percent.

But this winter surge is occurring amid a new reality: The Republicans in Congress refused to pass more Covid funding in April, and they have held firm on that stance ever since. Now the government money to help people avoid getting Covid is running out. And it’s the poor, who are already more exposed to Covid, who will suffer the most.

Until this year, Congress allocated enough money for the federal government to buy Covid tests, vaccines, and treatments and provide them to Americans at no cost, even if they had no insurance. The federal government also used to reimburse doctors and other health care providers for testing, treating, and vaccinating uninsured people. But in April, after the Republicans in Congress stripped additional Covid money from a government funding package, the Department of Health and Human Services stopped these efforts. Now the pop-up tents that used to advertise and administer free Covid tests have blocked out the word “free” with duct tape or closed completely. And the program the government started in January to provide all Americans with eight free home Covid tests per household ended in September, although the Biden administration announced in mid-­December that it would use unspent funds to send out another round of free tests.

The uninsured, who are more likely to be low-income and people of color, will shoulder the burden of the government’s inaction. Some patients have faced bills of as much as $3,000 for a Covid test, and even at-home tests go for $25 for two—costs the uninsured will have to cover on their own. Vaccines and Paxlovid, Pfizer’s antiviral pills that reduce the risk of hospitalization and death, are free for now, but people can still be charged for the doctor’s visit to administer or prescribe them. Hospitalization for serious cases of Covid can cost a person more than $1 million.

These burdens are falling on a population that already faced lower access to vaccines even when far more funding and support was available. As of early November, 22 percent of households earning less than $50,000 a year were unvaccinated, and a quarter hadn’t gotten a booster shot. Compare that to 6.5 percent of households earning $150,000 or more who are unvaccinated and 15 percent who aren’t boosted. Of the lower-­income families who haven’t gotten a booster yet, about a third said it was because they hadn’t made an appointment or had the time, or because they didn’t have the transportation or couldn’t get an appointment.

The federal programs that provided free child care and transportation for vaccination appointments are long gone. So too is the mandatory paid time off for vaccination, even though low-income Americans are far less likely to get paid time off at work. And now these other supports are slipping away.

These disparities will get far worse next year without more federal funding.

When the government’s supply of vaccinations and tests runs out, people without insurance will have to pay for them out of pocket. After the vaccines are commercialized in the coming year, each Pfizer shot will cost $110 to $130. The government is going to stop covering the cost of Paxlovid in mid-2023 and allow the drug to be put on the market, and AstraZeneca’s Evu­sheld and ­Merck’s Lagevrio are set to be commercialized even sooner. The government got a discount when it bought Paxlovid in bulk, paying $530 for each individual round, and it will “cost far more on the private market,” according to Hannah Recht, a data reporter at Kaiser Health News.

Even those with insurance could feel the sting of these changes, facing high copays as they do for other expensive drugs. Their premiums may also rise as insurance companies absorb the cost of vaccines and treatments. Not to mention that allowing the virus to circulate among any portion of the population will spread it to everyone else.

President Biden has asked Congress for $2.5 billion to cover Covid vaccines and treatments—down from his original request of $30 billion—but Congress has yet to respond. If the Republicans don’t get on board and vote for more funding, they’ll be consigning the poor to even more preventable disease and death.