February 1, 2023 – An era is coming to an end. The Biden administration announced Monday that it could end the 2 COVID-19 emergency declarations, marking a significant shift within the three-year-old pandemic.
The orders spanned two presidencies. Trump administration Health Secretary Alex Azar declared a public health emergency in January 2020. Two months later, then-President Donald Trump declared the COVID-19 pandemic a national emergency. Both emergency declarations – which remained in effect under President Joe Biden – expire on May 11.
Read on for an summary of how the top of the general public health emergency will trigger quite a few changes in federal policy.
Changes that affect everyone
- There will likely be changes to cost-sharing for COVID-19 vaccines, tests and certain treatments. Full coverage for COVID testing, including free at-home testing, will expire on May 11.
- As of May 11, 2023, controlled substances may not be prescribed via telemedicine.
- The increased federal funding will likely be phased out through December 31, 2023. This extends the period during which states must receive federal funding for COVID-related services and products through the Consolidated Appropriations Act of 2023.. Otherwise, it could have expired on June 30, 2023.
- Emergency authorizations for COVID-19 treatments and vaccinations usually are not affected and can expire on May 11.
Changes for privately insured people
- For many, the fee of Covid-19 testing is prone to rise as free testing ends and cost-sharing begins in the approaching months.
- COVID-19 vaccinations and booster shots will proceed to be covered until the federal government's vaccine supply runs out, through which case you'll need an in-network provider.
- They still have access to COVID-19 treatments – but that would change if federal supplies run low.
Changes affecting Medicare beneficiaries
- Medicare telehealth flexibility is prolonged through December 31, 2024, whatever the status of the general public health emergency. This means people can access telehealth services from anywhere, not only in rural areas; they'll use a smartphone for telehealth and access telehealth from home.
- Medicare reimbursement for tests and coverings will expire on May 11, aside from oral antivirals.
Changes affecting Medicaid/CHIP recipients
- Medicaid and Children's Health Insurance Program (CHIP) recipients will proceed to receive approved vaccinations for free of charge, but cost-free testing and treatment will expire within the third quarter of 2024.
- The Medicaid continuous enrollment provision will likely be separated from the general public health emergency, and continuous enrollment will end on March 31, 2023.
Changes affecting uninsured individuals
- Uninsured persons are not entitled to 100% coverage for these services (free COVID-19 treatments, vaccinations and tests).
Changes affecting healthcare providers
- There will likely be changes to the reimbursement that providers receive for diagnosing individuals with COVID-19. Starting May 11, 2023, the increased reimbursement rate under the Inpatient Prospective Payment System will end.
- Potential exemptions under the Health Insurance Portability and Accountability Act (HIPAA) will likely be eliminated. This allows providers to speak with patients via telemedicine using a smartphone, for instance, without violating data protection laws and risking penalties.
What the experts say
WebMD asked several health experts for his or her thoughts on ending public health emergency declarations for COVID and what impact it may need. Many expressed concerns concerning the timing of the termination, saying the move could limit access to COVID-related treatments. Others said the move was inevitable but expressed concerns about federal guidelines surrounding the choice.
Q: Do you agree with the timing of the lifting of the state of emergency?
A: Robert Atmar, MD, professor of infectious diseases at Baylor College of Medicine in Houston: “A lead time to prepare and anticipate these consequences can ease the transition compared to an abrupt declaration that ends the declaration.”
A: Georges C. Benjamin, MD, Executive Director of the American Public Health Association: “I think it's time to do that. It needs to be done in a great, thoughtful, organized way because we have so many different things associated with this public health emergency. It's going to take some time for the system to adjust. Data collection by the CDC will most likely continue. People are used to reporting by now. The CDC needs to give guidelines to the states so that we are clear about what we are reporting and what we are not reporting. If we did that abruptly, it would just be chaos.”
A: Bruce Farber, MD, chief health and epidemiologist at Northwell Health in Manhasset, NY: “I used to be hoping it could be delayed.”
A: Steven Newmark, JD, general counsel and director of policy on the Global Healthy Living Foundation: “While we understand that an emergency cannot last forever, we hope that expanded services such as free vaccinations, promotion of widespread vaccination, increased use of pharmacists to administer vaccines, availability and reimbursement of telehealth, flexible work-from-home options, and more will continue. Access to equitable health care should never be rolled back or limited.”
Q: What does the top of free COVID vaccinations and free testing mean?
A: Color: “There will likely be a decline in vaccinations and testing. Vaccination rates are already very low and this will likely lower them even further.”
A: Atmar: “I think this will result in fewer people getting tested and vaccinated,” which “could lead to increased transmission, although wastewater studies suggest there are already many undetected infections.”
A: Benjamin: “That's a big problem. It means we need to get people, especially people with no or inadequate health insurance, access to these vaccines. There's a lot of discussion and debate about what the cost of these tests and vaccines is going to be, and it looks like the companies are going to impose very high, rising costs.”
Q: What impact does this have on higher-risk populations, such as people with weakened immune systems?
A: Color: “Without monoclonal antibodies [drugs to treat COVID] and free Paxlovid”, individuals with weakened immune systems could possibly be “undertreated”.
A: Atmar: “The impact of continued, widespread virus transmission is that immunocompromised individuals usually tend to be exposed to the virus and turn into infected and suffer the results of such infection, including severe disease. However, to some extent, this will already be the case. We are still seeing around 500 deaths a day, primarily amongst those at highest risk of severe disease.”
A: Benjamin: “People who are well insured, can afford a vaccine, and have a good relationship with their doctors will likely continue to be covered. However, people with lower incomes and people who really cannot afford a test or vaccine will likely be under-immunized and more likely to become infected.
“Even when the federal emergency is lifted, I hope the federal government will proceed to encourage all of us to deal with those populations which can be most in danger – individuals with chronic diseases and people with compromised immune systems.”
A: Newmark: “People whose immune systems are weakened on account of their chronic illness or the medications they take to treat acute or chronic conditions remain at higher risk for COVID-19 and its serious complications. The government must support the continued development of effective treatments and updated vaccines to guard individual and community health. We are also concerned that increased health services – resembling vaccinations or telemedicine – could revert to pre-pandemic levels, while the burden of protection, resembling wearing masks, could fall solely on those with chronic illnesses, further increasing the burden of living with the disease.”
Q: What impact will cutting funding for Medicaid expansion have?
A: Benjamin: Between 16 and 20 million people will lose their insurance coverage. I hope that states will look at their experiences over the last two years or so and conclude that there have been improvements in the health of the population.
Q: Will this impact public perception of the pandemic?
A: Color: “It might give the impression that COVID has disappeared, which is clearly not the case.”
A: Benjamin: “That's going to be another argument by some that the pandemic is over. People should think of it like a hurricane. A hurricane comes through and tragically devastates communities, and we have an emergency during that time. But then we have to go through a recovery period. I hope people will realize that even though the public health emergencies are over, we still have to go through a transition period… and that means they still have to protect themselves, get vaccinated, and wear a mask when appropriate.”
A: Atmar: “It must be made clear that while COVID-19 is moving beyond emergency management, it still represents a significant public health problem.”