End of the National Public Health Emergency for COVID-19: What Does It Mean for the Public?

At the end of January, President Joe Biden announced that the national public health emergency called in 2020 for COVID-19 would officially end on May 11, more than 3 years after it was first implemented. The news sparked immediate discussion on how this would change the way COVID-19 treatments, vaccines, and testing will be accessed throughout the United States as government funding would no longer extend to certain areas of need.

“When we declare a disease a public health emergency, certain restrictions are loosened,” said Perry Halkitis, PhD, MS, MPH, dean and professor of biostatistics and urban-global public health in the School of Public Health at Rutgers University. “Funds are made more available to help bring an end to that pandemic or to that outbreak or to that disease. So, with regard to COVID-19, there are implications for testing, for vaccines, and for treatment that will be affected by the end of the public health emergency.”

According to Kaiser Health News,¹ many policies that were designed to fight the spread of the virus will end come May 11. For example, vaccines that were previously purchased by the government will remain available for low or no cost as long as the supplies last. However, once that supply runs out, Pfizer has indicated that the prices for the booster will increase to $110 to $130 per dose, which could translate to billions of dollars of revenue for the manufacturers that consumers would be responsible for; Moderna has since announced that its booster will remain free for the time being.

“The signal of the end of the public health emergency starts a process where states will be migrating back to something that looks more like historically typical operations under Medicaid, with the caveat that there are some experiences and approaches that were adopted during the pandemic that will be carried forward,” said Kate McEvoy, executive director of the National Association of Medicaid Directors.

With the ending of the national public health emergency, what does this mean for residents on government-funded health care, and what does this mean for vaccine and treatment access? These questions are important in both the health care and policy sectors and have profound implications for how COVID-19 is addressed going forward.

Immediate Changes

When Biden announced his intention to terminate the national public health emergency, several news outlets covered the potential immediate effects of the change. While some things have changed in the month after his announcement, many of the immediate concerns remain the same.

An immediate concern was access to vaccines and their price point once the national emergency ends. In the month since Biden’s announcement, Moderna announced that it would continue to offer its vaccine for free for those who are uninsured. Because of that, Halkitis believes that vaccine access will not be an issue going forward and will not be majorly affected. However, accessibility and affordability of nirmatrelvir/ritonavir (Paxlovid) will largely depend on the federal supply that has been previously purchased, which would make continued use of this medication a long-term issue.

Telemedicine was also nearly up on the chopping block, but Congress recently passed a bill that would allow current Medicare reimbursement levels for telemedicine to continue through 2024.²

However, a change that will be felt immediately is that the government will no longer mail free COVID-19 tests to households through the United States Postal Service. For the past 3 years, all American residents were able to apply through a government website and have rapid COVID-19 tests delivered to their mailbox. With the ending of the national public health emergency, this program will cease to exist.

According to Kaiser Health News, out-of-pocket payments for testing will start in May, as Medicare beneficiaries and individuals with private, employer-based insurance will not be able to receive rapid antigen tests for free through government programs.

“The most obvious thing that will change [is that] you can’t get a free home COVID-19 test through the post office,” said John Graves, PhD, associate professor of health policy at Vanderbilt University School of Medicine. “[The] uninsured are going to face the full cost of COVID-19 testing.”

“Those with private insurance will also not be guaranteed to have free testing,” said Halkitis. “But after this time, testing is probably going to be the thing that’s going to be the most challenging and probably going to be costing people out of pocket.”

Another major area of concern is Medicaid redetermination. Due to the national public health emergency, US citizens could not be disenrolled from Medicaid, regardless of eligibility.^3,4

“Starting April 1, states have the option to start to unwind and start to disenroll people who don’t appear eligible,” said Graves. “That’s [not only] going to predominantly affect people in Medicaid, obviously, but probably people with the most variable incomes.…They got on at some point, maybe because they lost their job during COVID-19, and they’ve been able to continue along without having to prove eligibility every year since.”

“The process of redetermining eligibility for each and every person on Medicaid…is an extremely large undertaking,” said McEvoy. “I will say that states have been preparing for almost a year. Each state has prepared a detailed plan for resumption of this redetermination process. It involves communication with the public, it involves planning from a system standpoint, it involves working with community partners.”

McEvoy said that the expectation is that at least 70 million individuals on the program will remain eligible, which is an overwhelming majority of the estimated 90 million individuals covered by Medicaid. However, this would still leave up to 20 million without Medicaid coverage starting next month.

“You’re going to see it in probably states that are more red…that tend to be more poor than the blue states. And there you go, you exacerbate poverty and discrimination with lack of access to care and get a sick population,” said Halkitis.

What Can Be Done?

With all these major changes coming as soon as next month, the challenge is knowing how to combat the issues that will arise from loss of access to testing, treatment, and even health care.

As far as telemedicine access, McEvoy believes that telehealth will remain a permanent fixture in the future.

“I think there are many, many positives associated with telehealth that have persuaded states and other policy makers that we should continue to use this as a tool,” she said. “I think examining how best to use telehealth for many of the reasons that emerged during the pandemic while making sure that it is also straightforward and accessible for people to see people in person for their health services…is kind of the balance that states will be looking for.”

She also mentioned that policy makers will be examining whether telehealth will continue to be paid for at parity with in-person visits, which is how they were paid during the pandemic. “Those are the types of questions rather than is telehealth going to be continued. Because I think it certainly will be continued broadly,” she said.

While vaccine and treatment access is not going to be an immediate concern, future access when supply runs short will be heavily contingent on access to health care coverage and help for the uninsured. With Medicaid redetermination set to leave millions without coverage, it’s important to make sure that these individuals are not left without help in the long term.

Graves said that balancing new enrollments and redeterminations will likely cause an administrative surge. Administrations are looking to work with states to help people via an organized rollout. “There would be options.…Rather than just turn them loose because they’re ineligible for Medicaid, a state could be smart about how they refer the individual to the [Affordable Care Act] marketplaces because the loss of Medicaid would be a qualifying event for a special enrollment period,” he said.

McEvoy addressed the future course of action for those who are dropped from their Medicaid coverage in April, saying that the Affordable Care Act marketplace was among the potential options. “Many of those people will have eligibility for health care coverage under an employer plan. I recognize that the scope of those plans, and also the cost sharing involved with them, will likely be less extensive than Medicaid and more out of pocket. But those are the other 2 sources of coverage that Medicaid programs will be using all their best efforts to help people connect with,” she said.

McEvoy also said that CMS is collaborating with the Department of Labor on connections to private insurance plans and large employers, as well as investing funding in helping local assisters in connecting people to information about Marketplace plans.

“This is something that would best benefit from everyone kind of shouldering us together and collaborating to make sure that we don’t leave someone without the information about options that they may be able to avail themselves of,” she said.

Moving Forward: Important Aspects to Keep in Mind

While there are ways to address some of the primary areas of concern with the national public health emergency ending, experts stress the importance of remaining vigilant about these issues going forward, especially regarding the mindset of both patients and health care providers.

Halkitis believes the main challenge of the national public health emergency ending will be complacency or avoidance from patients.

“There is going to be, in my view, a different orientation of the population to the disease. By that I mean both a cognitive psychological orientation that this maybe doesn’t matter anymore because the federal government says no public health emergency,” he said, “but also people avoiding care, or avoiding treatment, or avoiding testing simply because of the out-of-pocket costs.…How people are experiencing this and what they’re going to do as a result of this is probably the biggest issue at hand here.”

To prevent the perception that COVID-19 is no longer a problem, the federal and state government should explain to the public that COVID-19 is not gone over the next couple of months, he added.

He also said that doctors and health care providers should continue conversations about getting the vaccine with their patients. “Maybe…this upcoming September when people go start seeing their physicians again, the physician can say, ‘Oh, did you get your flu shot yet? Did you get your COVID-19 shot yet?’ This is something that health care providers can do and that pharmacies can do and remind people that COVID-19 is still around.”

Graves said the path forward was to make sure that the health system becomes more resilient to illnesses like COVID-19 that will likely happen again in the future.

“Having structures and processes in place that you can turn on in the event there’s a bad variant or a new infectious virus or respiratory virus that comes around, [or] a bad flu season” will be key, he said. “That would mean things like being able to turn on these various policies that [make] sure people aren’t financially destroyed by having to go to an out-of-network hospital because their in-network hospital is full.”

McEvoy agreed with this idea, saying that state governments are planning to fund future emerging vaccines and transition them into being funded by vaccine programs in collaboration between HHS and Medicaid programs.

“I think they’re also thinking about overall preparation [if] we have another type of pandemic,” she said. “So building in standing emergency plans for pieces as seemingly straightforward as purchase of personal protective equipment…Getting those plans in place, identifying roles, and the way of paying for things through the program is something I think most states are really in active preparation for.”

The end of the national public health emergency spells significant changes in the way that health care and insurance have operated for the past 3 years. With proper information and communication, as well as preparation for similar events that could occur in the future, it appears possible to mitigate some of the worst outcomes. Preparing for the end of the national public health emergency and acknowledging the continued presence of the COVID-19 virus will continue to dictate future progress after the emergency officially ends.

References

1. Appleby J. Era of ‘free’ covid vaccines, test kits, and treatments is ending. Who will pay the tab now? Kaiser Health News. February 10, 2023. Accessed March 1, 2023. https://khn.org/news/article/free-covid-vaccines-test-kits-treatments-ending-public-health-emergency/

2. Scott D. Biden is ending the Covid public health emergency. Here’s what that means for you. Vox. February 1, 2023. Accessed March 1, 2023. https://www.vox.com/policy-and-politics/2023/2/1/23579495/biden-to-end-covid-19-public-health-emergency-tests-vaccines

3. Miller Z, Seitz A. President Biden to end COVID-19 emergencies on May 11. AP News. January 30, 2023. Accessed March 1, 2023. https://apnews.com/article/biden-united-states-government-district-of-columbia-covid-public-health-2a80b547f6d55706a6986debc343b9fe

4. Luhby T, Mattingly P, Diamond J. These benefits will disappear when Biden ends the Covid national and public health emergencies in May. CNN Politics. January 31, 2023. Accessed March 1, 2023. https://www.cnn.com/2023/01/30/politics/may-11-end-of-covid-and-public-health-emergencies/index.html