What the End of the COVID-19 Public Health Emergency Means for Testing and Treatment Costs

The COVID-19 public health emergency and national emergency declarations are set to expire on May 11.

  • The COVID-19 public health emergency and national emergency declarations will expire on May 11, the White House announced Monday.
  • Accessibility and cost for things such as COVID treatments, tests, and vaccines all vary depending on a person’s insurance status.
  • Uninsured and underinsured people will see the largest decline in assistance.

The U.S. COVID-19 public health emergency (PHE) and national emergency declarations—both of which have been in place since January and March of 2020, respectively—will expire on May 11, 2023, the White House announced.

These declarations have allowed the U.S. greater flexibility to respond to COVID over the last three years, including making changes to government health insurance program requirements, expanding the use of telehealth, and making COVID vaccines and tests free to the public via emergency funding.45 If these changes aren’t kept around through new state or federal legislation, they’ll expire with the public health and national emergency. 

“COVID-19 will become more like other infectious diseases that we deal with day in and day out, similar to influenza,” Amesh Adalja, MD, infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security, told Health. “[It] will transition from being exclusively a taxpayer-funded endeavor—in terms of payment for vaccines, for boosters, for antivirals, for tests—to one that will be handled by the regular process, which includes insurance companies, Medicare, Medicaid, and the like.” 

The May 11 expiration date aligns with the Biden administration’s agreement to give at least 60 days of notice before the expiration date of these declarations, the White House said. The weeks leading up to the expiration date are intended to provide adequate time for government agencies and offices to transition out of this emergency period, rather than ending the declarations now as two measures introduced by Republican representatives have proposed.67

“Ending these emergency declarations in the manner contemplated by H.R. 382 and H.J. Res. 7 would have two highly significant impacts on our nation’s health system and government operations,” the White House said in its statement. 

Here’s what experts had to say about when might be the best time to let the public health and national emergency declarations expire, and how it will likely change the ways that we interact with and manage the pandemic going forward. 

Many People May Lose Health Insurance Gained During the Pandemic

More so than signaling some sort of large culture or societal change in how we deal with the COVID pandemic, the public health emergency and national emergency expirations are more centered around public policy.

“It’s more about some of the ancillary aspects of it that they might have to prepare for, especially those who might have gotten health insurance because of this,” Dr. Adalja said.

The biggest change after May 11 will probably be for those people who were enrolled in or kept on Medicaid during the pandemic. 

“During the PHE, the Medicaid program has operated under special rules to provide extra funding to states to ensure that tens of millions of vulnerable Americans kept their Medicaid coverage during a global pandemic,” the White House said. 

With the expiration of the public health emergency, however, those extra flexibilities which allowed people to remain insured during the pandemic will be phased out. 

“People will lose insurance, namely people who had expanded access or expanded enrollment to Medicaid,” Rebecca Wurtz, MD, MPH, an associate professor at the University of Minnesota School of Public Health, told Health. “[They] won’t lose it instantly as of the expiration of the emergency declarations, but over time, over several months after that. And so, [there are] significant potential problems for people in terms of cost and access.”

Though the PHE is one of many federal and state policies helping to decrease the number of uninsured people in the U.S., its expiration could cause more than 15 million people to lose their Medicaid health insurance.8

It’s challenging to pinpoint the actual number of people who may be affected by this, as people may have gotten jobs with health insurance since the public health emergency was enacted, plus many states have expanded Medicaid coverage, explained Dr. Wurtz.9 

Still, this expiration of the PHE probably poses the biggest issue for those people who currently have health insurance because of this Medicare expansion, Dr. Adalja said.

Vaccines Will Remain Free for Many, but Tests and Treatments May Have Costs

Accessibility and cost for things such as COVID treatments, tests, and vaccines all vary depending on a person’s insurance status, according to the Kaiser Family Foundation. The nonprofit organization tracked all three and how insurance status or lack thereof might change following the expiration of the PHE.5

For vaccines, nearly every person should be able to access them for free, at least for the time being. The government has already purchased a stockpile of COVID vaccines, meaning that everyone will be able to continue to access those for free until they run out. Even after that happens, people covered by Medicare and Medicaid will have free vaccines. People with private insurance should also see their COVID vaccines covered, especially if they go to an in-network provider or pharmacy.

Things get a bit more complicated regarding COVID testing and treatment costs after the PHE expires. Again, the federal government has already purchased a bulk of tests and antiviral treatments that will be available at no cost for now. After those run out, costs depend largely on the type of health insurance a person has.

For those with Medicare, they will likely see some kind of cost sharing for treatments, and will likely have to pay for COVID tests. If tests are ordered by a doctor, however, they should be covered.

With Medicaid, people won’t see any changes for a bit longer. The American Rescue Plan Act requires that the Medicaid program pay for COVID treatments and tests for a year after the public health emergency expires, which would be June 2024. After that, all Food and Drug Administration (FDA) approved treatments should be covered, though people may have to pay a bit for cost sharing. At-home test costs will likely vary by state, but doctor-ordered tests should be paid for.

People with private insurance will likely see cost sharing for COVID medications and maybe even slightly higher premiums as the federal doses run out. They may also see co-pays for COVID tests or restrictions on where or how many tests they can access.

“There may be some out-of-pocket costs depending on your insurance company. There may be some steps to get reimbursement from your insurance company. And I think that will vary,” Dr. Adalja explained. “There’s different plans that people have. The easiest way to put this, is it’s going to be just like any other medical condition, in terms of how you access the tools that you need—tests, vaccines, antivirals.”

Though the PHE expiration is simply moving COVID to what’s standard for healthcare in America, Dr. Wurtz said it will make things generally “more burdensome.”

“People who are insured will pay more for testing and medications,” Dr. Wurtz said.

After the PHE expires, it’s the uninsured who are likely facing the biggest changes and issues with accessing these measures. When the free vaccines, treatments, and tests are gone, uninsured people will be responsible for purchasing all three. There are federal programs that people can access to help them get vaccines, though there’s not enough funding for every person. There are also 60,000 available doses of one monoclonal antibody treatment purchased by the Department of Health and Human Services specifically for the uninsured.

Other effects include narrower telehealth services and the end of the Title 42 border policy which has blocked the number of migrants admitted to the U.S.3

The End of the Emergency Phase Doesn’t Mean the End of COVID

Despite the fact that the U.S. is now moving into an endemic phase of COVID-19, versus a pandemic, it’s not accurate to say that the end of the public health emergency makes the virus any less serious.

“At a certain point, we have to say that this isn’t an emergency anymore,” Dr. Wurtz said. “But I think it’s important to decouple the end of the emergency from the end of COVID—COVID isn’t over, we still have to take [it] seriously.”

Since October 2022, the U.S. has mostly seen between 2,500 and 4,000 weekly deaths from COVID.10 And beyond the U.S., the World Health Organization on Monday again dubbed COVID a public health emergency of international concern.11 Even without a PHE in the U.S., people should be ready and willing to change their behavior if the COVID risk in their communities goes steeply up, Dr. Wurtz said. 

Despite the continuing gravity of the situation, the country has come a long way since the winter and spring of 2020, when the public health and national emergencies were first announced.

“I think it’s reasonable,” Dr. Adalja said. “What prompted the public health emergency, what prompted the national emergency, was the plight of hospitals and hospital capacity. Were we going to have enough ventilators, were we going to have enough PPE, were we going to be able to care for everybody’s needs, and also care for a deal with the COVID surge? Those concerns have long been gone in the United States.”

The availability and efficacy of tools such as COVID boosters, masks, treatments, and even just sufficient hospital capacity means that the country is in a situation where things are much more manageable, he added.

The other potential bright spot of the public health and national emergency declarations is that they allowed for a more widespread and robust healthcare response in the U.S. that some are interested in keeping around long term.

For example, the PHE allows for people to rely more on telehealth—as a response, a bill called the Expanded Telehealth Access Act was introduced in Congress in 2021 that would allow physical therapists, speech pathologists, and some other providers to practice via telehealth under Medicare.12

“Part of what was interesting about these emergency declarations was the increased flexibility that we pumped into our healthcare system—increased access, increased coverage, decreased cost, increased telehealth,” Dr. Wurtz said. “What did having better healthcare coverage mean for people’s health? And whether we can use that then as a case for going back and making some of the changes permanent.”

Source: Health.com

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