What’s at Stake as US Ends Covid Emergency Measures

What's at Stake as US Ends Covid Emergency Measures

The United States has begun unwinding its Covid-19 crisis measures that have expanded access to health care for millions of people since the outbreak began in the country in 2020. On April 10, President Joe Biden signed into law a measure that ended the country’s domestic law. emergency order. On May 11, the White House plans to end a separate, larger public health emergency and disband its Covid response team. A policy that increased health coverage for low-income people has already been scrapped. The same goes for the federal government’s purchase of Covid vaccines and treatments. While some rules regarding telehealth will remain relaxed, others will be tightened again. The rollback of the Covid emergency rules also has implications for US immigration policy.

1. What is the Covid toll in the US right now?

Covid killed more than 1.1 million people in the United States in early April. About 250 people died each day, according to the Centers for Disease Control and Prevention, compared to about 3,400 at the January 2021 peak.

2. What were the declarations of urgency?

• In January 2020, then-Health Secretary Alex Azar declared a public health emergency. This allowed his department to relax or waive certain requirements and put in place flexibilities to deal with the Covid outbreak.

• Azar issued a separate emergency statement the following month that allowed the Food and Drug Administration to grant emergency use authorizations for Covid products. No plans have been announced to end this declaration, which has made Covid vaccines, treatments and diagnostics – which otherwise could have taken years to bring to market – available more quickly. If the declaration is revoked, the emergency authorizations for these products will also be revoked. With that in mind, many companies, like Pfizer, Moderna, and Gilead, have sought to have their products approved through formal, more permanent channels.

• Then-President Donald Trump issued a declaration of national emergency in March 2020 that enabled the federal government to mobilize resources and support activities beyond public health boundaries. For example, the declaration has extended the deadlines for workers to register to retain health insurance after leaving their jobs. The Biden administration intended to keep the national emergency in effect until May 11, but the president signed into law a Republican-backed measure that ended it on April 10.

3. Why has health coverage for the poor increased during the pandemic?

Typically, states regularly assess whether people enrolled in Medicaid, the government health program for the poor, remain eligible. During the pandemic, Congress dramatically increased federal funding for state Medicaid programs, and in return, states suspended the enrollment review process for the duration of the public health emergency. Easing eligibility requirements thus increased Medicaid enrollment in every state. Overall, enrollment in Medicaid and the related children’s health insurance program has increased 28% since the start of the pandemic to more than 91 million people, according to data from the Kaiser Family Foundation.

4. What has changed with the Medicaid rules?

In its year-end spending bill, Congress decoupled this new flexibility from the public health emergency and tightened Medicaid enrollment provisions beginning March 31. States are no longer required to keep people enrolled — and some will now begin the long process of re-determining Medicaid eligibility for millions. (Arkansas, Arizona, New Hampshire, South Dakota and Idaho will begin terminations in April, while most other states will begin the process this summer). Registrants will need to verify information ranging from income to household size.

5. How many people will be affected by the change in Medicaid?

The Kaiser Family Foundation estimates that between 5 million and 14 million people could lose their Medicaid coverage. The Department of Health and Human Services has estimated that up to 15 million people could be removed from the program. The Georgetown University Health Policy Institute estimates that nearly 7 million children and adolescents are at risk of losing their coverage. Some people leaving Medicaid may be eligible for other coverage, including through Affordable Care Act employers or contracts.

6. How will payment for Covid vaccines and treatments change?

Throughout the pandemic, the US government purchased supplies of Covid vaccines and treatments, which for the most part were offered to people at no cost. That’s about to change. Absent new funding for these products from Congress, the Biden administration will stop buying them, leaving their purchase and distribution to the market. For now, the supply of government-purchased Covid vaccines and treatments is sufficient, so access “will generally not be affected,” the health department said in February.

7. What happens after government-purchased supplies run out?

When that happens, most Americans will get their Covid vaccines and treatments through private health insurance plans or federal health programs — such as Medicaid and Medicare, the program for the elderly — as they already do. with annual flu shots. Covid vaccines will continue to be provided to older Americans through Medicare Part B without cost sharing, and Medicaid will cover all vaccines and treatments without cost sharing until September 30, 2024. Thereafter, the cost may vary depending on the ‘State. For those with private insurance, out-of-pocket expenses for treatments may vary depending on their plan.

8. What about those without health coverage?

Those without health insurance can face significant costs. The Centers for Disease Control and Prevention’s “Vaccines for Children” program will continue to offer free vaccines to children. The Biden administration has offered a similar program for American adults. CDC Director Rochelle Walensky raised concerns about difficulties in access for underinsured adults. However, Pfizer Inc. and Moderna Inc. said they would provide their Covid vaccines free of charge to uninsured people in the United States through their patient assistance programs.

9. Who will pay for the Covid tests?

The public health emergency allowed Medicare and Medicaid beneficiaries to receive free, rapid over-the-counter Covid tests, and the Biden administration then demanded that private insurance companies cover the tests without out-of-pocket. After the emergency order ends on May 11, Medicare beneficiaries will not be able to get free tests unless ordered by a health care provider. (There may be fees associated with visiting the doctor, however). Medicaid, meanwhile, will continue to cover home testing and PCR until September 2024, after which coverage will vary by state. For those with private insurance, costs will depend on their plans. The Department of Health and Human Services has issued guidance encouraging employer health plan sponsors and health insurers to continue covering Covid testing after the emergency ends without requiring beneficiaries to pay out-of-pocket costs . Depending on supply, the United States may continue to distribute free Covid tests from the National Strategic Stockpile. Every US household can still order four free rapid home tests at covid.gov/tests.

10. What happens with the rules regarding telehealth?

Throughout the pandemic, Medicare beneficiaries have been able to receive telehealth care from home, with new laws expanding the types of facilities that can provide such services as well as the list of services that would be covered. Congress assured in its year-end spending plan that most Medicare telehealth flexibilities will remain in place through December 2024. Meanwhile, most states have made Medicaid telehealth flexibilities permanent. With private health insurance, coverage continues to vary by plan. Some rules regarding telehealth prescriptions may change.

11. What prescribing practices are being reconsidered?

The public health emergency has allowed telehealth providers to prescribe certain controlled substances virtually or over the phone without conducting an in-person medical exam. The Drug Enforcement Administration proposed new rules in February that would no longer allow providers to prescribe Adderall, Vicodin or OxyContin, for example, if the patient had never had an in-person visit. For another class of drugs — which includes testosterone and buprenorphine, a treatment for opioid use disorder that can prevent withdrawal symptoms — a clinician could order an initial 30-day supply of the drug via telemedicine, but would need an in person visit to provide a refill. The DEA is considering public comments on the proposed rules.

12. What is the impact on immigration policy?

An end to the public health emergency will also mean an end to Title 42, an obscure public health order dusted off under Trump at the start of the pandemic that made it easier for authorities to deport undocumented migrants. In about half of migrant arrests in fiscal year 2022, in which U.S. Border Patrol encountered a record 2.2 million people entering the country without permission, authorities used the rule to remove quickly individuals in their country of origin or in the country from which they came. entered the United States. The alternative is to deal with apprehended migrants under ordinary immigration law. This gives them a chance to stay in the United States at least temporarily in order to make long-term offers for asylum, available to people who can show they have a legitimate fear of persecution in their country. .

–With help from Josh Wingrove, John Tozzi and Madison Muller.

More stories like this are available at bloomberg.com

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