Last month, the White House made an announcement stating that the COVID-19 public health emergency (PHE) declared by the Trump administration at the start of the pandemic in 2020 would come to an end on 11th May. As the COVID-related expenses shift away from the federal government, some Americans might incur extra costs. However, experts say that one group is likely to inherit the most significant burden.
COVID Public Health Emergency Declaration: Implications and Significance
The COVID-19 public health emergency declaration, issued by the Trump administration at the onset of the pandemic in 2020, brought many changes to the healthcare system. One of the key provisions was to make medical care accessible to everyone, including virtual medical visits, free testing, no-cost vaccines, and COVID-19 treatment, according to Dr. Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia Mailman School of Public Health.
The declaration also helped various agencies fast-track their processes, providing more accessible COVID-related screening tools and treatments, as per Keon Gilbert, a Brookings Institution fellow and associate professor at Saint Louis University’s College for Public Health and Social Justice.
Moreover, the PHE allowed people who lost their jobs or were underemployed, particularly in states that expanded Medicaid, to have access to healthcare insurance and coverage through the Medicaid pathway, added Gilbert.
With the end of the PHE on May 11, there could be a shift in COVID-related expenses away from the federal government, which could potentially impact Americans. However, experts warn that one group, in particular, may face the biggest burden in terms of costs.
People to be Impacted the most?
The conclusion of the Public Health Emergency (PHE) will affect those without insurance the most, according to Gilbert and El-Sadr. The vulnerable members of society, including the uninsured and undocumented, are typically the ones who are left behind and bear the brunt of service gaps.
El-Sadr warns that while the uninsured may face the most challenges, we are not yet aware of all the specifics, and more information will become available as the deadline of May 11 approaches. However, the “safety net” provided by federally funded testing kits, vaccines, and treatments will eventually disappear.
Thanks to the pandemic policies, which safeguarded individuals who lost their jobs or income, the number of uninsured people in the US declined by almost 1.5 million in 2021, totaling 27.5 million, as per the Kaiser Family Foundation.
However, the termination of the PHE may result in an increase in uninsured individuals, as Medicaid’s continuous enrollment provision concludes. Gilbert explains that millions of people will be disenrolled over time when the PHE concludes, but some may have already found employment with health benefits, leaving the unemployed or underemployed to bear the brunt of the impact.
Furthermore, millions of people continue to experience long-term COVID symptoms, and some of them have not returned to work full-time, if at all. Depending on their work status, they may also be significantly impacted.
According to a Department of Health and Human Services analysis, children and young adults will be disproportionately affected, with 5.3 million children and 4.7 million young adults aged 18-34 predicted to lose Medicaid/CHIP (Children’s Health Insurance Program) coverage. Additionally, almost a third of those projected to lose coverage are Latino and Black individuals.
What changes could affect uninsured individuals in regards to COVID-19 vaccines, testing, and treatments?
According to the Kaiser Family Foundation, COVID-19 vaccines will continue to be free for everyone, regardless of insurance coverage, as long as the federal stockpile lasts. However, once the supply runs out and vaccine manufacturers start selling to healthcare providers at a higher cost, uninsured adults may have to pay out of pocket for COVID-19 vaccines. Meanwhile, the Vaccines for Children program provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay.
For uninsured adults, getting COVID-19 vaccines may be more difficult. They may have to rely on federally qualified healthcare centers and other places that offer COVID-19 tests and vaccines at a low cost or for free. In many states, uninsured individuals have already had to pay for COVID-19 tests out of pocket, with the median cost being $127 per test.
While the CDC’s Increasing Community Access to Testing program will continue to ensure equitable access to testing for uninsured individuals and areas of high social vulnerability, the Medicaid coverage option that allowed uninsured people access to testing services with no cost sharing will expire with the PHE. The U.S. government may continue to distribute free tests from the national stockpile while supplies last, but the access to free at-home COVID-19 testing kits through a government website will likely cease once supplies run out.
Lastly, uninsured patients may need to start paying for COVID-19 treatments like Paxlovid once the federal supply runs out. The U.S. government purchased 20 million courses of Paxlovid from Pfizer last year at a discounted rate of $530 each.
In Conclusion
Public health experts recognize that the expiration of the PHE marks a new chapter in the pandemic. While acknowledging the progress made in the understanding and management of COVID-19, experts agree that sudden changes should be avoided. Gilbert explains that the policy changes will take several months to take effect, and those affected by the Medicaid disenrollment will be given ample time to prepare for new changes or costs.
The sunsetting of the PHE also brings attention to the gaps in the U.S. healthcare system unrelated to COVID-19. Gilbert highlights the importance of having clear and clean public health infrastructure that ensures people remain safe, access preventative health services, and prevent COVID-19. El-Sadr stresses the significance of examining the implications of ending the PHE carefully, particularly regarding access to COVID-related and overall health services.
El-Sadr notes that the PHE has brought some desirable changes to health care, such as virtual medical visits, which are particularly helpful to vulnerable members of society. As we move beyond the PHE era, it is essential to understand the broader consequences of rescinding these changes.