By Reagan Cavanaugh

The World Health Organization declared COVID-19 a global pandemic on March 11, 2020, after the virus reached 118,000 cases in over 110 countries and territories around the world.[1] The disease caused by SARS-CoV-2 quickly spread to all corners of the world and proved to be deadly to many of those in its path.[2] A public health emergency was declared by the United States Secretary of the Department of Health and Human Services (pursuant to § 319 of the Public Health Service Act) followed by a national emergency declaration (pursuant to § 201 of the National Emergency Act) issued by former President Donald Trump in March of 2020.[3] A national emergency declaration remains in effect until terminated by the President, through a joint resolution of Congress, or if the President does not issue a continuation notice annually.[4] Such a notice was issued by former President Trump and by President Biden in 2021 and 2022.[5] However, the Biden Administration recently announced on January 20, 2023, that the administration will extend the national emergency till May 11, 2023, at which time it will expire.[6] While it seems the purported end of the pandemic should be a celebratory event, after taking the lives of 1.12 million Americans, this does not signal the end of the virus as Americans continue to die and will continue to present new policy changes and challenges in the future.[7]

Medicaid saw a 30% increase in enrollment during the 3 years of the public health emergency, bringing the total Medicaid enrollment to more than 110 million by the end of the fiscal year 2022.[8] Uninsured rates dropped to a record low.[9] Between 5.3 to 14.2 million Americans are likely to lose coverage when the pandemic ends and states commence to conduct reassessments as they lose additional funding for Medicaid.[10] States were previously barred from removing anyone from Medicaid and the declaration allowed people the ability to avoid the bureaucratic renewal process.[11] Because the process is complex and burdensome there is now concern that it will lead to eligible beneficiaries losing their coverage or worse, as beneficiaries could lose coverage without even knowing it as states start disenrolling members.[12]

The cost of COVID-19 care will also increase. At-home rapid test kits were previously covered by insurance and were also available for ordering free through the government. Testing in doctor’s offices and clinics was also free but insurers will no longer be required to cover COVID testing. Successful treatment regimens such as the drug Paxlovid to treat COVID-19 cost approximately $500 and will rise to $906.[13] Pfizer and Moderna have already announced that the commercial prices of their COVID-19 vaccine will likely be between $82 and $139 per dose which is 3-4 times higher than what the government has paid.[14] Certain therapeutic treatments such as monoclonal antibodies were also fully covered but will no longer be. With the escalating cost of copays, office visits, and lab tests people may decide not to seek health care due to financial constraints as Americans end up paying out of pocket for services.

Hospitals will no longer receive the 20% higher Medicare payment rates for treating COVID patients, causing a financial burden on an already overextended system.[15] Access to care faces challenges as telehealth services will return to a more limited form, making healthcare more difficult for seniors and other recipients to obtain. Telehealth has been approved by Congress for the next 2 years for Medicare recipients–however, private insurance coverage would depend upon state laws and individual insurance policies.[16] Pandemic data may also be harder to track with the expiration of the national emergency declaration that mandated reporting of COVID-19 case counts and deaths along with hospital capacity.[17] States will be asked to voluntarily share this information but some will choose not to. This could prevent insight into possible infection surges and slower responses from health officials, resulting in uncertainty throughout the healthcare system.

The end of the COVID emergency is also linked to some very different issues.[18] Congress increased food stamp benefits to the maximum for their family size in the 2020 pandemic relief package along with a boost in the spring of 2021 of an additional $95 a month, both of which will expire.[19] The expiration could also affect the position of the Biden Administration on the cancellation of student loan debt for some 40 million Americans, as the national emergency was used as a justification for the Secretary of Education’s authority to change the status and terms of student debt at a time when many Americans were at risk of defaulting on their loans during the pandemic.[20] Changes will also occur with immigration as Title 42 would expire.[21] The public health emergency allowed for the expulsion of migrants seeking asylum from the border based on the threat of spreading COVID-19.

Broadly speaking, the public health emergency declarations have allowed the government the power to activate funds, personnel, and materials as well as change the legal landscape to aid in the response to the public health threat of COVID-19. About 500 Americans continue to die from the pandemic every day.[22] While this is a significant decrease from the height of the pandemic, COVID-19 remains at the forefront of discussion.

 

[1] Domenico Cucinotta & Maurizo Vanelli, WHO Declares COVID-19 a Pandemic, Acta Biomed (Mar. 20, 2020), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569573/.

[2] Id.

[3] Juliette Cubanski et al., What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access, Kaiser Fam. Found. (Jan. 31, 2023), https://www.kff.org/coronavirus-covid-19/issue-brief/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access/.

[4] Id.

[5] Id.

[6] Id.

[7] Centers for Disease Control and Prevention, COVID Data Tracker, U.S. Dep’t Health & Hum. Servs., https://covid.cdc.gov/covid-data-tracker/#datatracker-home (last visited Feb. 7, 2023).

[8] Cheyenne Haslett & Mary Kekatos, What the end of the COVID-19 emergencies in the US means, ABC News (Jan. 31, 2023), https://abcnews.go.com/Health/end-covid-19-emergencies-us-means/story?id=96789743.

[9] Id.

[10] Id.

[11] Id.

[12] Id.

[13] Jasper Joyner, Pfizer COVID Treatment Price Cut by 80 Percent, HealthNews (Dec. 23, 2022), https://healthnews.com/news/pfizer-covid-treatment-price-cut-by-80-percent/.

[14] Id.

[15] Sharon LaFraniere & Noah Weiland, U.S. Plans to End Public Health Emergency for Covid in May, N.Y. Times (Jan 30, 2023), https://www.nytimes.com/2023/01/30/us/politics/biden-covid-public-health-emergency.html.

[16] Lisa Larrimore Ouellette et al., What does ending the COVID-19 pandemic mean from a legal perspective?, Written Description (June 8, 2022), https://writtendescription.blogspot.com/2022/06/what-does-ending-covid-19-pandemic-mean.html.

[17] Tami Luhby et al., These benefits will disappear when Biden ends the Covid national and public health emergencies in May, Cable News Network (Jan. 31, 2023), https://www.cnn.com/2023/01/30/politics/may-11-end-of-covid-and-public-health-emergencies/index.html.

[18] Id.

[19] Id.

[20] Id.

[21] Id.

[22] Centers for Disease Control and Prevention, supra note 7.