• Posted February 8, 2023

Big Changes Are Coming to U.S. Health Care as Pandemic Emergencies Expire

Americans received unprecedented access to health care during the pandemic, including hassle-free public insurance and free tests, treatments and vaccines for COVID-19.

Now, they need to prepare for most of that to unwind, experts say.

"Essentially, Congress and the administration moved to a model of universal health coverage for COVID vaccines, treatments and tests"during the pandemic, said Jennifer Kates, senior vice president with the Kaiser Family Foundation.

But the United States' public health emergency declarations related to the pandemic will end on May 11, as ordered in January by the Biden administration.

And late last year, Congress voted to allow states to end the expanded Medicaid benefits provided during the pandemic.

"It's not the case that everything's going to end, but some things are going to end and some things are going to change,"Kates said.

The change most Americans will notice is an end to free COVID care, starting with testing, experts said.

"People were used to getting eight COVID tests a month from the government for free,"said Dr. Carlos del Rio, president of the Infectious Diseases Society of America. "That, for sure, is going to end."

Depending on their insurance status, people will have to pay some or part of the cost of both at-home tests as well as the more comprehensive and accurate COVID tests conducted at doctors' offices and hospitals.

"Testing is going to become something that is going to be more like testing for other diseases,"del Rio said.

Eventually, people will also have to start forking over money for COVID vaccines and treatments like Paxlovid.

Not immediately, though. The federal government still has a supply of Paxlovid and COVID vaccines on hand as a result of its pandemic response, Kates said.

"Those products that were purchased by the federal government, we can't be charged for those. Those are paid for already,"Kates explained. "But when those supplies are gone, that's when everything will be moved into the commercial market."

This could especially hit the poor and uninsured, said Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases.

A five-day course of Paxlovid costs $530, and people without insurance will have to either pay the full amount or go without treatment.

The uninsured also will have to pay for COVID vaccines, unless programs similar to free flu shot clinics are set up.

"They are likely to be representative of parts of our population that are disproportionately affected by COVID because they are poorer and they have much more difficulty accessing medical care,"Schaffner said. "So, we're concerned that disparities in vaccination by race and by income, perhaps by urban and rural location, may start to be evident."

Millions will lose Medicaid

A less evident, but more dramatic, change related to the pandemic's end will be the loss of Medicaid coverage for millions of Americans.

As part of the federal pandemic response, states were required to provide continuous Medicaid coverage for anyone who qualified. They weren't allowed to take anyone off the Medicaid rolls.

"Normally the way Medicaid works is that Medicaid programs are assessing people's eligibility on a regular basis,"Kates said. "During the pandemic, that process was halted."

As a result, Medicaid enrollment swelled by about 20 million people during the pandemic, as people who otherwise would have lost eligibility remained enrolled, KFF has estimated. Currently there are nearly 84 million people with Medicaid coverage.

But starting on April 1, states can begin shedding their Medicaid rolls of people who no longer qualify, under the spending bill passed by Congress in December.

The U.S. Department of Health and Human Services has estimated that about 15 million people are at risk of losing their Medicaid coverage.

About 8 million are people who no longer qualify for Medicaid, but KFF estimates that nearly 7 million will unfairly lose their coverage due to bureaucratic snafus or procedural snags.

Experts recommend that people on Medicaid reach out to their state's program or health insurance marketplace to determine their eligibility.

"If someone is still low-income but they don't quite make eligibility, there'll be a special enrollment period in the health care marketplace where they can buy a subsidized individual plan in the marketplace,"Kates said. "So, that may be an option."

If a person is still eligible, they need to make sure all their contact information is up to date with their state Medicaid office, and be ready to supply information needed to remain in the program.

Telemedicine may be affected

American health care will become less flexible and convenient in ways outside insurance, experts say.

For example, people may not be able to get the same kind of telemedicine care that they could during the pandemic.

Doctors were allowed to write prescriptions for controlled substances via telemedicine during the public health emergency, but in-person visits will be required after May 11, KFF says.

Some also might not be able to receive telemedicine care from the doctor they now use, particularly if the doctor is located out of state, Kates said.

"During the pandemic, all states basically waived some aspects of their state licensure requirements so that a provider with an equivalent license in one state could practice remotely in another,"Kates said. "Some states tied those policies to the end of the federal public health emergency. Unless they change their policy at the state level, somebody might not be able to get that care anymore."

However, telemedicine itself is likely to remain a major means by which people access health care.

Congress has extended Medicare's telemedicine benefit past the public health emergency, and many private insurers have followed suit, Kates said.

Finally, experts are concerned that public health surveillance of COVID will lag as a result of the public health emergency's end.

To receive federal pandemic funds, states had to sign agreements ensuring that their COVID data would be passed on to the U.S. Centers for Disease Control and Prevention in a timely fashion.

"There's a concern that these emergency declarations have allowed much, much more expeditious reporting of data, in some cases requiring data,"Kates said. "And some of those requirements will go away."

COVID reporting also could vary state by state, hampering efforts to track trends, Schaffner said.

"The transmission of data may, in the case of some states, be delayed -- for example, if they don't have the personnel who are able to devote to that,"Schaffner said. "You know, the public health capacities of our states vary considerably."

Kates added that she's also concerned about how the public at large will perceive the declared end of the public health emergency.

"This undoubtedly will send a message to some people that COVID is over, and that's not the case,"Kates said. "It's not the case that on May 10 we have COVID and May 11 we don't. It's much more complicated than that.

"We still have about 500 people dying each day from COVID,"Kates continued. "I think there's some risk that people will let up their guard."

More information

The Kaiser Family Foundation has more on changes from the declared end of the COVID public health emergency and the resumption of Medicaid eligibility checks.

SOURCES: Jennifer Kates, PhD, senior vice president, Kaiser Family Foundation; Carlos del Rio, MD, president of the Infectious Diseases Society of America; William Schaffner, MD, medical director of the National Foundation for Infectious Diseases