America isn’t prepared for the end of the COVID emergency

Funding for vaccines and tests is ultimately allocated by Congress, and members chose not to extend the Medicaid provision. But the Biden administration has also been half-hearted in how it has chosen (or not) to defend these steps.

A sign outside the Salt Lake County Health Department announced COVID-19 testing, Dec. 20, 2022, in Salt Lake City. The declaration of a COVID-19 public health emergency three years ago changed the lives of millions of Americans by offering increased health care coverage, beefed up food assistance, and universal access to coronavirus vaccines and tests. Much of that is now coming to an end, with the Biden administration plan to end the emergencies declared around the pandemic on May 11.Rick Bowmer/Associated Press

The Biden administration announced last week that it would be ending the public health emergency declaration for COVID-19 in May because the country is in a better place when it comes to hospitalizations and deaths. The administration has given a few months’ notice of the planned move because health care systems will need time to facilitate an orderly transition. Regardless of the administrative procedures the end of the emergency declaration has set in motion, thousands of Americans continue to die of COVID each week. Though the administration is framing the end of the public health emergency positively, we are concerned it will have grave impacts on the ability to control the disease and adversely affect how people are able to access care to prevent and treat COVID.

During the early days of the pandemic, Congress passed a law that required states to keep people continuously on Medicaid (rather than the typical process of requiring reenrollment each month) during the public health emergency. In December, Congress passed another law, which Biden has since signed, allowing this “continuous enrollment” provision to expire in April. As a result, an estimated 6.8 million Americans are at risk of losing their care. According to figures collected by the Kaiser Family Foundation from 2016 to 2019, about two-thirds of those affected experience some period of being uninsured during the year after disenrollment, and nearly 20 percent will remain uninsured for the whole year. Ending the public health emergency — and with it the continuous enrollment provision — will further burden families with insurmountable medical bills and delay necessary care for many.

The end of the public health emergency also brings an end to government funding of tests, treatments, and vaccines. How much you pay for these tools will depend on where you find yourself in the insurance system — if you’re covered by Medicaid, everything will be the same. If you’re on Medicare or have private insurance, you might have increased copays. But there is no plan for the nearly 27.5 million people who lack health insurance. Ending the emergency will result in more people becoming uninsured while simultaneously making it necessary to have insurance to access COVID-related care.

Moderna and Pfizer recently announced plans to increase the price of their mRNA vaccines 400 percent from the $26 they currently charge the government to between $110 and $130 per dose. Even people with insurance who will not need to pay out of pocket for the shots may see increases in their premiums. This will continue to increase the burden of death and illness, particularly in low-income and communities of color across the United States, communities that have already been hit hard by the pandemic and are much more likely to have inadequate insurance coverage.

Congress shares the blame for this avoidable tragedy — funding for vaccines and tests is ultimately allocated by Congress, and members chose not to extend the Medicaid provision. But the Biden administration has also been half-hearted in how it has chosen (or not) to defend these steps. It is hamstrung by the internal inconsistency of its own rhetoric, insisting it is working hard to convince Congress to shore up the pandemic response while at the same time broadcasting far and wide that the pandemic is over.

Ending the public health emergency represents backward progress on health justice, and as the federal COVID response is wound down and transitioned to the private market, the virus will continue to enact a heavy cost. To mend the nation’s social safety net frayed by three years of pandemic strain on top of decades of disinvestment and neglect, there needs to be transformative long-term solutions, including Medicare For All (inclusive of pharmaceuticals), funding for development of new and better therapeutics and vaccines, and increased public health and health care capacity.

The Biden administration says it’s serious about making sure no one is left behind and that ending the emergency does not mean ending work on COVID. But if it cannot muster the fight needed to provide basic protections during an acute phase, there is no reason to expect executive agencies will be willing, or even capable, of tackling bigger problems.

Abdullah Shihipar is a writer and research associate; William Goedel is an assistant professor of epidemiology; and Abigail Cartus is a postdoctoral research associate at the People, Place, and Health Collective at the Brown University School of Public Health.