Three years after the federal government officially declared COVID-19 both a public health and national emergency, the White House is ready to relinquish the extra powers that came with those proclamations. Last week, the Biden administration announced that it will end the twin emergencies on May 11, a move that would trigger some major changes in how people access COVID vaccines, treatments, and testing.
That’s not necessarily a bad step. Presidential emergency powers should be confined to just that — emergencies that require a swifter response than the normal legislative process. But until the federal government ensures that states, insurers, health care providers, and its own agencies are prepared for the transition, ending the emergency declarations may be premature.
Biden and his predecessor, Donald Trump, used those emergency powers for an array of purposes, from border enforcement to instituting an eviction ban. But perhaps the powers’ most important function was to establish a nationwide safety net for reliable and free access to COVID-related care. New rules for insurers and health care providers, such as requirements to cover telehealth visits or nursing home stays, were quickly enacted. The federal government was also able to funnel supplemental funds to state Medicaid programs, protecting existing enrollees from losing coverage and expanding the number of people eligible. And as soon as they were available, vaccines and tests were all paid for.
Once the emergency declaration expires, though, a patchwork of different policies will take that safety net’s place: Americans’ access to vaccines, treatments, and tests will vary based on which state they live in. (Massachusetts, for example, requires that insurers cover all COVID services, but that’s not necessarily the case in other states.)
Uninsured Americans will have to start paying out of pocket for these services; pharmaceutical companies are already preparing to dramatically increase prices. Before it can declare the national emergency over, the Biden administration must articulate a plan for the uninsured to have access to the care they will continue to need.
This is not a minor issue. The uninsured population is roughly 27 million people, and that number is likely to grow after April 1, when states will have to resume the process of reassessing eligibility for Medicaid recipients because of a recent order from Congress. Those reassessments had been put on hold as part of the federal government’s emergency response in order to reduce the number of uninsured Americans during the pandemic.
In Massachusetts, MassHealth, which runs the state’s Medicaid program, has already taken steps to limit the disruption that residents might face. It plans to hire over 150 staff members — some permanent, some temporary — to answer questions from recipients. It will also maintain coverage for more vulnerable populations, including a year of continuous coverage for postpartum individuals and people who were recently released from prison, and two years of continuous coverage for people experiencing homelessness. But many other states have no such provisions in their Medicaid programs.
In his State of the Union address, President Biden called on congressional lawmakers to “finish the job” and expand Medicaid for good. But given that Republicans control the House, that’s unlikely to happen anytime soon. The reality is that just before Biden ends the emergency declaration in May, many Americans will begin losing their Medicaid coverage and will no longer have access to COVID-related care. How will imploring the uninsured to get vaccinated sound if they potentially have to spend upward of $100 to do so?
To its credit, the White House acknowledged the need for some time before the change takes effect. “An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” the White House said in a statement last week.
That comment was aimed at Republicans in the House, who had passed a bill to terminate the national emergency immediately. But now it’s up to the Biden administration to ensure that the cancellation of the emergency declaration is indeed a smooth transition and not the abrupt end it warned about. And if, in three months, circumstances have changed, the administration shouldn’t be afraid of changing course too. This is an evolving disease, one that is still killing some 500 people a day, and there is no telling when another surge in infections could overwhelm the health care system again. While COVID has fortunately lost its grip on most Americans’ everyday lives, it’s still here.
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