COVID public health emergency likely to end in 2023, affecting millions of Americans

The Biden Administration is considering ending the public health emergency (PHE) that was declared as a response to the onset of the COVID pandemic in early 2020. As a result, up to 15 million Americans could lose their health insurance coverage through Medicaid, and telehealth and pharmacy services could also see changes.

The COVID pandemic PHE was declared in the U.S. on January 31, 2020, and has been renewed every 90 days since then. On October 15, Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the emergency again until January 11, 2023.

However, HHS has also issued guidance for ending the PHE, and statements from President Biden and others suggest that the administration is likely to end the emergency status in coming months, with officials saying that they will give 60 days’ notice to health care providers and the public before the health emergency officially ends.

Millions may lose coverage

Declaring a PHE allows more flexibility in how regulations and laws are administered in the health care industry. For example, Medicaid enrollment increased more than 25% during the PHE, due in part to changes in continuous enrollment requirements. Because Medicaid is administered primarily by states, different states have different standards for who is eligible to be enrolled, and for how long. The PHE and another act, the Families First Coronavirus Response Act, required states to provide continuous coverage for Medicaid enrollees until the PHE is declared over.

The Kaiser Family Foundation (KFF) says that going back to the previous standards will lead to large numbers of people losing enrollment. “When the PHE ends, states will begin processing redeterminations and millions of people could lose coverage if they are no longer eligible or face administrative barriers during renewals even if they continue to be eligible,” the analysis says.

KFF says that “churn” often results in lower-income Americans going back and forth in eligibility and enrollment for the program, resulting in access barriers and administrative costs. “Estimates indicate that among full-benefit beneficiaries enrolled at any point in 2018, 10.3% had a gap in coverage of less than a year,” the report says. “About 4.2% were disenrolled and then re-enrolled within three months and 6.9% within six months. However, by halting disenrollment during the PHE, the continuous enrollment requirement has also halted this churning among Medicaid enrollees.”

Enrollment in the Child Health Insurance Program has similar eligibility complexities that will likely result in a decrease in overall enrollment in the program once the PHE is ended, officials note.

Telehealth and Pharmacies may also be affected

Industry experts say other parts of health care delivery will be affected by the ending of the PHE. For example, telehealth rules that were changed during COVID to allow more flexibility in providing telehealth to Americans could be reinstated — decreasing the use of telehealth, which has become very popular with Americans.

According to an article in Healthcare IT News, telehealth saw a huge increase in use during the pandemic. “Between March 2020 and February 2021, over 28 million Medicare beneficiaries, or more than 40%, used telehealth services. This is an astounding 88 times more telehealth used during the first year of the pandemic, compared to the year before.”

Telehealth providers and organizations are pushing Congress to pass legislation to make those changes permanent. “Without action from Congress, most of the telehealth flexibilities will cease, cutting off telehealth access to a majority of Medicare beneficiaries. It would also stall much-needed progress to fully integrate telehealth as a central element of health care delivery. We cannot afford to let that happen. Patients and providers deserve to have continued access to every tool at their disposal,” says David Gray, director of government relations and connected health policy at The Healthcare Information and Management Systems Society, which sponsors Healthcare IT News.

Read more: Still plenty to consider for COVID-related benefit mandates

The COVID PHE also allowed the federal government to create a more universal and flexible system for distributing vaccines, allowing pharmacies much more leeway in giving shots to Americans. There is still uncertainty over whether the end of the PHE will force pharmacies to go back to old limits on giving vaccinations. It is likely that states will need to pass laws or regulations to maintain the current flexibility in this area.

“Steve Anderson, president of the [National Association of Chain Drug Stores], asked Biden and the White House COVID task force in a September letter to keep the [regulatory flexibility] in place until October 2024,” writes Spencer Kimball for CNBC. “Roszak said this later date will give states time to make pharmacies’ expanded role in vaccinations permanent at the local level.”