When the federal Covid-19 public health emergency ends on May 11, it will mark the end of an era for the US health system.
For more than three years, in a country where patients usually pay more for health care than residents of any other high-income country, tests and vaccines were available for free to all Americans. The treatment was also free for many people, including those who were not insured.
Healthcare providers quickly adapted and shifted services to computers or phones to continue treating patients. Hospitals received a major push from government funding at a time when, at least initially, they were forced to cancel many of their surgeries and other services to deal with the influx of patients as the coronavirus spread.
But the Biden administration announced on Monday that the public health emergency will end in May, cutting off some of those services. Others, recently extended by Congress, will have a limited lifespan unless lawmakers decide to act again.
The U.S. health care system, like everything else, is returning to normal — which means it will be harder for some people to access the health care they need.
“As we transition to the new normal, we are largely returning to our fragmented health system as we knew it,” said Jen Kates, director of global health at the Kaiser Family Foundation, who has analyzed the implications of the end of the emergencytold me.
The main pandemic provision that will begin to diminish in the coming months is Medicaid’s policy of continuous coverage. Usually, states regularly check whether people enrolled in Medicaid are still eligible for it. But with additional federal funding, states kept everyone going during the pandemic. Those checks will be resumed in the course of this year, and millions of people are expected to lose their health insurance — whether or not they should.
The resumption of enrollment verification is not directly tied to the end of the public health emergency announced by the Biden administration this week. Nevertheless, the imminent end of some policies for the pandemic will affect millions of others. Here are a few worth knowing.
1) People are no longer getting free Covid tests at home in the mail – and that’s not the only thing
The pandemic has in some ways been a unique experiment in universal health care for America. While the rules have evolved over time, Covid-19 tests, vaccines and treatments are freely available to everyone at some point. From now on you can still order free home tests from the federal government. Even those without insurance can get their injections or an antiviral for free.
That will begin to change with the end of the public health emergency, but how much people will have to pay and what for will depend on their insurer. For people without insurance still about 8 percent of the populationthey now get the full cost if they want to get tested or need medication after contracting the coronavirus.
People with health insurance may also face additional costs. People with private insurance, about half the population, could already get on the hook for out-of-pocket costs for antivirals, but tests and vaccines are free. That may now change depending on your individual health plan. Medicare beneficiaries will also no longer receive free home tests.
Medicaid enrollees will receive free tests and treatments for another year, though they may bear some cost-sharing responsibility after that. Vaccines will remain free, as the program must cover all recommended vaccines at no cost to the patient.
The partial economic shutdown of 2020 has led to a proliferation of online and telephone services offered by healthcare providers and the willingness of insurers, including government programs, to cover them. It has made an essential difference: according to Kaiser Family Foundation40 percent of visits related to mental health and substance use disorders took place virtually during the height of the pandemic.
The end of the public health emergency would have ended the expanded telehealth access that Medicare and Medicaid had allowed during the pandemic. But Congress pushed that expiration date for Medicare to the end of 2024 in the year-end spending package. For Medicaid, it will vary by state: Most states say they plan to make permanent some of the looser geographic restrictions and other policy changes they adopted during the pandemic, but beneficiaries may lose access to some services that they currently have, lose.
Medicare would also lose its authority to cover drugs approved by the Food and Drug Administration (FDA) for emergency use during a public health emergency, such as the current Covid-19 antivirals, but Congress came intervened there as well, delaying the end of that provision until the end of 2024. States will make their own decisions about Medicaid coverage.
3) Hospitals are about to lose more of their Covid emergency funding
The story of how the pandemic hit hospitals is a complicated one. Major systems were better positioned to weather tough fiscal times, such as when they canceled elective surgeries in the early weeks of the pandemic. They also took advantage of the emergency funding that Congress approved, even though they didn’t necessarily need it the Wall Street Journal documented in a recent study.
But smaller hospitals are already operating on thinner financial margins, many of which are unprofitable and already rely on government funding to stay afloat. The pandemic had brought a number of additional revenue streams, including a provision related to the public health emergency, which gave them a 20 percent pay raise for every layoff due to Covid-19. But that expires with the end of the emergency.
These hospitals already lost other funding sources for the pandemic early last year. What followed was one of the worst periods of the pandemic, some leaders of these facilities say, as they could no longer afford to hire additional staff to handle the influx of patients.
As small community hospitals struggle to maintain services and staff given their fiscally precarious position, this additional loss of revenue is likely to make their situation even more difficult.