The COVID public health emergency is over – but what does that mean, and who will be affected?

President Biden receives a COVID-19 booster shot at the White House in October 2022. (Tom Brenner for The Washington Post via Getty Images)

The White House announced last month that the public health emergency COVID-19, or PHE, declared by the Trump administration at the beginning of the pandemic in 2020, will end on May 11. And while some Americans may incur extra costs as COVID-related expenses fall away from the federal government. , There is a group, experts say, that will probably inherit the biggest burden.

What did the public health emergency declaration of COVID do?

“Many of the emergency declarations really had to do with trying to adjust our systems in general in the context of the COVID-19 pandemic,” said Dr. Wafaa El-Sadr, a professor of epidemiology and medicine at the Columbia Mailman School of Public Health, he said. Yahoo News. “Allowing more virtual medical visits is one example. Another example would be providing free tests for people who don’t have health insurance. A third example would be providing vaccines at no cost. Another example would be providing treatment for COVID-19 at no cost” .

Keon Gilbert, a fellow at the Brookings Institution and associate professor at Saint Louis University’s College of Public Health and Social Justice, explained that the PHE allowed the various agencies to go through the processes a little faster so that everyone will be able to access more COVID-related screening tools and treatments. easily

“As people began to lose their jobs or became underemployed, as hours were cut further during the pandemic, [the PHE] it allowed people, especially in states that expanded Medicaid, to get health insurance and health care coverage through the Medicaid route,” he explained.

Who will likely have the most impact?

Gilbert said those most affected by the PHE’s conclusion would be “definitely [be] people who have no insurance” – a prediction El-Sadr agrees with.

“Often, it is the most vulnerable individuals in society who end up being the ones left behind. This includes, to a large extent, the uninsured [and] undocumented people,” he said. “It’s often the most vulnerable people in society who bear the brunt of the gaps in services.”

El-Sadr warned that while the insured will probably encounter the most obstacles, we do not know all the details, and more information should be available when we approach May 11. But in all likelihood, the “safety net” provided. from federally funded test kits, vaccines and treatments will eventually fall.

Thanks to policies implemented during the pandemic to protect those who lost their jobs or income, the number of people without insurance in the United States decreased by almost 1.5 million in 2021, to a total of 27.5 million , according to the Kaiser Family Foundation.

But the expiry of PHE could mean an increase in people without insurance since the Medicaid continuous enrollment provision has ended.

“When it was declared, [the PHE] allowed states to enroll many people on Medicaid so that they have insurance. Millions of people will be out of service over time when PHE ends,” explained Gilbert. “Some of these people have already secured employment with health benefits, so they will be fine for the most part. It is indeed the people who remain unemployed or underemployed who will be most affected.

“Also, we have to understand that there are also millions of people who are experiencing long-term symptoms of COVID, and some of them may not have returned to work full time. Some of them may even be completely unemployed. And so, depending on their particular employment status, they can also be greatly affected by this.

According to analysis published by the Department of Health and Human Services“Children and young adults will be disproportionately affected, with 5.3 million children and 4.7 million adults ages 18-34 expected to lose Medicaid/CHIP. [Children’s Health Insurance Program] coverage.” Latino and black individuals make up nearly a third of those expected to lose coverage.

A nurse prepares a COVID booster shot.

A nurse prepares a COVID booster shot in Los Angeles in December. (Hans Gutknecht/MediaNews Group/Los Angeles Daily News via Getty Images)

What could change for people without insurance?

As long as the US federal vaccine stockpile lasts, primary and booster COVID vaccines will, thanks to the Affordable Care Act, continue to be free for everyone regardless of insurance coverage, according to a analysis by the Kaiser Family Foundation. The availability and cost of COVID vaccines is determined by the federally purchased vaccine supply, not by the PHE. But once supplies run out, vaccine costs “may become a barrier for uninsured and underinsured adults,” Kaiser says. As of this fall, the US government plans to stop buying COVID vaccines and vaccine manufacturers will sell them to health care providers at a higher cost – that uninsured individuals may have to pay out of pocket.

For uninsured children, Gilbert said, vaccines may be available at very low or no cost. The federally funded Vaccines for children The program, for example, has been around since long before COVID and provides vaccines “at no cost to children who might otherwise not be vaccinated due to inability to pay,” with the Centers for Disease Control and Prevention they buy shots at a discounted rate to distribute. to providers registered with the program.

But for uninsured adults, Gilbert said, “it’s going to be a little more complicated.”

“Hopefully, federally qualified health care centers and other places will be able to offer people COVID tests and COVID vaccines, either at a very low cost or free, even if they don’t have insurance,” he said.

For COVID-19 tests, uninsured people in many states already had to pay out-of-pocket for PCR tests, the average cost of which is $127 for testing, unless they were tested at a free clinic or community health center. A Medicaid coverage option adopted by 15 states, which allows uninsured people access to testing services without cost sharing, will expire with the PHE.

Health and Human Services says that “pending the availability of resources,” the CDC’s program for increasing community access to testing “will continue to work to ensure continued equitable access to testing for uninsured individuals and high-vulnerability areas social through pharmacies and community-based sites.”

The US government may also continue to distribute free tests from the national stockpile until supplies last. But access to free at-home COVID test kits through a government website it will likely cease once these supplies have been exhausted.

“It looks like free testing is going to end, unless some clinics offer free testing,” Gilbert said. “I imagine that for some people, especially the elderly population and families with children, they can arrange some of the free tests to help them get through a few more months.”

COVID treatments like Paxlovid, an antiviral therapy which can reduce the risk of hospitalization and death, will also continue to be free while the federal supply lasts, but uninsured patients may need to start footing the bill once the offer ends. As with vaccines, the cost and availability of Paxlovid depends on federal supply and not on PHE, Kaiser explains. Last year the US government bought 20 million courses of Paxlovid from Pfizer at a discounted rate of $530 each.

Are we ready?

While Gilbert said there are “very mixed feelings” about the end of the PHE, public health experts recognize that we have entered a new phase in the pandemic.

“I think we recognize that we are in a different place with COVID-19 versus where we were in early 2020, or even early 2021,” El-Sadr said. “We know a lot more about the virus itself and how to diagnose and manage COVID-19. We are in a very different place, which means there is a reason to adjust at the moment.”

Although the PHE ends on May 11, Gilbert said many changes should not happen overnight.

“It will still take several months for the policy to come into effect,” he explained. “Those that have to be cancelled [from Medicaid] it will not be unregistered immediately. They should be given some time and a notice date for when their Medicaid benefits will end.

“I hope it gives people many, many months to be able to prepare for any new changes or new costs that will be incurred. So I think it’s kind of a positive piece – that everything doesn’t happen immediately.”

But PHE’s demise also calls attention to non-COVID gaps in US health care.

“I think one of the challenges, just in general, is that we don’t always have a very clear and clean public health infrastructure that allows people to feel that even if this particular statement ends, that there are a lot of safeguards “Gilbert. he said. “So I think what becomes important is that public health agencies like the CDC and state, county and local health departments communicate the role they play in making sure that people continue to not only stay safe and prevent COVID , but also that there are opportunities. and structures in place for them to access many of these preventive health services as well.”

El-Sadr pointed out that the PHE has brought some changes that have been welcomed especially by some of the most vulnerable members of society – such as access to virtual medical visits, making health care more available to the seniors Understanding the broader consequences of ending what some consider desirable changes to health care, he said, will be important as we move into a post-PHE era.

“I understand that we are in a different place,” said El-Sadr, “but at the same time we must examine very carefully what are the implications of canceling the public health emergency in terms of access to services and treatments related to COVID-19. and vaccines – and also in terms of access to health services in general.”

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