President Joe Biden intends to end the COVID-19 national and public health emergencies on May 11, the White House said Monday. That means that many Americans could have to start paying for COVID-19 testing and treatment after the declarations cease.
The White House, in a statement of administration policy announcing opposition to two House Republican measures to end the emergencies, said the national emergency and public health emergency authorities declared in response to the pandemic would each be extended one final time to May 11.
“This wind down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the (public health emergency),” the statement said.
Benefits allowed by emergencies will disappear
The public health emergency has enabled the government to provide many Americans with COVID-19 tests, treatments and vaccines at no charge, as well as offer enhanced social safety net benefits, to help the nation cope with the pandemic and minimize its impact.
“People will have to start paying some money for things they didn’t have to pay for during the emergency,” said Jen Kates, senior vice president at the Kaiser Family Foundation. “That’s the main thing people will start to notice.”
Most Americans covered by Medicare, Medicaid and private insurance plans have been able to obtain COVID-19 tests and vaccines at no cost during the pandemic. Those covered by Medicare and private insurance have been able to get up to eight at-home tests per month from retailers at no charge. Medicaid also picks up the cost of at-home tests, though coverage can vary by state.
Those covered by Medicare and Medicaid have also had certain therapeutic treatments, such as monoclonal antibodies, fully covered.
Once the emergency ends, Medicare beneficiaries generally will face out-of-pocket costs for at-home testing and all treatment. However, vaccines will continue to be covered at no cost, as will testing ordered by a health care provider.
State Medicaid programs will have to continue covering COVID-19 tests ordered by a physician and vaccines at no charge. But enrollees may face out-of-pocket costs for treatments.
Those with private insurance could face charges for lab tests, even if they are ordered by a provider. Vaccinations will continue to be free for those with private insurance who go to in-network providers, but going to an out-of-network providers could incur charges.
COVID-19 vaccinations will be free for those with insurance even when the public health emergency ends because of various federal laws, including the Affordable Care Act and pandemic-era measures, the Inflation Reduction Act and a 2020 relief package.
Americans with private insurance have not been charged for monoclonal antibody treatment since they were prepaid by the federal government, though patients may be charged for the office visit or administration of the treatment. But that is not tied to the public health emergency, and the free treatments will be available until the federal supply is exhausted. The government has already run out of some of the treatments so those with private insurance may already be picking up some of the cost.
The uninsured had been able to access no-cost testing, treatments and vaccines through a different pandemic relief program. However, the federal funding ran out in the spring of 2022, making it more difficult for those without coverage to obtain free services.
The federal government has been preparing to shift COVID-19 care to the commercial market since last year, in part because Congress has not authorized additional funding to purchase additional vaccines, treatments and tests.
Pfizer and Moderna have already announced that the commercial prices of their COVID-19 vaccines will likely be between $82 and $130 per dose — about three to four times what the federal government has paid, according to Kaiser.
The public health emergency has also meant additional funds for hospitals, which have been receiving a 20% increase in Medicare’s payment rate for treating COVID-19 patients.
Also, Medicare Advantage plans have been required to bill enrollees affected by the emergency and receiving care at out-of-network facilities the same as if they were at in-network facilities.
This will end once the public health emergency expires.
Less of an impact
But several of the most meaningful pandemic enhancements to public assistance programs are no longer tied to the public health emergency. Congress severed the connection in December as part of its fiscal year 2023 government funding package.
Most notably, states will now be able to start processing Medicaid redeterminations and disenrolling residents who no longer qualify, starting April 1. They have 14 months to review the eligibility of their beneficiaries.
As part of a COVID-19 relief package passed in March 2020, states were barred from kicking people off Medicaid during the public health emergency in exchange for additional federal matching funds. Medicaid enrollment has skyrocketed to a record 90 million people since then, and millions are expected to lose coverage once states began culling the rolls.
A total of roughly 15 million people could be dropped from Medicaid when the continuous enrollment requirement ends, according to an analysis the Department of Health and Human Services released in August. About 8.2 million folks would no longer qualify, but 6.8 million people would be terminated even though they are still eligible, the department estimated.
Many who are disenrolled from Medicaid, however could qualify for other coverage.
Food stamp recipients had been receiving a boost during the public health emergency. Congress increased food stamp benefits to the maximum for their family size in a 2020 pandemic relief package.
The Biden administration expanded the boost in the spring of 2021 so that households already receiving the maximum amount and those who received only a small monthly benefit get a supplement of at least $95 a month.
This extra assistance will end as of March, though several states have already stopped providing it.
Congress, however, extended one set of pandemic flexibilities as part of the government funding package.
More Medicare enrollees are able to get care via telehealth during the public health emergency. The service is no longer limited just to those living in rural areas. They can conduct the telehealth visit at home, rather than having to travel to a health care facility. Plus, beneficiaries can use smartphones and receive a wider array of services via telehealth.
These will now continue through 2024.
Impact on the FDA
The US Food and Drug Administration said Tuesday that when the Biden administration ends the emergency, existing emergency use authorizations for COVID-19 vaccines, tests or treatments will not be affected, and the agency may continue to issue emergency use authorizations.
“Importantly, the ending of the public health emergency declared by HHS under the Public Health Service Act will not impact FDA’s ability to authorize devices (including tests), treatments or vaccines for emergency use. Existing emergency use authorizations (EUAs) for products will remain in effect and the agency may continue to issue new EUAs going forward when criteria for issuance are met,” the agency said in a statement to CNN.
Since the start of the COVID-19 public health emergency, it “has allowed the FDA to provide important tools and flexibilities to manufacturers, health care facilities, providers, patients, and other stakeholders,” according to the statement.
In addition to the public health emergency, HHS has issued two other emergency declarations that provide broader access to medical measures for COVID-19. For instance, the emergency use authorizations for tests, treatments and vaccines are not tied to the public health emergency, but HHS will have to determine when to end the declaration that allows their use.
Many tests are available to the public under emergency use authorization, though several have been granted more permanent marketing authorization by the FDA. A few therapeutics, including remdesivir, have been approved to treat COVID-19, though others are still available under emergency use authorization.
Paxlovid and other oral antiviral drugs made available under emergency use authorization will remain covered by Medicare even though it has yet to be fully approved by the FDA, thanks to a provision Congress put in place as part of the fiscal year 2023 government spending package that passed in December.
Medicare typically doesn’t cover treatments available under emergency use authorization but has done so during the pandemic as part of the public health emergency.
Vaccines developed by Pfizer/BioNTech, Moderna and Johnson & Johnson and Novavax were also initially made available through emergency use authorization, though some have since been fully FDA-approved for certain ages.
HHS also issued another declaration that provides liability immunity to pharmacists who administer COVID-19 vaccines to children and to healthcare providers who vaccinate people in states outside of the state in which they are licensed. That is set to expire in October 2024.
White House response
The White House weighed in because House Democrats were concerned about voting against the Republican legislation to end the public health emergency that is coming to the floor this week without a plan from the Biden administration, a senior Democratic aide told CNN.
“Democrats were concerned about the optics of voting against Republicans winding down the public health emergency, absent an understanding of whether and how we intended to do so from the White House,” the aide said. “As soon as we saw this bill, it obviously concerns the White House. So, it was important for them to weigh in.”
The administration argues that the bills are unnecessary because it intends to end the emergencies anyway. And it noted that continuing the declarations until mid-May does not come with any restrictions.
“To be clear, continuation of these emergency declarations until May 11 does not impose any restriction at all on individual conduct with regard to COVID-19,” the White House statement said. “They do not impose mask mandates or vaccine mandates. They do not restrict school or business operations. They do not require the use of any medicines or tests in response to cases of COVID-19.”
The White House said it would extend the COVID-19 emergencies one final time in order to ensure an orderly wind-down of key authorities that states, health care providers and patients have relied on throughout the pandemic.
A White House official pointed to a successful vaccination campaign and reductions in COVID cases, hospitalizations and deaths as a rationale for lifting the emergency declarations. The official said a final extension will allow for a smooth transition for health care providers and patients and noted that health care facilities have already begun preparing for that transition.
The administration is actively reviewing flexible policies that were authorized under the public health emergency to determine which can remain in place after it is lifted on May 11.
The aide told CNN that it will be up to every member to decide what is best for their district and how they will vote on the legislation this week. Declaring an end to the public health emergency will also end the border restriction known as Title 42, which will also likely set up a showdown on Capitol Hill.
This story has been updated with additional details.
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