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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.

Medicare provisions
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.

<https://www.cnn.com/2023/01/30/politics/may-11-end-of-covid-and-public- health-emergencies/index.html>

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