The Middletown Press (Middletown, CT)
End of COVID emergency may change access to care
WASHINGTON — After three years of adjusting to life under the COVID-19 pandemic, Americans now face a new landscape that could limit access to health care and bring the prospect of higher costs as the national emergency declarations over the killer virus are lifted May 11.
President Joe Biden signaled last week that’s the date he will end the national public health emergency declarations, which will impact thousands of Texans’ access to some health care benefits and alter pandemic safeguards.
“All emergencies must come to an end and [Biden] has tried to have a well planned and soft landing. When the emergency ends, most Americans won’t notice a difference,” said Lawrence Gostin, a public health law expert at Georgetown University, in an email. “My greatest worry is about the vulnerable, the poor, and the uninsured or underinsured.”
While the pandemic continues to fade from some American’s minds, COVID-19 cases, hospitalizations and deaths persist at a lower rate than peaks with a state average of 3,218 per day.
Gostin said vulnerable communities are likely to bear the brunt of the end of these policies, as access to care will become more difficult and they are at greater risk from COVID due to underlying health conditions.
“What we are witnessing is the unraveling of the healthcare and social safety net that was erected during the pandemic and exemplified by the PHE,” Gostin said, referring to the public health emergency. “We will continue to have a drumbeat of preventable deaths.”
Scaling back testing, health care
COVID vaccines, tests and treatments will still be authorized for emergency use by the Food and Drug Administration, but may no longer be free, as Americans have grown accustomed. Texans with private health care plans could see more costs for these measures depending on the terms of insurance, while those without health insurance will likely pay out of pocket.
Vaccines are likely to remain free for those on Medicaid or private insurance. However, Congress has not approved requests from Biden to purchase more vaccines and testing which could mean future costs for uninsured Texans.
The number of people enrolled in Medicaid skyrocketed under a pandemic provision prohibiting states from disenrolling people.
Congress included a provision in the 2022 end of the year spending bill that ends the continuous enrollment on March 31 and winds down enhanced federal Medicaid matching funds through December 2023. This allows states to disenroll some Medicaid recipients starting in April.
Kaiser Family Foundation estimates between 5.3 and 14.2 million Americans will lose Medicaid coverage throughout 2023.
The emergency declaration suspended rules on telehealth medicine that allowed doctors to bill Medicare for virtual care, which encouraged hospitals to invest and move toward telehealth during the pandemic. Also in the spending package, Congress extended this rule through 2024 so it won’t be immediately impacted by the end of the declaration.
However, pandemic rules allowing doctors to prescribe controlled substances through telehealth without an in-person visit may also end unless the Drug Enforcement Administration extends them. This could impact those seeking mental health and hormone therapy care virtually.
A provision giving hospitals a 20% increase in Medicare payments for treating COVID patients will also end in May. Texas hospitals are already bracing for the end of emergency declarations as they work to financially bounce back from the pandemic.
Some state public emergencies may remain in place despite the end of national declarations. Late last month, Gov. Greg Abbott told conservative radio talk show host Chad Hasty that he plans to keep the state order in effect until
the Texas legislature codifies executive orders he made banning mask, vaccine mandates.
The emergency declarations also impact areas outside healthcare. Throughout the pandemic, Congress and the Biden administration increased food stamp benefits to the maximum for their family size and a $95 monthly supplement for low-income families.
The pandemic assistance will end federally in March after Congress voted to cut off benefits. Lawmakers in 17 states cut off those benefits used by recipients to help cover food costs in January, and in Texas these benefits will end in February. Texans have received over $9.3 billion in emergency food assistance since April 2020, according to the governor’s office.
Additionally, under the emergency declaration, work requirements for SNAP benefits were suspended but will resume in June, according to The Associated Press.
The White House has also indicated that the end of emergency declarations will also automatically terminate Title 42, a public health measure that has limited the entrance of migrants at the border.
The Biden administration has pushed to end Title 42 earlier, however, in December 2022 the U.S. Supreme Court extended a temporary stay t hat will remain in place until the justices issue a decision.
NBC reported a White House official said the Biden administration plans to end Title 42 on May 11 if courts allow. However, Republicans have pushed back against Biden’s assertion and said Title 42 is not tied to the public health emergency.
Josh Blackman, a professor at
South Texas College of Law Houston and U.S. Supreme Court expert, said the end of the COVID emergencies is likely to weaken the states’ case who are vying to keep Title 42 in place. However, he said the outcome is still “murky.”
Another pandemic-related measure from the Biden administration was the pause on student loan payments and the forgiveness of some student debt for borrowers.
The plan, announced in August, would forgive $10,000 of student loan debt, and $20,000 for Pell Grant recipients. Only borrowers earning less than $125,000 a year are eligible.
Already 16 million Americans were approved for the forgiveness program. However, relief was paused after two federal court rulings, including from a Fort Worth-based judge, said the program was an unconstitutional use of power.
The Supreme Court will hear oral arguments in the case in February, and the distribution of
the relief remains blocked until a decision is reached.
Blackman said there may not be a tremendous impact of the COVID emergency ending on the Supreme Court’s decision. This is in part because the student loan case relies on the HEROES Act rather than a public health authority. The HEROES Act, enacted in wake of the 9/11 terrorist attacks, allows the forgiveness of some debt after a national emergency or disaster.
“With most emergencies, even if they’re over there’s still collateral effects,” Blackman said. “Imagine there is a hurricane that wipes through a town, even after the rain stops, people still may be hurt and impacted by it.”
COVID remains GOP talking point
Biden’s notice about the end date for the emergency declarations came in a response to two Republican-backed bills calling for an immediate end to the national and public health emergencies, which were originally
scheduled to end March 1 and April 11, respectively. In the notice, Biden said extending the emergency declarations before ending them would fulfill his commitment to give the public at least 60 days’ notice.
“An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” Biden wrote in the notice.
While the pandemic-era safeguards are ending, a recent flurry of GOP action indicates COVID will remain a key talking point for the party.
Recently, some Republican newcomers including Houston Rep. Wesley Hunt cited a COVID-19 testing requirement for not attending a White House reception with Biden.
On Tuesday the House passed a measure to end the public health emergency strictly along party lines, 220-210. A measure ending vaccine mandates for many health workers also passed 227-203, with some Democrats crossing party lines.
On Wednesday, the House also passed a measure ending the COVID national emergency declared in 2020, 229-197 and another measure that requires federal agencies to reinstate their prepandemic telework policies, 221206.
“Over a year after we have returned to work, school, and normalcy, this Administration and HHS continue to ignore the science and limit the personal health choices of our frontline nurses and doctors,” said Rep. Jake Ellzey, R-Midlothian, in a statement. Ellzey presided over the House for both of Tuesday’s votes. “Those elected to office who are accountable to voters should be the ones making the laws, not individuals hired by the Washington establishment.”
The measures passed in the GOP-led House are unlikely to pass the Senate, where Democrats hold a slim majority. Still, on Tuesday Texas Sen. Ted Cruz re-introduced a slate of seven bills aimed at scaling back various vaccine and mask mandates. Texas has banned mask mandates, but a handful of states have revived them temporarily in schools as both COVID and RSV had a resurgence.
Additionally, the House has made the pandemic one of the first subjects in some committee hearings. On Wednesday, the first House Oversight and Accountability Committee hearing of the new congress discussed fraud in COVID relief spending while a House Energy and Commerce subcommittee examined challenges and opportunities in investigating the origins of pandemics. Another hearing is slated early February on the federal response to the virus.