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The COVID public health emergency is coming to an end, but what does that mean and who will it affect?

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

The White House announced last month that the COVID-19 public health emergency, or PHE, declared by the Trump administration at the start of the 2020 pandemic, will end on May 11. And while some Americans may incur additional costs as COVID-related spending shifts away from the federal government, there’s one group, experts say, likely to inherit the biggest burden.

What did the COVID public health emergency declaration do?

“A lot of the emergency declarations really had to do with trying to adapt our systems in general in the context of the COVID-19 pandemic,” Dr. Wafaa El-Sadr, professor of epidemiology and medicine at Columbia Mailman School of Public Health. Yahoo News. “Allowing more virtual medical visits is one example. Another example is offering free tests to individuals who do not have health insurance. A third example is the free provision of vaccines. Another example is free treatment of COVID-19.”

Keon Gilbert, a Brookings Institution fellow and associate professor at Saint Louis University’s College for Public Health and Social Justice, explained that the PHE enabled several agencies to move through processes a little faster so that everyone could have access to COVID-related screening tools and treatments more easily.

“As people started losing their jobs or being underemployed, as hours got shorter as the pandemic continued, [the PHE] enabled people, especially in states that were expanding Medicaid, to get health insurance and health insurance coverage through the Medicaid pathway,” he explained.

Who is most likely to be affected?

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

“It is often the most vulnerable individuals in society who are left behind. This largely includes the uninsured [and] undocumented people,” she said. “Often it is the most vulnerable people in society who will bear the brunt of service gaps.”

El-Sadr warned that while the uninsured are likely to face the most obstacles, we don’t yet know all the details and more information should be available as we get closer to May 11. federally funded test kits, vaccines and treatments will eventually fall away.

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Thanks to policies put in place during the pandemic to protect those who lost their jobs or income, the number of the uninsured in the U.S. will drop by nearly 1.5 million by 2021 to a total of 27.5 million, according to the Kaiser Family Foundation.

But the passage of the PHE could mean a rise in the number of uninsured people as Medicaid’s continuous enrollment provision comes to an end.

“When it was announced, [the PHE] allowed states to enroll many people on Medicaid so they would have insurance. Millions of people will unsubscribe over time when the PBL ends,’ explains Gilbert. “Some of those people may have already found a job with health benefits, so for the most part they’ll be fine. It is really the people who remain unemployed or underemployed who will be most affected.

“We also need to realize that there are still millions of people experiencing long-term COVID symptoms, and some of them may not return to full-time work. Some of them may still be completely unemployed. And so, depending on their specific employment status, they can also be strongly influenced by this.”

According to an analysis released 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 between the ages of 18 and 34 predicted to lose Medicaid/CHIP. [Children’s Health Insurance Program] Coverage.” Latino and black individuals make up nearly a third of those predicted to lose coverage.

A nurse prepares a COVID booster injection.

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

What changes for the uninsured?

As long as the U.S.’s sizable federal stockpile of vaccines lasts, thanks to the Affordable Care Act, COVID primary and booster vaccinations will remain free for everyone, regardless of insurance coverage, according to an analysis by the Kaiser Family Foundation. The availability and costs of COVID vaccines are determined by the delivery of federally purchased vaccines, not the PHE. But once that supply runs out, vaccine costs “could become a barrier for uninsured and underinsured adults,” Kaiser says. As early as this fall, the U.S. government plans to stop purchasing COVID vaccines, and vaccine manufacturers will sell them to health care providers at a higher cost — which uninsured individuals may have to pay out of pocket.

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For uninsured children, Gilbert said, vaccines may be available at very low cost or at no cost. For example, the government-funded Vaccines for Children program has been around long before COVID, providing vaccines “for free to children who might not otherwise be vaccinated because they can’t afford to pay,” with the Centers for Disease Control and Prevention buying shots at a discounted rate. to distribute to providers registered with the program.

But for uninsured adults, Gilbert said, “it gets a little trickier.”

“Hopefully, federally qualified health centers and other places will be able to offer people both COVID testing and COVID vaccines, at very low cost or for free, even though they don’t have insurance,” he said.

For COVID-19 testing, uninsured people in many states have already had to pay out of pocket for PCR testing, the median cost of which is $127 per test, unless tested at a free clinic or community health center. A Medicaid coverage option adopted by 15 states, which gave uninsured people access to testing services without cost sharing, expires with the PHE.

Health and Human Services says “pending resource availability,” the CDC’s Increasing Community Access to Testing program “will continue to work to ensure continued equitable access to testing for uninsured individuals and areas of high social vulnerability through pharmacies and community sites.”

The US government may also continue to distribute free tests from the national supply while supplies last. But access to free home COVID test kits through a government website will likely cease once those supplies are used up.

“It looks like free testing is coming to an end unless certain clinics start offering free testing,” Gilbert said. “I imagine some people, especially the older population and families with children, may stock up on some of the free tests to help them get through several more months.”

COVID treatments like Paxlovid, an antiviral therapy that can reduce the risk of hospitalization and death, will also remain free while federal supplies last, but uninsured patients may have to foot the bill once that supply runs out. As with vaccines, the cost and availability of Paxlovid depends on federal supply, not the PGO, Kaiser explains. Last year, the US government bought 20 million Paxlovid courses from Pfizer at a discounted rate of $530 each.

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Are we done?

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

“I think we recognize that with COVID-19, we are in a different place from where we were in early 2020 or even early 2021,” said El-Sadr. “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 reason to adapt to the moment.”

Although the PHE expires on May 11, Gilbert said many changes shouldn’t happen overnight.

“It will be several months before the policy takes effect,” he explained. “Those who are going to unsubscribe [from Medicaid] is not issued immediately. They should be given some time and a notice date for when their Medicaid benefits end.

“Hopefully that will give people many, many months to prepare for whatever new change or new cost they will incur. So I think that’s kind of a positive piece — that not everything is going to happen right away.

But the disappearance of the PHE also calls attention to non-COVID-related gaps in the US healthcare system.

“I think one of the challenges, broadly speaking, is that we still don’t have a very clear and clean public health infrastructure that makes people feel that even though this particular statement is expiring, there are adequate safeguards in place,” Gilbert said. said. “So I think what becomes important is for public health agencies like the CDC and state, county and local health departments to communicate the role they will play in making sure people not only stay safe and prevent COVID, but also that there are opportunities and structures for them to also access many of these preventive health services.”

El-Sadr pointed out that the PHE brought about some changes that were particularly welcomed by some of the more vulnerable members of society, such as access to virtual medical visits, making health care more available to the elderly. Understanding the wider ramifications of ending what some would consider desirable health care changes, she said, will be important as we enter a post-PHE era.

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

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