COVID-19 emergency status prompted coordinated vaccination efforts by health care providers, paramedics, volunteers and others.

COVID-19 emergency status prompted coordinated vaccination efforts by health care providers, paramedics, volunteers and others. Wesley Lapointe / Los Angeles Times via Getty Images)

Biden’s Plan for Ending the Emergency Declaration for COVID-19 Signals a Pivotal Point in the Pandemic—4 Questions Answered

President Joe Biden’s intention to end the national COVID-19 emergency will have long-lasting ripple effects on federal programs such as Medicare, Medicaid and the Children’s Health Insurance Program.

President Joe Biden announced on Jan. 30, 2023, that he intends to end both the national emergency and the public health emergency declarations related to COVID-19 on May 11, 2023.

Biden’s announcement came on the same day that the World Health Organization said it still considers the COVID-19 pandemic to be a public health emergency of international concern, or PHEIC, a status that is reassessed every three months. The WHO’s advisory committee noted that although the pandemic is at a turning point, “COVID-19 remains a dangerous infectious disease with the capacity to cause substantial damage to health and health systems.”

The Conversation asked public health experts Marian Moser Jones and Amy Lauren Fairchild to put these statements into context and to explain their ramifications for the next stage of the pandemic.

What does ending the emergency phase of the COVID-19 pandemic mean?

Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders.

In practical terms, it means that two declarations – the federal Public Health Emergency, first declared on Jan. 31, 2020, and the COVID-19 national emergency that President Donald Trump announced on March 13, 2020 – will be allowed to expire in May 2023.

Declaring those emergencies enabled the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficiently. For instance, the declarations allowed funds to be made available so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made resources available to launch investigations into the “cause, treatment or prevention” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency.

The emergency status also allowed the federal government to make health care more widely available by suspending many requirements for accessing Medicare, Medicaid and the Children’s Health Program. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and enabled Medicaid and Medicare to more easily cover telehealth services.

What policy changes will occur once the emergency is declared over?

The end to the federal emergency could substantially reduce the number of people insured under Medicaid. Before the pandemic, states required people to prove every year that they met income and other eligibility requirements.

In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. In a December 2022 appropriations bill, Congress passed a provision that will end continuous enrollment on March 31, 2023.

The Biden administration has defended this time frame as sufficient to ensure that “patients do not lose access to care unpredictably” and that state Medicaid budgets – which have been infused with emergency funds since 2020 – “don’t face a radical cliff.” But many people with Medicaid may be unaware of these changes until they actually lose their benefits.

Some states have already indicated that they will begin disenrolling members in April 2023 or require members to apply to be considered for renewal. This could result in between 5 million and 14 million people losing coverage.

People with Medicare do not have to worry about losing their benefits, since this program is age-based, not income-based. The array of telehealth services that Medicare began covering during the pandemic will continue to be covered through December 2023. Medicare coverage for many telehealth services could also be made permanent after this year.

The end of the emergency could additionally curb access to COVID-19 drugs, tests and vaccines. Federal emergency funding for free treatment or vaccination will end when the emergency status is lifted on May 11. If such programs are to continue, the cost will fall to state and local health agencies or insurance companies.

We are concerned that the withdrawal of federal emergency funds for vaccination may further slow the already sluggish uptake of boosters. As of Jan. 25, 2023, about 20% of the population ages 5 and up and only 40.1% of those 65 and older – who are at the highest risk of death from COVID-19 – had received an updated bivalent booster dose. Once the emergency ends, measures that allowed a broad array of health providers – from pharmacist interns to retired nurses and even veterinarians – to administer vaccines will expire, which could lead to decreased access to vaccination in many parts of the U.S.

What does this mean for the status of the pandemic?

A pandemic declaration represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more states and that controlling it requires an international response.

At some point the WHO will end its pandemic declaration. On Jan. 30, 2023, World Health Organization Director-General Tedros Adhanom Ghebreyesus described the pandemic as being “at a transition point.” But the WHO’s assessment is that the risks are still considerable. Ghebreyesus noted that COVID-19 continues to strain health care systems, exacerbate health care workforce shortages and exceed surveillance system capacities.

The U.S. remains one of the global COVID-19 hot spots. With more than 3,500 hospitalizations per week on average in January 2023, and 3,452 deaths per week as of early February 2023, the U.S. has among the highest deaths per capita in the world.

How does the Biden administration’s stance differ from the WHO’s position?

In some ways they are very similar. The WHO is looking at the pandemic from a global perspective while the Biden administration is examining it from a national perspective. The WHO’s stance reflects the assessment that the world is not sufficiently vaccinated, that health care systems remain vulnerable and that unchecked disease transmission in some parts of the world should remain a source of international concern and attention.

China’s massive outbreak after the lifting of its zero-COVID policy in early December 2022 has received a great deal of media attention. But less noted is the fact that vaccination rates across African nations average 40%, and that vaccination rates are very low in countries that are experiencing conflict, such as Syria, where only 15% of the population has received any COVID-19 vaccine.

The WHO’s continuation of the global pandemic status signals that there is more international coordination and work to be done. In contrast, the Biden administration is making a social and political judgment that it is time to wind down the federal role.

Biden’s order will not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have included provisions allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth.

Almost all U.S. states, however, have ended their own public health emergency declarations. Eight states – California, Colorado, Delaware, Georgia, Illinois, New Mexico, Rhode Island and Texas – still have emergency declarations in effect, but all of them will expire by the end of February 2023 unless renewed.

While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, it could be a long time before either politicians or the public regain an appetite for any emergency orders directly related to COVID-19.

The Conversation

Amy Lauren Fairchild, Dean and Professor of Public Health, The Ohio State University and Marian Moser Jones, Associate Professor and Graduate Director of Family Science, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.