When the end of the COVID-19 pandemic arrives, it could create major disruptions for a cumbersome US healthcare system made more generous, flexible and technologically up-to-date through a series of temporary emergency measures.
The end of these policies could begin as early as the summer. It could force an estimated 15 million Medicaid beneficiaries to find new sources of coverage, require congressional action to preserve broad access to telehealth for Medicare enrollees, and blur special COVID-19 rules and payment policies for hospitals, doctors and insurers. There are also questions about how emergency use approvals for COVID-19 treatments will be handled.
The range of issues is tied to the coronavirus public health emergency first declared more than two years ago and periodically renewed since then. It is scheduled to end on April 16, and the Biden administration is expected to extend it until mid-July. Some would like a longer exit ramp.
The transitions do not bode well for America’s complex health care system, with its mix of private and government insurance and its maze of policies and procedures. The health care chaos, if it breaks out, could create midterm election headaches for Democrats and Republicans alike.
“The flexibilities given under the public health emergency have helped people stay covered and have access to care, so moving forward the key question is how to build on what has been successful and not losing ground,” said Juliette Cubanski, a Medicare expert at the nonpartisan Kaiser Family Foundation who has studied the potential consequences of the pandemic emergency ending.
Medicaid, the state-federal health insurance program for low-income people, covers about 79 million people, a record partly due to the pandemic.
But the nonpartisan Urban Institute think tank estimates that about 15 million people could lose Medicaid when the public health emergency ends, at the rate of at least 1 million per month.
Congress increased federal Medicaid payments to states due to COVID-19, but it also required states to keep people on track during the health emergency. Normally, states routinely de-enroll Medicaid recipients whose income exceeds certain levels, or for other life changes affecting eligibility. This process will reactivate when the emergency ends and some states are eager to move forward.
Virtually everyone who loses Medicaid should be eligible for another source of coverage, either through employers, the Affordable Care Act or, for children, the Children’s Health Insurance Program.
But that’s not going to happen automatically, said Matthew Buettgens, lead researcher of the Urban Institute study. Cost and lack of knowledge about options could get in the way.
Medicaid dropouts may not realize that they can qualify for taxpayer-subsidized ACA coverage. Medicaid is usually free, so people with workers’ compensation insurance might find the premiums too high.
“This is an unprecedented situation,” Buettgens said. “The uncertainty is real.”
The federal Centers for Medicare and Medicaid Services, or CMS, advises states to slow down and connect Medicaid beneficiaries who are opted out with other potential coverage. The agency will keep tabs on states’ accuracy in making eligibility decisions. Biden officials want coverage changes, not losses.
“We are working to maintain the hedging gains we made under the Biden-Harris administration,” CMS Administrator Chiquita Brooks-LaSure said. “We are at the strongest point in our history and we will make sure to maintain the coverage gains.”
ACA – or “Obamacare” – coverage is an option for many who would lose Medicaid. But it will be less affordable if congressional Democrats fail to deliver the generous financial assistance called for in President Joe Biden’s welfare legislation. Democrats who block the bill would be blamed.
Republicans in most Southern states who have refused to expand Medicaid are also vulnerable. In these states, it can be very difficult for low-income adults to get coverage, and more people could end up without insurance.
State Medicaid officials do not want to be scapegoats. “Medicaid has done its job,” said Matt Salo, head of the National Association of Medicaid Directors. “We looked after physical, mental and behavioral health needs. As we emerge from this emergency, we are expected to scale the program. »
Millions of Americans discovered telehealth in 2020 when coronavirus shutdowns caused routine medical visits to be suspended. In-person visits are again the norm, but telehealth has shown its usefulness and has been widely accepted.
An end to the public health emergency would jeopardize access to telehealth for millions of people enrolled in traditional health insurance. Pre-COVID-19 restrictions limit telehealth primarily to rural residents, in part to mitigate healthcare fraud. Congress has given itself 151 days after the end of the public health emergency to propose new rules.
“If there is no change in the law after this, most Medicare beneficiaries will lose access to telehealth coverage,” said Cubanski of the Kaiser Foundation.
A major exception applies to those enrolled in private Medicare Advantage plans, which typically cover telehealth. However, nearly 6 in 10 Medicare enrollees participate in the traditional fee-for-service program.
TESTS, VACCINES, TREATMENTS, PAYMENTS AND PROCEDURES
Widespread access to COVID-19 vaccines, tests and treatments rests on legal authority related to the public health emergency.
One example is the Biden administration’s requirement for insurers to cover up to eight free at-home COVID-19 tests per month.
One particularly murky area is what happens to tests, treatments and vaccines covered by the Food and Drug Administration’s emergency use authorization.
Some experts say emergency use approvals only last for the duration of the public health emergency. Others say it’s not that simple, because different federal emergency law also applies to vaccines, tests and treatments. There are no clear guidelines yet from health officials.
The FDA granted full approval to Pfizer-BioNTech’s COVID-19 vaccine for ages 16 and older and Moderna for ages 18 and older, so their continued use would not be affected.
But hospitals could take a financial hit. Currently, they are paid 20% more for caring for COVID-19 patients. This additional payment is valid only for the duration of the emergency.
And those enrolled in Medicare would have more hurdles to clear to be approved for rehab in a nursing home. A suspended Medicare rule requiring prior three-day hospitalization would return to effect.
Health and Human Services Secretary Xavier Becerra recently told The Associated Press that his department is committed to giving “adequate notice” when ending the public health emergency.
“We want to make sure we don’t put Americans who still need our help in a prejudicial position,” Becerra said. “The one that really worries people is Medicaid.”
This story was originally published March 31, 2022 6:25 a.m.