What you’ll miss if the public health emergency ends now

As the coronavirus unleashes its deadly grip on the United States and the pandemic rules governing daily life are lifted, is it time to declare the national health emergency over?

Polls show more than a third of Americans think so. Ditto for dozens of Republican congressmen who have urged President Biden to “resolve” the emergency declaration “so that our country can return to normal.”

After two years of nearly 80 million infections in the US and nearly 1 million deaths from COVID-19, the desire to keep going is understandable. But experts warn that ending the health emergency would leave Americans in a vulnerable position if a new variant sparks another spike and officials don’t have the legal authority to respond.

It would also end the Food and Drug Administration’s power to expedite approval of COVID-19 vaccines, tests and treatments. Also, it would deprive many Americans of the benefits they take for granted, including the ability to get these items for free.

The path from the pandemic

This is the first in an occasional series of stories about the transition out of the COVID-19 pandemic and how life in the US will change as a result.

“People have wished for a return to normal, but you should be careful what you wish for,” said Georgetown University’s Lawrence Gostin, a public health law expert. “It’s going to be a whole new world.”

The public health emergency was first declared on January 31, 2020 by then Secretary of Health and Human Services Alex Azar. Since then, it has been renewed every 90 days to maintain a comprehensive set of measures taken by Washington and the states to combat the pandemic. It will be up for review again on April 15th.

The declaration of emergency is the primary legal pillar of the US response to the pandemic. Even with new infections and deaths falling sharply, Biden hinted in his State of the Union address that he wasn’t ready to let it go just yet.

“We will never just accept living with COVID-19; We will continue to fight the virus like other diseases,” said the President. “And because this virus is mutating and spreading, we have to stay alert.”

76 Republican lawmakers want more details, and they want them by Tuesday.

“It is time your government abandoned its pretentious and authoritarian approach and showed the country that the COVID-19 emergency is over,” they wrote in a scathing letter to the President and Secretary of Health and Human Services, Xavier Becerra.

Their impatience shows in opinion polls. At the end of February, 58% of Americans agreed that fighting the coronavirus should remain a priority “even if it means limiting normal activities.” But 38% in a poll by ABC News and Washington Post said it was more important “to have no restrictions on normal activities”.

The pandemic has forced federal and state governments to deviate from their usual practices in a variety of ways, and the public health emergency declaration is making this possible.

It allows the FDA to issue emergency use authorizations for new drugs and devices, and either lets the federal government foot the bill for their use or requires insurers to cover them at no co-payment. It also gives the Centers for Disease Control and Prevention the power to require face masks on planes, trains and other public transport.

A sign at Los Angeles International Airport advises travelers to wear a mask or other face covering.

A sign at Los Angeles International Airport advises travelers to wear a mask or other face covering.

(Al Seib/Los Angeles Times)

The federal recognition of a public health emergency paved the way for governors to issue their own emergency declarations. That gave them the power to issue stay-at-home orders, implement mask and vaccination requirements, and protect residents at risk of eviction for defaulting on their rent or mortgage, to name a few.

Washington’s action also provided governors with legal and political cover and – sometimes – federal funds to carry out their orders.

The federal government’s $19.3 billion program to accelerate COVID-19 vaccine development relies on powers made possible by the public health emergency declaration. So does the use of military and other government resources to distribute the syringes and other drugs. And without the declaration, a president would take legal action, invoking the Defense Manufacturing Act to essentially force companies to make personal protective equipment and other pandemic supplies.

Other exceptional pandemic measures have been less obvious to the public. Because of the emergency declaration, Washington was able to give states a lot of leeway in using the federal funds they received for public health. That way, they could reallocate money and manpower from other programs as needed to fight the coronavirus.

In addition, the declaration of emergency made it easier for healthcare providers to practice in states where they were not officially licensed. And it gave doctors, nurses and hospitals practicing in extraordinary pandemic circumstances some protection from being sued for the care they were providing to COVID-19 patients.

The use of telemedicine was expanded for patients across the board, and insurers who refused to pay for it – or did so at a deep discount – were instructed to treat these virtual visits as if they had taken place in a doctor’s office.

dr Vibin Roy speaks to a patient during an online primary care visit from his home in Keller, Texas.

dr Vibin Roy spoke to a patient during an online primary care visit from his home in Keller, Texas last year.

(LM Otero/Associated Press)

The legal basis for practically all of these extraordinary measures lay in the declaration of a state of health emergency by the federal government or in the declarations of state of emergency derived from it.

“It’s just a few sentences long,” said Andy Baker-White, legal counsel for the Assn. of state and territory health officials. But he said its implications are far-reaching – as long as it is in effect.

The statement also limits the duration of these measures. Virtually all congressional sanctioned and funded pandemic programs will complete after the public health emergency has passed or some period after that milestone.

“Once the emergency ends, the free lunch ends,” Gostin said.

In fact, Americans have come to believe that everything related to COVID-19 — vaccines, tests, medicines — is available on demand and for free, he said. But without the emergency declaration, a shot or treatment with Paxlovid could add up to a sizeable bill.

The impact would hit hardest those who can least afford to foot the bill, experts said.

Tribal health services, which rely heavily on federal government funds and powers, would feel it first. And rural populations, hit hard by COVID-19, could see their struggling hospitals lose the emergency revenue they now rely on to stay open.

Under Biden’s new “test-to-treat” plan, Americans still need access to testing that doesn’t incur out-of-pocket expenses, Gostin said. If they suddenly come up with a bill, “you would have a declining testing rate in America, and it’s going to fall the most in poor communities that are most at risk.” of COVID,” he added.

Rapid at-home COVID-19 testing kits are being made in Chelsea, Mass.

Rapid at-home COVID-19 test kits will be available for free in Chelsea, Mass.

(Joseph Prezioso/AFP/Getty Images)

Low-income communities are also likely to bear the brunt of a major change to Medicaid, the health insurance program for disabled and low-income Americans.

In the Families First Coronavirus Relief Act, which went into effect in March 2020, Congress increased federal contributions to state Medicaid spending by 6.2% for the duration of the pandemic emergency. But the additional funding came with one condition: for the duration of the pandemic emergency, states that accepted it were barred from opting out of virtually everyone covered by the program.

This fine print has had a big impact. In many states, a small increase in income or change in status will result in a Medicaid beneficiary and their dependents being delisted, even if the change is temporary. The Families First Act reduced that churn and ensured eligible Americans stayed covered during the pandemic.

The law has been a particular boon to children, whose Medicaid enrollment has increased more than 11% during the pandemic. Today, more than half of all children in the US are covered by these programs.

But that won’t last. Several states are already planning their return to standard practices when the public health emergency ends. In addition to enforcing pre-pandemic income limits, many states will require all beneficiaries to re-register — a bureaucratic requirement that will result in many low-income families losing insurance coverage.

According to an analysis by the Robert Wood Johnson Foundation and the Urban Institute, nearly 13 million Americans would be left without health insurance when the state of emergency ends in mid-April. And Georgetown’s Health Policy Institute estimates that in the first year after the health emergency ends, at least 6.7 million children are “at very high risk of not being insured.”

https://www.latimes.com/science/story/2022-03-14/why-you-may-miss-the-covid-public-health-emergency-when-its-over What you’ll miss if the public health emergency ends now

Russell Falcon

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