Electronic Health Reporter

By Ken Perez, marketing and strategy advisor to Vindeca Health and former vice president of healthcare policy and government affairs, Omnicell.

On Jan. 30, the Biden administration notified Congress that it plans to let the public health emergency (PHE) and the national emergency declarations related to the COVID-19 pandemic expire on May 11. The end of these declarations logically follows President Joe Biden’s “Sixty Minutes” interview that aired on Sept. 18, 2022 during which he stated, “The pandemic is over. We still have a problem with COVID. We’re still doing a lot of work on it, but the pandemic is over. If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape.”

Accordingly, on February 9, the Department of Health and Human Services (HHS) cited these developments since the peak of the Omicron surge at the end of January 2022 to justify the end of the two emergency declarations:

• Daily COVID-19 reported cases are down 92%

• COVID-19 deaths have declined by over 80%; and

• New COVID-19 hospitalizations are down nearly 80%

Background

On Jan. 31, 2020, then-HHS Secretary Alex Azar, under section 319 of the Public Health Service Act, declared a public health emergency because of the continued spread of COVID-19. As of that date, there had been an estimated 16 cases of COVID-19 in the U.S., nearly 10,000 people had been diagnosed with the virus globally, and more than 200 had died, all in China. The following day, the World Health Organization (WHO) declared a global health emergency.

Then on Mar. 13, 2020, then-President Donald Trump, in accord with sections 201 and 301 of the National Emergencies Act, declared a national emergency concerning COVID-19, mentioning that 1,645 Americans in 47 states had contracted the virus.

The two declarations granted the federal government broad authority during the pandemic to expand healthcare services and helped expedite the authorization of COVID-19 treatments and vaccines.

The PHE declaration was renewed 12 times, four times by Azar and eight times by HHS Secretary Xavier Becerra.

An analysis conducted by Jonathan Blum and Jennifer Podulka found that from January 2020 through July 2020, Congress and the Trump administration modified 212 Medicare regulations, with 203 of the modifications expected to expire at the end of the PHE.

While the Feb. 9 HHS announcement emphasized what will not be affected by the end of the PHE, concerns have been raised about its impacts on Medicaid enrollment and telehealth.

Medicaid

In response to the PHE, the Families First Coronavirus Response Act, which became law on Mar. 18, 2020, allowed states to receive additional funding for providing continuous Medicaid coverage to enrollees, putting eligibility renewals and redeterminations on hold. An analysis by the Kaiser Family Foundation found Medicaid/Children’s Health Insurance Program (CHIP) enrollment increased by 21.2 million (29.8%) between February 2020 and December 2022. It should also be noted that the U.S. uninsured rate hit a historic low of 8% in early 2022.

With the planned end of the PHE, there have been numerous headlines expressing concern that as many as 15 million Medicaid and CHIP enrollees could lose their health insurance coverage.

Originally, continuous enrollment was to continue until the end of the month when the PHE ends. However, the passage of the Consolidated Appropriations Act, 2023 in December 2022 separated the continuous enrollment provision from the PHE, allowing states to start removing ineligible individuals from Medicaid as of April 1, though the cessation of continuous enrollment and the redetermination process will vary by state. The increased Medicaid funding states were receiving will phase out by the end of December.

According to a December 2022 research report by Matthew Buettgens and Andrew Green of the Urban Institute, which assumed the end of the PHE in April, Medicaid enrollment would drop by 18 million over a period of 14 months, but 9.5 million would transition to employer-sponsored insurance because of the improved labor market.

In addition, 3.2 million children would transition from Medicaid to coverage under a separate Children’s Health Insurance Program, and 1.5 million people would access health insurance through the nongroup market, which includes Affordable Care Act (ACA) marketplaces. As a result, Buettgens and Green conclude that some 3.8 million people would be newly uninsured. However, another analyst estimates that 6.8 million people could lose coverage due to what federal officials call “administrative churning.”

Telehealth

During the PHE, certain restrictions regarding the use of telehealth by Medicare beneficiaries were waived. As a result, according to a report by the Bipartisan Policy Center, 44% of continuously enrolled Medicare fee-for-service beneficiaries had a telehealth visit (accounting for 45 million visits) in 2020 versus just 1% in 2019. As of March, overall telehealth use has grown 38 times pre-pandemic levels.

Given the evident usefulness and popularity of telehealth, as well as the tying of expanded use of telehealth for Medicare beneficiaries to the PHE, healthcare provider organizations, such as the American Hospital Association (AHA), have urged HHS to make the telehealth waivers permanent.

Fortunately, the Consolidated Appropriations Act, 2023 delinked the Medicare telehealth flexibilities from the PHE, and they will remain in place through December 2024.

As for Medicaid, states have broad authority to cover telehealth without federal approval, and most states have made or expressed plans to make some Medicaid telehealth flexibilities permanent. And most private insurers already covered telehealth prior to the pandemic.

One related and outstanding issue is whether clinicians can prescribe the addiction treatment medication buprenorphine via telehealth or by phone without the need for an initial in-person visit. This flexibility was provided in response to the PHE. In February, the Drug Enforcement Administration announced a proposal to make the buprenorphine rule change permanent, but to limit the amount providers are allowed to prescribe to a 30-day supply. Public comments on the proposed rule were accepted until March 31.

Conclusion

While the Biden administration’s announcements regarding the end of the PHE have reflected a celebratory tone, some groups have raised concerns about the potential impacts on insurance coverage and access, as well as the use of telehealth. Fortunately, the number of newly uninsured should be significantly less than originally feared, and legislation and rulemaking have reflected a willingness to apply the lessons learned from the nation’s experience with the pandemic.