Lisa Jarvis Bloomberg Opinion
On May 11, the COVID-19 public health emergency in the United States officially ended, and with it largely free access to all related health services. House Republicans might want to explain it right now, but a cushion is needed – and this one might not even be enough – to make sure everyone, from insurers to drug companies to every one of us, knows what the reversal means.
The transition timing makes sense. Largely thanks to vaccines, tests, and treatments, COVID is no longer overwhelming hospitals (although it continues to kill thousands every week). Millions of people will continue to get sick every year and some of them will need treatment. And many of us — though not nearly as many as we will in 2021 — unless we develop better vaccines — will want every booster that comes next. The question is how easily each of us will access these interventions after May 11th.
The answer is: choose your own adventure based on insurance status—one that ends less happily for some than others. The complexity of how different people can access and pay for medical care could make for a rather cumbersome transition after three years with a single plan: free vaccines, medicines and treatment for all.
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The people most directly affected will be the uninsured and those who treat them, says Lindsay F. Wiley, law professor and faculty director of the Health Law and Policy Program at the UCLA School of Law. The public health emergency declaration included provisions that allowed hospitals and health care providers to seek reimbursement from Medicaid after treating uninsured people for COVID. Well, “that falls back on our ordinary, unfair, really bad health care system,” Wiley told me. In other words, uninsured patients have to pay for these costs.
For some, the new reality arrived when federal funding for the program began to dry up last spring. Now, the number of uninsured people could rise by millions as pandemic-era regulations that ensured continued enrollment in Medicaid expire, albeit in a timeframe no longer tied to the emergency declaration.
People on Medicare and Medicaid, meanwhile, are still entitled to free vaccines, but will likely share the cost of treatments like Pfizer Inc.’s Paxlovid, Merck & Co.’s Molnupiravir, and Gilead Sciences Inc.’s Remdesivir, eventually testing.
For those with private insurance, COVID prevention and treatment is generally covered like any other infectious disease with some nuances. Vaccines, like other preventive measures, should be fully covered, but the end of PHE means where you get them now matters. Under the PHE, both the appointment and the shot itself were free, whether or not you stayed on your insurer’s network. Now you want to be sure that the provider is on the network or risk an unexpected bill.
If you do get sick, you’ll likely have to jump through the same insurance hoops as with other care. Insurers and drug companies will set the cost of treatment, not the government, said Amesh Adalja, senior scientist at the Johns Hopkins Center for Health Security. “It’s going back to the norm.”
Another nuance worth noting: Private insurers will no longer have to pay for eight at-home tests per person per month, and it’s unclear how they’ll cover them once the PHE ends. “One of the challenges is that our healthcare funding system isn’t really aligned with public health benefits,” says Wiley. If you’re at low risk of a severe case of COVID, your main purpose in getting a test is to make sure you don’t spread the virus – in other words, the benefits of this test go largely to society rather than your insurance company .
Insurers might decide it’s not worth covering at-home testing, or at least not for people who aren’t at risk of serious illness. And with people paying out of pocket, it’s hard to imagine families using so many. Even tied to the $12-per-test the government is currently covering, the costs will add up. This could be another consequence of the end of the PHE: we just won’t feel as motivated to test, which in turn could increase the spread of the community.
Full approval of Paxlovid, or future COVID antiviral pills that are only useful when people know they have COVID, could change that scenario. Because Paxlovid is currently available under what is known as “emergency use authorization,” a status that will remain in place after the end of the PHE, Pfizer cannot commercialize the drug. But once it has full approval and can, it seems prudent for the company to find a way to ensure everyone has access to affordable testing to maximize uptake of the drug.
Navigating this new world order, where COVID will be treated like any other infectious disease, is sure to have hiccups. Fortunately, not all PHE benefits are eliminated at once: Services like telemedicine for everything from cancer treatment to therapy appointments are sometimes not tied to the termination of the emergency. And some have been made permanent, for example virtual visits to a mental health provider are now covered for people on Medicare. As healthcare providers, insurers, and corporations use the left-hand runway to resolve coverage questions and embrace the need to contain community spread, we can hope it all results in a softer landing for patients.
Lisa Jarvis is a columnist for Bloomberg Opinion, covering biotechnology, healthcare and the pharmaceutical industry.