Millions could lose health insurance when Covid emergency ends

Secretary of Health and Human Services Xavier Becerra testifies before the Senate Health, Education, Labor, and Pensions Committee hearing to discuss reopening schools during the coronavirus disease (COVID-19) at Capitol Hill in Washington, D.C., September 30, 2021.

Shawn Thew | Pool | Reuters

The Biden administration is telling health-care providers to begin preparing for an end to the public health emergency declared in response to the Covid-19 pandemic nearly three years ago.

The change will have broad implications for Medicaid health insurance recipients and could significantly impact how hospitals and pharmacies operate.

How the U.S. manages Covid this fall and winter will provide crucial data on whether the emergency needs to remain in place, Health Secretary Xavier Becerra told reporters on a call earlier this month.

The Health and Human Services Department will give the public 60 days notice before lifting the public health emergency, Becerra said. His comments come after President Joe Biden claimed in September that the pandemic is over, though he said Covid still presents a health challenge.

Becerra renewed the emergency declaration until Jan. 11 last week as the U.S. presses ahead with a fall booster campaign, but the Centers for Medicare and Medicaid Services told health-care providers in August to start preparing for a return to pre-pandemic rules as soon as possible.

The public health emergency, first declared by the Trump administration in January 2020, has been renewed every 90 days since Covid arrived in the U.S. and ravaged the country.

A view of a medical personnel attending to a patient at Elmhurst Hospital Center in the Queens borough of New York City on March 27, 2020.

John Nacion | NurPhoto | Getty Images

HHS has used its emergency powers to transform how healthcare is delivered in the U.S., support beleaguered hospitals, simplify access to vaccines at pharmacies and keep millions of Americans enrolled in public health insurance. The health emergency also allowed millions of people to receive increased food benefits through the federal government’s nutrition program.

When the public health emergency does end, HHS estimates up to 15 million people will be disenrolled from Medicare and the Children’s Health Insurance Program. Nutrition experts fear millions of families will face a hunger cliff. Hospitals are concerned the end of pandemic flexibilities will compound a serious healthcare worker shortage. And pharmacies are warning that it could become more difficult for people to access vaccines.

“We’re in the third year of the pandemic. We’ve gone through hell. We’ve sacrificed. We’ve used all kinds of emergency powers,” said Lawrence Gostin, an expert on health law at Georgetown University in Washington, D.C.

“So if you’re going to end all that, you have to end it in a transparent way honestly with the American public about what they gain and what they lose,” Gostin said.

Millions to lose Medicaid coverage

The most dramatic impact from ending the public health emergency will fall on people enrolled in Medicaid and the Children’s Health Insurance Program. Medicaid provides inexpensive and often free health insurance to lower-income adults while CHIP does the same for children whose families are struggling to make ends meet.

Medicaid and CHIP enrollment increased 26% during the pandemic to a record of more than 89 million people as of June, according to the federal government. Enrollment surged because Congress basically prohibited states, which administer the programs, from kicking people out for the duration of the public health emergency.

States received extra federal money through the Families First Coronavirus Response Act for Medicaid and CHIP on the condition that they kept all current and new recipients enrolled during the public health crisis.

“That basically means states can’t disenroll anyone from the program except under unique circumstances,” said Jennifer Tolbert, a Medicaid expert at the Kaiser Family Foundation. States could only disenroll people if they were no longer a state resident or if the recipient voluntarily left the program.

Before the pandemic, people had to renew their Medicaid coverage every year by confirming to state officials that they still met income and other eligibility requirements. While many people were disenrolled for a change in income, others were kicked off simply because they did not respond to state requests for information or because they couldn’t be contacted, Tolbert said.

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Medicaid and CHIP will return to business as usual when the public health emergency ends. States will have 14 months to verify who is eligible and who is not. An estimated 15 million will have to leave the programs, according to HHS. About 7 million will lose Medicaid coverage due to bureaucratic obstacles despite still being eligible for the program, according to HHS.

While some of these people may be eligible for subsidized coverage through the Affordable Care Act, they have to apply through the health insurance marketplace. Molly Smith with the American Hospital Association said some people will likely fall through the cracks and end up uninsured.

“We don’t have a good track record in this country of transitioning between different types of coverage,” Smith said.

In 12 states that haven’t expanded Medicaid, with Florida and Texas the biggest, as many as 383,000 people are expected to fall into a gap in which their incomes are too high to meet their state’s eligibility for Medicaid, which guarantees coverage for the poor, but too low to qualify for discounted insurance under the Affordable Care Act, according to HHS. The ACA, know as Obamacare, was designed to help low- and moderate-income Americans.

HHS, in an August report, said it’s crucial for states that haven’t expanded Medicaid under the ACA to do so in order to prevent these people from becoming uninsured after the public health emergency ends.

Medicaid’s expanded role during the pandemic helped reduce barriers to health care and also helped alleviate some of the financial pressure hospitals faced as patients surged, Smith said.

Covid shots at pharmacies

“They basically took away those inconsistencies that could have impeded pharmacies from delivering those services. That’s one of the biggest advances we’ve had throughout the pandemic,” said Sara Roszak, head of health policy at the National Association of Chain Drug Stores.

It’s unclear whether the nationalization of rules for vaccinations at pharmacies will end when the public health emergency has lifted. The rules were simplified under a separate emergency power called the Public Readiness and Emergency Preparedness Act.

When HHS activated this power, it was able to preempt state laws and provide liability protections for health-care personnel administering vaccines and treatments to combat Covid.

Whenever HHS decides to lift the PREP Act declaration, states will regulate how pharmacies administer vaccines again, which could bring back the inconsistences that existed before the pandemic and make it more difficult for some people to get vaccinated.

HHS has provided the National Association of Chain Drug Stores with a rough timeline of when this might happen, according to Roszak with the drug store association. The PREP Act declaration will lift either when the public health emergency ends, the vaccines have moved to a commercial market which is expected sometime in 2023, or in October 2024 — whichever date comes first.

Steve Anderson, president of the chain drug store association, asked Biden and the White House Covid task force in a September letter to keep the PREP Act declaration in place until October 2024. Roszak said this later date will give states time to make pharmacies’ expanded role in vaccinations permanent at the local level.

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Food insecurity

A sign alerting customers about SNAP food stamps benefits is displayed at a Brooklyn grocery store on December 5, 2019 in New York City.

Scott Heins | Getty Images

Family food benefits were increased by the states to the maximum allowed. Poorer households that were already receiving the maximum got an extra $95 per month. The average monthly benefit per household jumped from $276 per month in March 2020 to $416 as of June 2022, according to federal data.

It also became easier for people to remain enrolled in SNAP. Before the pandemic, adults ages 18 to 49 who were unemployed and didn’t have children could only receive benefits for three months every three years. That time limit was suspended during the public health emergency.

The additional food benefits kept 4.2 million people out of poverty in the fourth quarter of 2021, according to an August report from the Urban Institute. The increased food benefits reduced child poverty by 14% across the board. The greatest impact was among Black families with child poverty dropping by about 18%, according to the report.

The increased food benefits will end when HHS declares the Covid public health emergency is over. Households participating in SNAP will lose $82 a month on average, according to the Food Research Action Center. Those who qualify for the minimum SNAP benefit will see their monthly subsidy drop from $250 to $20, according to the group.

Ellen Vollinger at the Food Research & Action Center said an abrupt loss of pandemic-era SNAP benefits will result in more food insecurity in the U.S.

“As much hardship and disruption there was in this country during this period, this was one of the ingredients that helped protect against food insecurity and hardship,” Vollinger said of the increased food benefits.

Source: https://www.cnbc.com/2022/10/19/us-could-end-covid-public-health-emergency-in-january-what-it-means.html