The end of the COVID-19 pandemic could bring turbulence to the US health care system
The end of the COVID-19 pandemic could bring turbulence to the US health care system

The end of the COVID-19 pandemic could bring turbulence to the US health care system

WASHINGTON – When the end of the COVID-19 pandemic comes, it could create major disruption to a cumbersome U.S. health care system that has been made more generous, flexible, and technologically up-to-date through a series of temporary emergency measures.

The implementation of these policies can begin as early as the summer. It could force an estimated 15 million Medicaid recipients to find new sources of coverage, require congressional efforts to maintain broad telecommunications access for Medicare enrollees, and distort specific COVID-19 rules and payment policies for hospitals, physicians, and insurance companies. There are also questions about how emergency use approvals for COVID-19 treatments will be handled.

The series of problems is linked to the public health emergency with coronavirus, which was first declared more than two years ago and periodically renewed since then. It is set to end on April 16, and the expectation is that the Biden administration will extend it until mid-July. Some would like a longer exit.

Transitions do not bode well for the complex US healthcare system with its mix of private and public insurance policies and its maze of policies and procedures. Chaos in health care, if it erupts, could create headaches in the midterm elections for both Democrats and Republicans.

“The flexibility given through public health emergencies has helped people stay covered and have access to care, so the most important question is how to build on what has been successful and not lose ground,” Juliette said. Cubanski, a Medicare expert with the party-affiliated Kaiser Family Foundation, who has researched the potential consequences of resolving the pandemic emergency.

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Medicaid, the state federal health insurance program for low-income people, covers about 79 million people, which is a record, in part because of the pandemic.

But the impartial think tank Urban Institute estimates that about 15 million people could lose Medicaid when the public health emergency ends, at a rate of at least 1 million a month.

Congress increased federal Medicaid payments to states because of COVID-19, but it also required states to keep people on the roll during the health emergency. In normal times, states routinely opt out of Medicaid recipients whose income rises above certain levels, or for other life changes that affect eligibility. That process will turn on again when the emergency ends and some states are eager to move forward.

Virtually all those who lose Medicaid are expected to be eligible for another source of coverage, either through employers, the Affordable Care Act or – for children – the Children’s Health Insurance Program.

But it is not going to happen automatically, said Matthew Buettgens, lead researcher at the Urban Institute study. Costs and lack of awareness of opportunities can get in the way.

People who have dropped out of Medicaid may not be aware that they can pick up taxpayer-subsidized ACA coverage. Medicaid is usually free, so people who are offered workplace insurance may 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, advise states to take it slow and connect deregistered Medicaid recipients with other potential coverage. The Agency will monitor the accuracy of states in making eligibility decisions. Biden officials want change of coverage, not loss.

“We are focused on ensuring that we adhere to the gains in coverage we have achieved under the Biden-Harris administration,” said CMS Administrator Chiquita Brooks-LaSure. “We’re at the strongest point in our history and we want to make sure we stick to the capital gains.”

ACA coverage – or “Obamacare” – is an option for many who would lose Medicaid. But it will be less affordable if Congress Democrats fail to provide the generous financial assistance required by President Joe Biden’s social legislation. Democrats who stop the bill will be blamed.

Republicans in predominantly 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 can become uninsured.

State Medicaid officials do not want to be scapegoats. “Medicaid has done its job,” said Matt Salo, president of the National Association of Medicaid Directors. “We’ve been looking for physical, mental and behavioral health needs. When we get out of this emergency, we’re supposed to adapt the program to the right size.”


Millions of Americans discovered telesealth in 2020, when coronavirus shutdowns led to the suspension of routine medical consultations. Personal visits are again the norm, but telesealth has shown its usefulness and gained wider acceptance.

Ending the public health emergency would put telecommunications access at risk for millions enrolled in traditional Medicare. Restrictions that precede COVID-19 restrict telecommunications health 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 come up with new rules.

“If there is no change in the law after that, most Medicare recipients will lose access to telehealth coverage,” the Kaiser Foundations Cubanski said.

A major exception applies to enrollees in private Medicare Advantage plans, which generally cover telehealth. However, nearly 6 out of 10 Medicare enrollees in the traditional fee-for-service program.


Widespread access to COVID-19 vaccines, tests and treatments is based on legal authority in connection with the public health emergency.

One example is the Biden administration’s requirement that insurance companies cover up to eight free home covid-19 tests per month.

One area that is particularly unclear is what happens to tests, treatments and vaccines that are covered by the Food and Drug Administration’s emergency use permit.

Some experts say that emergency use approvals only last during the public health emergency. Others say it is not that simple because another federal emergency statute also applies to vaccines, tests and treatments. There is still no clear direction from the health authorities.

The FDA has given full approval to Pfizer-BioNTech’s COVID-19 vaccine for the 16 and older and Modernas for the 18 and older, so their continued use will not be affected.

But hospitals can be hit financially. At present, Medicare pays them 20% more for the treatment of COVID-19 patients. It is only for the duration of the emergency.

And Medicare enrollees would have more braces to jump through to be approved for rehab at a nursing home. A suspended Medicare rule requiring a prior three-day hospital stay would take effect again.

Health and Human Affairs Secretary Xavier Becerra recently told the Associated Press that his department is obligated to give the “right message” when it ends the public health emergency.

“We want to make sure we do not put Americans in a harmful position who still need our help,” Becerra said. “The one that people are really worried about is Medicaid.”

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