What the end of the COVID-19 emergencies in the US means

(NEW YORK) — On May 11, the U.S. will no longer officially be in a COVID-19 emergency for the first time since the pandemic began three years ago.

While hundreds of COVID-19 deaths are still reported each day in the U.S. — adding to a toll of more than one million — public health experts said the Biden administration is likely looking to end the national and public health emergencies related to COVID-19 because the omicron subvariants that are circulating are producing milder disease and the U.S. has high levels of immunity from previous vaccinations or infections.

The threat of the virus has also receded for many Americans, thanks to testing, treatments and vaccines.

Jen Kates, with the nonpartisan nonprofit Kaiser Family Foundation (KFF), called the end of the emergencies “symbolically a big change.” But it will also alter systems that people have come to rely on without realizing they were temporary, at the same time that experts say that it’s unclear what the future will hold.

“I think the administration is hoping that we are clearly transitioning into an endemic period, and that the pandemic period is in the past,” Dr. William Schaffner, a professor of preventive medicine at the Vanderbilt University Medical Center in Nashville, Tennessee, told ABC News.

“Now, that said, those of us in infectious diseases and public health are a little nervous. And the reason is, here we are at the end of January predicting what the circumstances will be in May,” Schaffner added. “This is a very unpredictable virus.”

Here are the biggest impacts of the public health and national emergencies ending, according to experts:

Millions could lose Medicaid

After three years of major enrollment increases for Medicaid, anywhere from five to 14 million Americans could soon lose their access to the government’s health insurance program for low-income people and others, according to KFF, which focuses on national health.

And according to estimates from the U.S. Department of Health and Human Services, nearly seven million of these people could still be eligible but will fall through the cracks of the renewal process and lose their health insurance.

For context, almost 20 million people enrolled in Medicaid during the COVID-19 public health emergency, an increase of nearly 30% since before the pandemic, and uninsured rates dropped to record lows.

That increase was fueled by a rule under the public health emergency that barred states from removing anyone from Medicaid while the pandemic was at its worst — allowing people to avoid the bureaucratic renewal processes that experts said could often lead to people losing their coverage even when they were still eligible.

But a recently passed law in Congress returned the right to states to disenroll people from Medicaid beginning on April 1, ending the continuous enrollment afforded to people during the public health emergency.

“This is going to lead to people who are eligible for the program losing out,” said Kates, a senior vice president at KFF. “And so I think this is a concern right now, because they would lose coverage for all of their health care during that period.”

In the year after the Medicaid rules change, KFF estimates that enrollment will decline between 5% and 13%.

There are efforts to catch some of those people who lose their Medicaid insurance, like a special open enrollment period through the Affordable Care Act.

And some Americans will be disenrolled from Medicaid because they get a job that offers health insurance instead — or because they then are making too much money to qualify for Medicaid.

“As a person on the street, I understand where the government is going. But as a physician, I’m a little bit worried, because [losing Medicaid] makes a difference between the haves and have nots,” Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told ABC News.

“Particularly with a price tag of $500 for a Paxlovid course [to treat COVID-19], $130 for a shot, we already know how much testing costs for going to Walgreens and CVS,” he continued. “So I think all of these things together makes it difficult for everyone to protect not only themselves but each other.”

New COVID costs for tests and treatments

The end of the public health emergency will mean that Americans start paying more for certain COVID-19 health measures, but the increase likely won’t all be felt at once.

One of the most obvious new costs will be at-home rapid tests, which have been free for most of the time they’ve existed. People can get eight free tests a month covered by their insurance, for example, or order free tests in the mail from the government.

But that ends with the public health emergency on May 11, Kates at KFF said. The same is true for walking into a clinic or doctor’s office to get a test. That could come with costs in the future, whereas it is free under the emergency order.

As for treatments, like the antiviral Paxlovid, that will depend on when the federal government’s supply runs out, at which point insurance companies will change their policies. Until then, people will likely not see a huge cost increase on treatments.

“The federal declaration has big implications, mainly financial, that many people don’t even realize,” Chin-Hong said.

“All of a sudden, you have to be paying for copays and office visits, or even lab tests,” he added. “And then people may not want to seek health care because they are afraid of paying some sort of copay or being saddled with a huge bill.”

But vaccines will remain free for people with insurance. Because of work in Congress and by the Centers for Disease Control and Prevention, COVID-19 vaccines are mandated to be covered by insurance — through the end of the public health emergency and even once the government stops buying and distributing them for free.

Telehealth access remains through Medicare

Congress moved to ensure telehealth access for all Medicare recipients for the next two years, so the audio and video visits that those patients have come to rely on are not threatened by the end of the emergency.

As for people on private insurance, telehealth access will depend on state laws and insurance company policies. People can check with their providers for more information, as there’s no one-size-fits-all answer.

Pandemic data may be harder to track

The public health emergency mandated that states share certain data with the CDC, like COVID-19 case counts and deaths. Though a senior Biden administration official said that the CDC will continue to encourage states to voluntarily share that information with them, some states will choose not to.

The result could be a cloudier picture of the pandemic, including less insight into possible infection surges and slower responses from health officials.

“It means that we won’t be able to track simple things like hospital capacity,” Chin-Hong said.

“So there’ll be less ability to sound the alarm before the storm comes essentially,” he said.

Schaffner, the professor of preventive medicine, said that the end of all the emergency measures will signal to the public that the pandemic is over — when infections and deaths continue.

“Somewhere between 300 to 500 people die of COVID in the United States daily, at the present time,” he said. “So we’re going to have to keep our guard up. But if we declare an official end, I think the general public will hear that as a message that they don’t have to worry about it anymore and that may lead, as you can imagine, to an increase in COVID.”

Title 42 is still up in the air

The end of the COVID-19 emergencies is linked to a very different issue — immigration.

The public health emergency has allowed both the Trump and Biden administrations to cite Title 42 of federal law to quickly expel migrants seeking asylum from the border based on the threat of spreading COVID-19.

While the Biden administration is now seeking to end Title 42, a group of mostly Republican-led states wants to keep it in place, arguing they would be harmed from the resulting immigration.

The issue is before the Supreme Court. Their decision will come sometime before June, when the court’s term ends.

Student loan debt cancellation may get more complicated

Ending the COVID-19 emergencies could legally complicate the position the Biden administration has taken while arguing it has the ability to cancel government-held student loan debt for some 40 million Americans.

That plan has been challenged in court and goes before the Supreme Court next month.

The administration has been using the COVID-19 national emergency as justification for the secretary of education’s authority to change the status and terms of the student debt.

“There was a national emergency that impacted millions of student borrowers. Many of those borrowers still face risk of default on their student loans due to that emergency. Congress gave the Secretary of Education the authority under the HEROES Act to take steps to prevent that harm, and he is,” an administration official said in a statement to ABC News.

Nebraska and five other GOP-led states challenging the plan argued in court filings that the White House can’t have it both ways, pointing to President Joe Biden’s remarks last year suggesting Americans could live with the virus going forward.

“The government has been undermining what the [Department of Education] said in the rationale memo. As to the COVID-19 justification, the president declared ‘the pandemic…over’ in September 2022. And as to the current economic conditions, the White House announced that ‘household finances are stronger than pre-pandemic,"” the GOP states argued.

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