The state of emergency gave the federal government more flexibility with its resources to respond to COVID-19, and for most people its lifting will primarily be felt in the delivery and cost of pandemic healthcare.
With much uncertainty surrounding the coming changes, people can expect some confusion during the transition, public health experts and officials say – although additional costs are likely for vaccines, tests and treatments required after the emergency has passed be retained in the event of an emergency.
“The most tangible impact on real people will be the removal of the special treatment we have given to vaccines, COVID antiviral drugs and tests,” said Dr. Bob Wachter, chief medical officer of UCSF, in an email to the Chronicle. “All have been free up until now and have been covered by the government.”
But that doesn’t mean everyone has to pay for it, he said. Instead, they are treated like any other vaccine, treatment or test: “covered or not by a patchwork of insurance policies”.
During the pandemic, the federal government has bought large quantities of vaccines and treatments like Paxlovid and made them available to the public for free.
Even after the emergency ends, these will remain free for everyone while federal supplies last, officials say, although an administration fee may apply. “We have millions of doses of bivalent vaccines and Paxlovid,” said Dr. Ashish K. Jha, White House COVID-19 Response Director explained on Twitter.
But when that runs out, vaccines and treatments will be brought to the commercial market, and it’s unclear what prices will be for consumers.
“My biggest concern is that the cost, or even just the complexity, will make it harder for people to do the right thing,” Wachter said.
dr Matt Willis, the Marin County Health Officer, added that with government-funded systems surrounding COVID being dismantled, even officials are not sure what the coming months will bring.
“In many ways we’re in the same boat as our communities and are looking for clarity from federal agencies about where this will settle,” he told The Chronicle on Thursday.
Here’s a breakdown of how costs are likely to be impacted:
cost of vaccines
People who have private insurance could face costs for vaccines if they go to an off-network provider, but the recommended doses are still expected to be free for those insured. The Affordable Care Act requires insurers to cover many recommended vaccines without charging out-of-pocket expenses, the Associated Press reported.
For those receiving Medicare and Medi-Cal, physician-prescribed vaccines will still be covered, according to the Kaiser Family Foundation.
Examination costs
Privately insured people could expect costs for PCR lab tests, depending on what their health plan entails. As with vaccines, those receiving Medicare and Medicaid will be covered for doctor-ordered COVID-19 testing.
Most people will also likely have to pay full price for rapid at-home tests that insurers were previously required to reimburse, Jha said in a UCSF Grand Rounds interview with Wachter on Thursday, though he added that he hoped insurers would continue to cover them after the emergency is over.
costs for treatments
Treatments will likely have some out-of-pocket costs for those with private insurance, as well as Medicare and Medicaid beneficiaries, although temporary protection through late 2024 allows Medicare to cover oral antivirals like Paxlovid that have emergency use approvals.
The cost of treatments is largely due to Congress not approving additional funds for the federal government to continue purchasing treatments, which has allowed insurers to offer those treatments for free, although administrative costs could still apply. The federal emergency did not oblige private health insurance companies to cover treatments.
For the uninsured
The move will also present additional challenges for uninsured Californians. While federal funding that allowed the uninsured to get free treatment dried up last spring after Congress refused to extend funding, California had its own program to help the uninsured get treatment. However, this program is scheduled to end with the federal public health emergency.
Many uninsured people have also had access to testing and vaccines through county-operated locations, many of which are closing as counties declare the end of their own states of emergency. It is currently unclear what support for the uninsured will look like after 11 May, but it will likely be local.
In California, people must have health insurance or face a penalty on their tax returns. Through Covered California, the state’s Affordable Care Act marketplace, individuals who are not otherwise insured — through private insurance, Medicare, or Medi-Cal — and who meet certain income criteria can receive state and federal assistance to pay their premiums.
Willis said Marin will focus on developing an answer for “those who fall through the cracks.”
“For example, for immunizations, we will maintain a core team focused on residents of long-term care facilities and uninsured and homeless residents, while the general public will turn to their healthcare providers for COVID immunizations – just as they do with any other vaccine.” , he said.
The San Francisco Department of Health also said it will continue to care for people without insurance through neighborhood clinics and Zuckerberg San Francisco General Hospital.
“As state and federal emergencies draw to a close, we continue our important partnerships with communities to ensure lower-barrier COVID-19 resources, such as emergency response, are available for long-term recovery,” the department said in a statement sent to E -Mail sent statement.
Jha, the White House COVID response director, said in an interview with Wachter that the federal government is working on a plan to help the uninsured, who he said would not have access to free vaccines and treatments without government action, like the one the case is for other diseases.
While he said the government is keen to ensure vaccines and treatments remain affordable and accessible, details on how they will do so will be announced over the next few months.
What happens between now and May?
The White House plans to use the next few months to transition the COVID-19 response to shifting COVID-19 responsibilities to traditional disease control methods.
And one change that the federal state of emergency has made possible for the next two years is increased flexibility for telemedicine, allowing more people to access healthcare from their homes.
Wachter noted that the CDC will need to “renegotiate its relationship with states and counties” in the coming months so it can continue to receive the public health data it needs to monitor for COVID and other threats.
But otherwise, he said, he thinks the move is appropriate, especially given that COVID-19 has stabilized in recent months and subsequently proved not to cause as much damage as public health officials feared last winter had.
“I support this move because we are in the pandemic – COVID is a very real but relatively small threat that will likely be with us forever. We need to integrate COVID care, prevention and surveillance throughout the health system,” he said. “It will take a couple of months for us to position our ducks so that there is as little disruption as possible when exiting the (public health emergency) and I think the president’s plan calibrates that transition as best it can.”
But for Willis, the remaining uncertainty about what that transition will look like is troubling.
“As the COVID response returns to normal healthcare economics, it’s a bit scary from a public health perspective,” he said. “Healthcare systems aren’t exactly looking for more problems to take on, even for their insured patients, and people who aren’t insured are being left out.”
His advice? Use the remaining months of the emergency.
“Get home testing kits through federal and state programs and get vaccinated knowing that next summer the cost of doing so will be borne by us personally and residents or our insurance provider,” he said.
Danielle Echeverria is a contributor to the San Francisco Chronicle. Email: danielle.echeverria@sfchronicle.com Twitter: @DanielleEchev