Here’s How the End of the COVID-19 Public Health Emergency Could Affect You, According to MDs

On January 30, 2023, the Biden Administration announced that the COVID-19 Public Health Emergency (PHE) and national emergency declarations would be ending on May 11, 2023. The declarations were announced in early 2020 at the beginning of the COVID-19 pandemic. These declarations have been powerful federal decisions that increase access to emergency funding for public health needs and relax red tape around resource access—but they also served as a bold statement to the American people about the risk of a contagious pandemic.

While it’s no secret that many people have moved on from COVID precautions, the fact is, the virus still poses a threat to the public. As of February 9, 2023, over 1.1 million people have died from the virus, and the average daily deaths in the U.S. rests at around 500 people. Long covid continues to be a risk as well for people of any age, while treatment for long-lasting symptoms remains challenging to access.

The impact of the end of these two sizable federal decisions is complex, with both immediate and far-reaching impacts on public health. A silver lining in the midst of all these changes is that many of them will not go into effect immediately, giving people time to prepare and plan. For example, reduced access to resources like healthcare, vaccines, and more won’t come into play until 2024.

Regardless, we talked to some experts in the field to get an idea of just how this affects the American people. “One of the keys to the end of the public health emergency is going to be accurate messaging. Just because the federal declaration is ending doesn’t mean that COVID is going away,” says Natasha Bhuyan, MD, vice president of in-office care at One Medical.

What did the COVID-19 public health emergency do?

The COVID-19 public health emergency declaration supported a range of policies, from the expansion of telehealth services to free COVID-19 testing. “Importantly, the public health emergency was also about healthcare coverage and services—under Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and private health insurance—with the ultimate goal of providing people COVID care, which was in the best interest of the country and larger public health,” says Dr. Bhuyan. These policies were intended to help curb the spread and impact of COVID.

“The policy was developed in response to the COVID pandemic to be able to issue orders, procure drugs/vaccines, and coordinate agency responses. More than anything, it provided a vehicle to implement funding measures enacted by Congress and the President,” says Carl J. Fichtenbaum, MD, professor of education in internal medicine, vice chair for clinical research for internal medicine at the University of Cincinnati, and a researcher previously involved in the development of the Moderna vaccine.

A range of vaccines and treatments were available to the public via the expedited emergency use authorization (EUA) before formal FDA approval as a result of these declarations. The EUA is not set to end in May, which speaks to the fact that the end of the PHE doesn’t undo every protective measure set in place for COVID-19.

How the end of the PHE will affect public health

Some of the biggest impacts this end of the PHE will have on public health will affect the most vulnerable among us, such as immunocompromised individuals, older adults, and children. That number grows if you consider the number of people experiencing long-term COVID complications.

Reduced access to federal health insurance

The end of the PHE has an impact on people’s access to resources like Medicare and Medicaid, though those impacts are complex, sprawling, and vary by state. One reason this will affect access to federal health insurance is that there was a suspension on reviewing if people are still qualified for their Medicare and Medicaid during the pandemic. Without the PHE, that suspension is set to end near the end of the year and into 2024.

The end of free COVID tests, and, potentially, vaccines

Another big change that comes with the end of the PHE is that it will have an effect on COVID mitigation resources like free testing and, potentially, vaccines later on.

One of the clearest and most immediate impacts of the end of the PHE is that the eight free tests insured Americans can currently get through their insurance will end, says Roger Seheult, MD, the medical advisor of On/Go. Support for public testing will likely decrease, which is a concern when one considers that testing is a primary way to assess the state of current waves of the virus.

There are also growing concerns about vaccine access and access to antiviral medication. However, there are policies from the federal government and U.S. Food and Drug Administration (FDA) that still protect access to these vital resources. The concern for access is for when the current federal supply runs out—experts question how insurance companies will begin to cover or not cover them, though it’s unclear exactly what will happen right now.

According to the Kaiser Family Foundation, vaccine access won’t be immediately impacted by the end of the PHE. Though after the federal supply runs out, there are questions marks about the cost for insured and uninsured Americans alike. “Of note, if we see another surge in cases, the federal government can certainly revisit these policies and decide which to reinstate,” says Dr. Bhuyan.

A full look at all the changes you can expect to see

While these are a few of the big concerns experts have about the end of the public health emergency, you can see a detailed list of all the changes that will take place once it ends in May:

• Coverage, costs, and payment for COVID-19 testing, treatments, and vaccines
• Medicaid coverage and federal match rates
• Telehealth
• Other Medicaid and CHIP flexibilities
• Other Medicare payment and coverage flexibilities
• Other private insurance coverage flexibilities
• Access to medical countermeasures (vaccines, tests, and treatments) through FDA emergency use authorization (EUA)
• Liability immunity to administer medical countermeasures

Will other resources be impacted by the end of the PHE?

Outside of COVID tests, vaccines, and government health insurance, there are other resources that may be impacted when the PHE ends. Dr. Bhuyan says to expect a cutback in SNAP, the supplemental nutrition assistance program for people who are low-income may be challenging after several years of greater allowances.

The expanded access to telehealth that occurred under the PHE could also be in jeopardy. “Many states made exceptions for doctors to practice medicine across states or loosened the regulations on telemedicine during the pandemic. Without those exceptions, fewer doctors will be available to treat patients across state lines,” Sophia Yen, MD, MPH, the co-founder and CEO of Pandia Health, a telehealth company specializing in women’s health. Though it isn’t yet clear what telehealth measures will be scaled back or kept.

How will this affect the public perception of COVID?

One of the most striking and bigger-picture impacts that the end of the PHE will have on the American people is the public perception of COVID-19. “Policies can structure public opinion and vice versa. When mask mandates were removed, public opinion shifted to believe COVID was at little to no risk. But this opinion does not reflect reality,” says Suzan M. Walters, PhD, a research assistant professor in the department of epidemiology at the School of Global Public Health at New York University.

As stated, over 1.1 million people have died due to COVID in the U.S., long COVID affects the health and well-being of nearly one in five people who have had COVID-19, according to the Centers for Disease Control and Prevention (CDC), and the life expectancy in the U.S. is decreasing. So, the concern is that the messaging around how the public health emergency is ending may signal to society at large that the pandemic is also over.

“Furthermore, the notion that children are not impacted by COVID is not scientifically backed. COVID is among the top 10 causes of death among children, and one in four children has long COVID. As a mother, public health researcher, and disabled person, I find this to be an unacceptable reality. We can, and need to, do better,” says Dr. Walters.

Who will be most impacted by the end of the COVID-19 Public Health Emergency?

While the end of the PHE will touch just about everyone, there are some people who will feel the changes more. “Medicaid and Medicare recipients, specifically older adults and people who have been able to access care through telehealth that included a prescription for a controlled substance: Substance use treatment, gender-affirming hormone care, etc., are among those who will likely be the most affected by the end of the PHE,” says Kate Steinle, a nurse practitioner and chief clinical officer FOLX Health.

Unfortunately, Dr. Walters expects that this will increase disparities for marginalized people even more than we are already seeing, as COVID infection and deaths are clustered in marginalized communities, particularly those of color.

“Rather than ending government support, we need better policies and structures to support all people in the U.S. When we protect everyone because when we have a more equitable approach, it is truly better for everyone’s health and our economy, I would like to see paid time off and sick leave, livable wages, housing, healthcare, distribution of masks and COVID tests to prevent and detect COVID-19, and better indoor air quality. We have the tools to address this pandemic, but the political will is lacking,” says Dr. Walters.