When the COVID-19 pandemic ends, it could wreak havoc on the cumbersome U.S. health care system, which has become technologically more generous, flexible and up-to-date with a raft of temporary emergency measures.

The phasing out of these policies could begin as early as the summer. This could force an estimated 15 million Medicaid recipients to find new sources of coverage, requiring Congress to act to preserve broad telehealth services for Medicare enrollees and create special COVID-19 rules for hospitals, doctors and insurers and payment policy. There are also questions about how emergency use approvals for COVID-19 treatments are handled.

The series of questions pertains to the coronavirus public health emergency first declared more than two years ago and has been updated regularly since then. It is set to end on April 16, and a Biden administration is expected to extend it until mid-July. Some people want longer exit ramps.

Transformation does not bode well for the complex U.S. health care system, which has a mix of private and government insurance, and an intricate mix of policies and procedures. A health care mess that could spell trouble for Democrats and Republicans in the midterms.

“The flexibility provided by public health emergencies helps people stay covered and get health care, so the key question moving forward is how to build on what’s been successful without losing ground,” said Juliette Cuban, a health insurance expert Juliette Cubanski said. The nonpartisan Kaiser Family Foundation has been studying the potential consequences of ending the pandemic emergency.

Medicaid loss

Medicaid, the state’s federal health insurance program for low-income people, covers about 79 million people, a record partly attributable to the pandemic.

But the nonpartisan Urban Institute think tank estimates that about 15 million people could lose Medicaid when the public health emergency ends, and at least 1 million people each month.

Congress has increased federal Medicaid payments to states because of COVID-19, but it’s also asking states to keep people engaged during the health emergency. Under normal circumstances, states typically cancel Medicaid recipients whose income exceeds a certain level or other life changes that affect eligibility. When the emergency is over, the process will start again, with some states eager to move forward.

Nearly everyone who loses Medicaid is expected to receive some other source of coverage through their employer, the Affordable Care Act, or the Children’s Health Insurance Plan.

But it won’t happen automatically, said Matthew Buettgens, lead researcher on the Urban Institute study. Cost and lack of awareness of options can get in the way.

People withdrawing from Medicaid may not realize they can get taxpayer-subsidized ACA coverage. Medicaid is usually free, so people who offer workplace insurance may find the premiums too high.

“This is an unprecedented situation,” Buettgens said. “Uncertainty is real.”

The Centers for Medicare and Medicaid Services (CMS) recommends states slow down and connect Medicaid recipients who have withdrawn with other potential coverages. The agency will pay close attention to the accuracy of states in making eligibility decisions. Biden officials want a change in reporting, not a loss.

“Our focus is to make sure we maintain the coverage gains we made during the Biden-Harris administration,” said CMS administrator Chiquita Brooks-LaSure. “We’re in the strongest period in history, and we’re going to make sure we maintain our coverage. growth of.”

ACA insurance — or “Obamacare” — is the option of many people who have lost Medicaid. But if congressional Democrats fail to provide the generous financial aid required by President Joe Biden’s social legislation, it will be less burdened. Democrats who delay the bill will face blame.

Republicans, who have resisted expanding Medicaid in most southern states, are also vulnerable. In these states, it may be difficult for low-income adults to obtain insurance, and many more may end up uninsured.

State Medicaid officials don’t want to be scapegoated. “Medicaid has done its job,” said Matt Salo, director of the National Association of Medicaid Directors. “We’ve been focusing on physical, mental and behavioral health needs. We should adjust the size of the program as we emerge from this emergency.”

telemedicine static

In 2020, when the coronavirus shutdown caused routine medical consultations to be suspended, millions of Americans discovered telehealth. In-person visits are once again the norm, but telehealth has shown its usefulness and gained wider acceptance.

The end of the public health emergency will jeopardize telehealth services for millions of people enrolled in traditional health insurance. Pre-COVID-19 restrictions limited telehealth to mostly rural residents, in part to reduce health care fraud. Congress gave itself 151 days to develop new rules after the public health emergency ended.

“If the law isn’t changed after that, most Medicare beneficiaries won’t be able to get telehealth coverage,” said Kubansky of the Kaiser Foundation.

A major exception applies to enrollees in private Medicare Advantage plans, which typically cover telehealth. However, nearly 6 in 10 Medicare enrollees are enrolled in traditional fee-for-service plans.

Tests, Vaccines, Treatments, Payments and Procedures

Widespread availability of COVID-19 vaccines, tests, and treatments depends on legal authorizations related to public health emergencies.

One example is the Biden administration requiring insurance companies to provide up to eight free home COVID-19 tests a month.

One particularly nebulous area is what happens to the tests, treatments and vaccines covered by the FDA’s emergency use authorization.

Some experts say emergency-use approvals only last until a public health emergency. Others say it’s not that simple, as different federal emergency regulations also apply to vaccines, testing and treatment. Health officials have not yet given clear instructions.

The FDA has fully approved Pfizer-BioNTech’s COVID-19 vaccine for people 16 years and older and Moderna’s vaccine for 18 years and older, so their continued use will not be affected.

But hospitals could take a financial hit. Currently, they pay 20% more for the care of COVID-19 patients. Additional payments are only available during emergencies.

Medicare enrollees will have more hurdles to jump through to get approved for rehabilitation in nursing homes. A suspending Medicare rule requiring three days’ early hospitalization will come back into effect.

Health and Human Services Secretary Xavier Becerra recently told The Associated Press that his department is committed to giving “sufficient notice” when it comes to ending the public health emergency.

“We want to make sure we don’t disadvantage Americans who still need our help,” Becerra said. “What people are really worried about is Medicaid.”