The COVID Public Health Emergency Is Ending. Here's What Will Happen to Health Care

US President Joe Biden told Congress on Monday that he intends to end the current public health emergency for COVID-19 on May 11, close to three years after it was first declared. His announcement came in response to legislation introduced by House Republicans to bring the emergency declaration to an end immediately.

The Department of Health and Human Services last extended the alert on Jan. 11. It was scheduled to end on April 11, but the White House is adding a month to help with the transition.

"An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors' offices, and, most importantly, for tens of millions of Americans," the White House said in a statement, NPR reported.

The order, which has now been renewed 13 times since January 2020, provides continued federal funding for free vaccines, testing and treatment, and maintains relaxed requirements for Medicaid and Medicare coverage. The Biden administration repeatedly said it would give 60 days' notice before allowing it to expire. 

Here's what to know about the public health emergency, including what it does and what happens when it ends.

For more on COVID-19, find out what we know about the latest variants, where to order more free test kits and how to differentiate coronavirus from the flu.

What is a public health emergency?

Under the Public Health Service Act of 1944, the secretary of the US Department of Health and Human Services can determine that a disease outbreak or bioterror attack poses a public health crisis for a period of 90 days at a time. After that, the declaration must be extended.

That public health emergency determination allows the HHS, the Centers for Disease Control and Prevention and other government agencies to access funding and increase staffing "to prevent, prepare for, or respond to an infectious disease emergency."

It also waives certain requirements for Medicare, Medicaid and the Children's Health Insurance Program (CHIP) and relaxes restrictions on telemedicine.

Some 20 million people have enrolled in Medicaid since the start of the pandemic, according to the Kaiser Family Foundation, an increase of 30% over typical numbers. 

What happens when the COVID public health emergency ends?

When the declaration lapses, responsibility for COVID-19 vaccines, testing and treatment will technically shift to individuals and their health insurance companies.

The retail price of Pfizer's two-dose COVID vaccine is expected to quadruple from the current government rate, from $30 per shot to between $110 and $130. 
Paxlovid, which has been shown to be nearly 90% effective in reducing the risk of a severe COVID disease, will also no longer be free. A course of the drug currently costs the US government $530, according to Kaiser Health News, but that's at a bulk discount. 

Pfizer, which manufactures Paxlovid, has not said what the retail price would be.

Special waivers for Medicaid and Medicare requirements that have been in place throughout the pandemic will also come to an end when the public health emergency expires. (The omnibus passed in December allows states to start disenrolling people from Medicaid in April.)
Close to 18 million people could be dropped from Medicaid when the emergency ends, according to the Urban Institute, though many will qualify for other government programs or employer-sponsored health insurance. 

State Medicaid plans will continue to cover COVID vaccines and tests ordered by a physician, but treatments and at-home testing may come with an out-of-pocket expense.

"People will have to start paying some money for things they didn't have to pay for during the emergency," Jen Kates, senior vice president at the Kaiser Family Foundation, told CNN. "That's the main thing people will start to notice."

Most vaccinations will continue to be covered for individuals with private insurance. But they, too, may have to pay for treatment once the federal supply of monoclonal antibody treatments runs out.
They may also have a copay for lab work and have to pay for vaccinations from out-of-network providers, CNN reported.  

Hospitals have been receiving a 20% increase in Medicare payment rates when treating COVID patients, according to the Kaiser Family Foundation, a boost that will expire when the state of emergency ends.
Government funding for COVID programs has already declined, with the Biden administration's request for $22.5 billion in additional pandemic aid going unanswered by Congress. Federal funds providing free vaccines, testing and treatment to uninsured Americans dried up in spring 2022.   
Read On: How the Lack of COVID Funding is Impacting Health Care

The end of the emergency also means the presumed end of Title 42, a seldom-used public health order that allows the government to override immigration law and send back migrants who enter the country illegally, rather than allow them to request asylum. The Trump administration cited concern over the spread of COVID-19 as justification for its interpretation of Title 42.

Court rulings have prevented the Biden administration from lifting the order.

The debate over ending it

In a November 2022 open letter to Congress, the National Association of Medicaid Directors said the "uncertainty" about the order is "no longer tenable." 

The organization asked lawmakers to provide concrete information on when normal Medicaid coverage would resume, with at least 120 days' notice. 

"The most critical thing Congress can do to ensure a successful unwinding from the PHE is to provide clear dates and funding levels in statute for state Medicaid agencies to reliably plan around," it said. PHE is short for public health emergency.

That same month, Mark Parkinson, president of the American Health Care Association and the National Center for Assisted Living, asked HHS Secretary Xavier Becerra to renew the public health emergency past the Jan. 11 cutoff.
"Coming out of the holiday season, we need to ensure our health care infrastructure can quickly adapt," Parkinson wrote. "Extending the PHE is critical to ensure states and health care providers, including long-term care providers, have the flexibilities and resources necessary to respond to this ever-evolving pandemic."
In December, 25 Republican governors asked President Joe Biden to end the public health emergency declaration immediately, claiming it's a financial burden costing states "hundreds of millions of dollars." 
"While the virus will be with us for some time, the emergency phase of the pandemic is behind us," they wrote.

On. Jan 17, Rep. Brett Guthrie, a Republican from Kansas, introduced the Pandemic is Over Act, a bill to end the state of emergency. On Monday, Guthrie pressed for the order to be rescinded immediately.