The end of the COVID pandemic may bring turmoil to the US healthcare system | Health

By RICARDO ALONSO-ZALDIVAR – Associated Press

WASHINGTON (AP) — When the end of the COVID-19 pandemic comes, it could cause significant disruption to a sluggish U.S. healthcare system that is being made more generous, flexible and technologically up-to-date through a series of temporary contingency measures.

The rollback of this policy could begin as early as the summer. This could force an estimated 15 million Medicaid recipients to find new sources of coverage, require congressional action to maintain widespread access to telemedicine for Medicare enrollments, and disrupt special COVID-19 rules and payment policies for hospitals, doctors, and insurers . There are also questions about how emergency permits for COVID-19 treatments will be handled.

The series of issues are related to the coronavirus public health emergency, which was first declared more than two years ago and has been renewed regularly ever since. It is scheduled to end on April 16, and the Biden administration is expected to extend it until mid-July. Some wish for a longer descent.

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Transitions do not bode well for the complex US healthcare system, with its mix of private and public insurance and its maze of policies and procedures. The healthcare chaos, if it erupts, could cause midterm election headaches for Democrats and Republicans alike.

“The flexibilities afforded by the public health emergency have helped people stay covered and access medical care. So the key question is how to build on the success and not lose ground,” said Juliette Cubanski, a Medicare expert at the nonpartisan Kaiser Family Foundation, who has researched possible consequences of managing the pandemic emergency.

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

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

Congress increased federal Medicaid payments to states because of COVID-19, but also urged states to keep people on the rollers during the health emergency. In normal times, states routinely disenroll Medicaid recipients whose income exceeds a certain level or for other life changes that affect eligibility. This process will resume when the emergency ends, and some states are eager to move forward.

Virtually all who lose Medicaid are expected to be eligible for another source of insurance, either through employers, the Affordable Care Act, or – for children – the Children’s Health Insurance Program.

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

Individuals who have been disfellowshipped from Medicaid may not realize that they can pick up taxpayer-subsidized ACA insurance. Medicaid is usually free, so people who are offered workplace insurance may find the premiums excessive.

“This is an unprecedented situation,” said Büttgens. “The uncertainty is real.”

The Federal Centers for Medicare and Medicaid Services (CMS) advises states to take it slow and connect opted-out Medicaid beneficiaries to other potential coverages. The agency will keep in mind the accuracy of states when deciding on eligibility. Biden officials want cover shifts, not casualties.

“We are focused on making sure we maintain the coverage gains we made under the Biden-Harris administration,” said CMS Administrator Chiquita Brooks-LaSure. “We are at the strongest point in our history and will ensure we hold on to the coverage gains.”

ACA coverage — or “Obamacare” — is an option for many who would lose Medicaid. But it will be less affordable if congressional Democrats fail to provide the generous financial support called for in President Joe Biden’s welfare legislation. Democrats who delay the law would be to blame.

Republicans in most southern states who have refused to expand Medicaid are also at risk. In these states, low-income adults can find it very difficult to obtain insurance coverage, and more people could remain uninsured.

State Medicaid officials don’t want to be the scapegoats. “Medicaid did its job,” said Matt Salo, head of the National Association of Medicaid Directors. “We looked for physical, mental and behavioral health needs. When we get out of this emergency, we should size the program right.”

Millions of Americans discovered telemedicine in 2020 when the coronavirus shutdown led to the suspension of routine medical consultations. Face-to-face visits are again the norm, but telemedicine has proven its usefulness and gained wider acceptance.

The end of the public health emergency would jeopardize access to telemedicine for millions of people enrolled in traditional Medicare. Pre-COVID-19 restrictions restrict telemedicine primarily to rural residents, in part to curb healthcare fraud. Congress has taken 151 days after the end of the health emergency to draft new rules.

“If there are no law changes after that, most Medicare beneficiaries will lose access to telemedicine coverage,” said Cubanski of the Kaiser Foundation.

An important exception applies to participants in private Medicare Advantage plans, which generally cover telemedicine. However, nearly 6 out of 10 Medicare applicants participate in the traditional fee-for-service program.

TESTS, VACCINES, TREATMENTS, PAYMENTS AND PROCEDURES

Widespread access to COVID-19 vaccines, tests and treatments depends on the legal authority associated with the public health emergency.

One example is the Biden administration’s requirement that insurers must cover up to eight free at-home COVID-19 tests per month.

One particularly unclear area is what happens to tests, treatments, and vaccines that fall under the Food and Drug Administration’s emergency use authorization.

Some experts say emergency permits are only for the duration of the public health emergency. Others say it’s not that simple, because another federal emergency law also applies to vaccines, tests and treatments. There is still no clear direction from health authorities.

The FDA has granted full approval for Pfizer-BioNTech’s COVID-19 vaccine for ages 16 and older and Moderna for ages 18 and older, so their continued use would not be impacted.

But hospitals could take a financial hit. Currently, Medicare pays them 20% more to care for COVID-19 patients. This only applies for the duration of the emergency.

And Medicare applicants would have more hurdles to clear to be eligible for rehab in a nursing home. A suspended Medicare rule that requires a prior three-day hospital stay would come back into effect.

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

“We want to make sure we don’t put Americans who still need our help in a disadvantaged position,” Becerra said. “The one people are really worried about is Medicaid.”

Copyright 2022 The Associated Press. All rights reserved. This material may not be published, broadcast, transcribed or redistributed without permission.

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