The debate over the COVID-19 public health emergency is failing America
The Department of Health and Human Services (HHS) recently renewed the national COVID-19 public health emergency — the ninth and perhaps most controversial renewal since its initial declaration nearly two and a half years ago.
Much of the debate has revolved around whether the word ‘emergency’ still applies to COVID-19. A person’s perspective or risk status, or varying community transmission levels, may lead to different individual judgments. But at a societal level, we need a broader and more objective focus on what a public health emergency allows us to do, the consequences of lifting it prematurely and how to plan for its eventual end. Getting caught up in semantics only pushes us further away from both the end of the pandemic and the policies necessary to make America a fairer and healthier nation long after it recedes.
Federal law authorizes public health emergency declarations to ensure swift and effective national responses to disease outbreaks, bioterrorist threats and other crises. Among other provisions, they trigger the rapid deployment of additional health funds, facilitate stronger coordination among federal, state and local public health agencies and ease regulatory requirements to ensure people most at risk receive vital healthcare services.
I experienced their importance firsthand as acting director of the U.S. Centers for Disease Control and Prevention (CDC) in 2009 when a public health emergency was issued for the H1N1 influenza pandemic. It empowered CDC to quickly deploy antiviral drugs from the federal stockpile; a critical, life-saving component of our response.
Over the past two decades, in addition to COVID-19 and H1N1, public health emergencies have been declared by both Republican and Democratic administrations for the Zika virus, Katrina and other hurricanes and wildfires, tornadoes and floods — even President Obama’s 2009 inauguration. They are far more common and bipartisan than the current controversy suggests. Indeed, given its status as perhaps the worst public health threat of our lifetimes, not issuing a public health emergency for COVID-19 would have been a far more extraordinary step.
First declared in January 2020, the COVID-19 public health emergency has been a key pillar of the pandemic response under two presidential administrations, and its provisions have benefitted the vast majority of Americans — particularly those with no or low wages, and people of color, who have shouldered a disproportionate burden of this pandemic. The COVID-19 declaration has meant vaccines and testing available at no cost, people eligible for Medicaid — particularly those with active medical needs — maintaining regular access to care without having to navigate complex eligibility procedures during a time of economic instability, people without regular access to in-person healthcare providers, such as many with disabilities, having more telehealth service options, more pharmacists administering routine vaccinations to children and those facing hunger or food insecurity having streamlined access to federal nutrition programs. States, in turn, have had increased authority to implement their own policies in response to regional and local conditions.
Until this pandemic is truly over — cases are up more than 50 percent nationwide over the past two weeks, and hundreds are still dying every day — these provisions remain necessary to save lives and reduce the pain that so many continue to experience. Having said that, we are in a far better position compared with previous points, and conditions may eventually warrant lifting this public health emergency. But to do so, careful planning and execution are required. The wind-down should be guided by data and readiness, not politics. It should ensure that millions of people continue to receive affordable healthcare. And we should preserve and build on, rather than discard, specific provisions that should be here to stay.
We have much work ahead of us to lay the proper groundwork. Consider Medicaid, the nation’s largest health insurance provider. Medicaid enrollment jumped by nearly 13 million people from February 2020 to July 2021, mostly due to the continuous coverage requirement and increased federal funding to cover additional eligible enrollments. Expanding healthcare coverage, however, should not be a goal reserved only for emergencies. Upwards of 15 million people, including 6.7 million children, could lose coverage once the designation is lifted.
Congress can and should take any number of steps now to strengthen Medicaid and ensure that individuals transitioning off the program once the public health emergency is lifted maintain access to coverage. This could include extending the highly effective premium tax credits for healthcare plans offered under the Affordable Care Act; providing coverage to people with low incomes who fall into the “Medicaid coverage gap” in 12 states and making a year of postpartum coverage mandatory for all pregnant women on Medicaid. But these smart policy solutions remained tabled. As a result, our nation faces a major shock to our healthcare system that may lead to trading one crisis for another when the public health emergency ends.
It does not have to be this way. With the public health emergency now safely ensconced through at least mid-July, we should use this critical window to plan for an orderly and equitable transition. In addition to the aforementioned Medicaid steps, states should follow and receive resources to implement federal guidance for increasing healthcare enrollment efforts and hiring additional staff to boost efforts to confirm eligibility. Telehealth flexibilities, already disappearing in some states, should be maintained and strengthened. And regardless of whether people have health insurance — but especially for those currently being forced to pay out of pocket — it is imperative that the federal government ensures COVID-19 vaccines, treatments and tests remain available at no charge for everyone in the United States. Denying lifesaving medical care to those who cannot afford it would be unconscionable.
Public health emergencies do not last in perpetuity, but the long-term lessons from this one are clear: We cannot permit a return to inequities that persisted prior to and have been exacerbated by COVID-19. There is still time to do this transition right and protect those who will be most affected. The stakes are far too high to squander it.
Richard E. Besser, a physician, is president and chief executive of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. Twitter: @DrRichBesser