As Covid-19 cases continue to drop nationwide, many lawmakers are calling for an end to the national emergency declaration for the pandemic—a move that would have significant impacts on the health care system.

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Senate passes resolution to end the national Covid-19 emergency

The Senate on Thursday passed a resolution to end the national emergency declaration for the Covid-19 pandemic. The resolution, which was sponsored by Senate Republicans, passed 48-47 along party lines.

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However, the resolution is unlikely to pass the Democrat-controlled House, and the Biden administration has indicated that President Joe Biden would veto the bill if it does progress.

In response to the resolution, the Office of Management and Budget said the national emergency allows the government "to more effectively respond to Covid-19, including ensuring that necessary supplies are promptly available to respond to the virus and facilitating the delivery of health care at a time when our health system has been under tremendous and prolonged stress."

Currently, the national emergency declaration for Covid-19 is slated to last until April and is likely to be renewed at least one more time until July since HHS has committed to giving states at least 60 days' notice before ending the declaration, STAT+ reports.

What will happen when the national Covid-19 emergency ends?

With the end of the national Covid-19 emergency potentially just a few months away, state governments, hospitals, test manufacturers, and more will soon have to prepare to transition away from pandemic-era health care reforms and regulations.

Aspects of health care that will be most impacted by the end of the national Covid-19 emergency include:

1. State Medicaid programs

At the start of the pandemic, Congress passed the Families First Coronavirus Response Act, which provided federal funding for state Medicaid programs to increase enrollment as many people began losing their jobs. The act also banned states from involuntarily disenrolling people from Medicaid due to income changes or missing paperwork.

Because of these provisions, enrollment in Medicaid and the Children's Health Insurance Program (CHIP) jumped during the pandemic. According to the Urban Institute, approximately 9 million Americans enrolled in Medicaid between February 2020 and January 2021. Similarly, the Kaiser Family Foundation found that 12.4 million children were enrolled in CHIP between February 2020 and July 2021.

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However, as the national Covid-19 emergency ends, states will begin reevaluating whether people are eligible for Medicaid. Many experts say that while some people may be able to transfer to employer plans or marketplace plans, a substantial number of people are expected to lose coverage.

In particular, an Urban Institute analysis estimates that 15 million people could be disenrolled from Medicaid when the emergency declaration ends. Almost 7 million children are also at risk of losing coverage.

To ease the transition, the Biden administration has been planning Medicaid re-evaluations for months. In addition, CMS last year launched a working group to meet with insurers, advocacy groups, providers, and Medicaid experts to work on guidance, and is currently holding biweekly calls with states.

2. Vaccines, treatments, and medical supplies currently under emergency use authorizations (EUAs)

Currently, many Covid-19 vaccines, treatments, and medical supplies are authorized by FDA only for emergency use. However, this doesn't necessarily mean that their authorization would automatically be rescinded if the public health emergency ends.

Although the length of EUAs is related to the length of an emergency declaration, HHS can make a separate declaration under a different law that protects companies from liability for products marketed in emergency situations, STAT+ reports. Currently, there is an active declaration for Covid-19 under this liability law, which could extend as far as October 2025, according to a Congressional Research Service report.

In addition, FDA in December released a draft transition plan for medical devices, saying an EUA is "distinct from, and is not dependent on" a public health emergency declaration. The agency also proposed a roughly six-month warning before ending an EUA.

So far, transition plans have not been issued for vaccines or treatments, and it is not clear whether a similar approach will be taken with these products, STAT+ reports.

3. Telehealth coverage

During the pandemic, telehealth use increased significantly, largely due to emergency-era provisions that allowed Medicare to expand telehealth coverage. These provisions also allowed people to receive telehealth care from doctors in different states more easily and added audio-only care.

The health care industry is currently lobbying lawmakers to ensure pandemic-era telehealth policies are made permanent after the public health emergency ends, but it's not clear whether these efforts will be successful, according to STAT+. In particular, many lawmakers have asked for more data on how telehealth is used and its health equity impacts before they decide about future coverage.

4. Hospital funding

During the pandemic, Congress increased federal funding for hospitals by 20% to pay for Covid-19 admissions. In addition, a separate national emergency declaration issued by President Biden gave the Federal Emergency Management Agency more flexibility to provide hospitals with financial assistance for pandemic-related expenses. Both of these provisions will likely end as the national public health emergency comes to an end.

Hospitals would also lose many CMS waivers, such as those related to workforce flexibilities, home care programs, and reporting, after the public emergency ends—although some hospitals argue that many of these waivers should be made permanent. (Hellmann, Modern Healthcare, 3/3; Ollstein, Politico, 3/3; Owens, Axios, 3/4; Firth, MedPage Today, 3/3; Cohrs, STAT+ [Subscription required], 3/3)