These policies could be canceled as soon as this summer. This could lead to 15 million Medicaid beneficiaries having to search for new coverage. Congress must act to keep telehealth access open to all Medicare enrollees and to scramble COVID-19 rules, payment policies, and payment policies for doctors, hospitals, and insurers. It is also unclear how emergency approvals for COVID-19 treatment will be handled.
This is all tied to the coronavirus emergency, which was declared over two years ago. It has been renewed periodically since then. It is scheduled to expire April 16, but the Biden administration plans on extending it until mid-July. Some people would prefer a longer off ramp.
The complex U.S. healthcare system with its mixture of government and private insurance, and the myriad of policies and procedures it contains, isn't looking good. Democrats and Republicans could be bothered by health care chaos if it breaks out during midterm elections.
The public health emergency has allowed people to stay covered and have access to care. So, moving forward, the key question is how to build upon what has been successful and not lose ground," Juliette Cubanski, a Medicare expert at the Kaiser Family Foundation, said. She has been studying the potential consequences of ending the pandemic.
MEDICAID CHURN
Medicaid, the federal state-run health insurance program for low income people, now covers about 79 millions people. This record is partly due to the pandemic.
The Urban Institute, a nonpartisan think tank, estimates that approximately 15 million people could lose Medicaid if the public health crisis ends. This is at a rate at least 1,000,000 per month.
COVID-19 led to increased federal Medicaid payments to the states. However, it also required that states keep people on the rolls in an emergency. Normal times, states disenroll Medicaid recipients who earn more than certain amounts or have other life circumstances that affect eligibility. This process will resume after an emergency ends. Some states are eager to continue.
Almost all those who lose Medicaid coverage will be eligible to receive some type of coverage through their employers, the Affordable Health Act, or, for children, the Children's Health Insurance Program.
Matthew Buettgens (lead researcher for the Urban Institute study) said that this is not going to happen by itself. The obstacles could be cost and ignorance about the options.
Some people who are dropped from Medicaid might not know that they can get taxpayer-subsidized ACA coverage. People who are offered insurance through their workplace may find that the premiums are too high because Medicaid is often free.
Buettgens said, "This is a unique situation." "The uncertainty is real."
The federal Centers for Medicare & Medicaid Services (or CMS) is encouraging states to slow down and connect Medicaid recipients who have been disenrolled with other coverage. The agency will monitor the accuracy of state eligibility decisions. Biden officials are looking for coverage shifts and not losses.
Chiquita Brooks LaSure, CMS Administrator, stated that "We are focused to make sure we keep the coverage gains we made under the Biden–Harris administration." "We are at our strongest point in history, and we will make sure we keep the coverage gains."
Many who lose Medicaid have the option of ACA coverage, or "Obamacare", which is also known as Obamacare. It will be more expensive if Congress Democrats don't extend the generous financial assistance President Joe Biden has requested in his social legislation. Democrats who stall the bill will be held responsible.
Republicans living in predominantly Southern states who have declined to expand Medicaid are also at risk. These states can make it difficult for low-income adults who want to be covered. More people may end up without insurance.
Officials from state Medicaid don't wish to be used as scapegoats. Matt Salo, the head of National Association of Medicaid Directors, stated that Medicaid has done its job. "We have taken care of behavioral, mental, and physical health needs. We are expected to right-size our program as we emerge from this emergency."
TELEHEALTH STATTIC
In 2020, millions of Americans discovered telehealth after coronavirus shut downs caused suspensions of routine medical consultations. Telehealth is becoming more popular than ever. While in-person visits remain the norm, telehealth has proven its value and gained wider acceptance.
Telehealth access would be affected for millions of Medicare beneficiaries. Pre-COVID-19 restrictions restrict telehealth to rural residents in order to protect against fraud in health care. Congress has 151 days to develop new rules after the end the public health emergency.
Cubanski, Kaiser Foundation's spokesperson for Telehealth, stated that "if there aren't any changes to the law thereafter most Medicare beneficiaries will lose coverage for telehealth."
The exception is for enrollees in private Medicare Advantage programs, which typically cover telehealth. Nearly 6 out 10 Medicare enrollees belong to the traditional fee-for service program.
TESTS, VACCINES TREATMENTS, TREATMENTS PAYMENTS AND PROCEDURES
Legal authority related to the public health emergency is required to ensure widespread access to COVID-19 tests, vaccines and treatments.
An example of this is the Biden administration's requirement that insurers cover up to eight COVID-19 test at-home per month.
One area of particular concern is the fate of vaccines, treatments and tests covered by emergency authorizations from the Food and Drug Administration.
Experts believe that emergency approvals are only valid for the duration of a public health emergency. Some experts say that it is not so simple because vaccines, tests, and treatments are subject to a different federal emergency statute. Officials from the health sector have not yet provided clear guidance.
Pfizer-BioNTech's COVID-19 vaccination for people 16 years and older has been approved by the FDA. Moderna's vaccine for those aged 18 and over has not been affected.
Hospitals could also take a financial loss. For COVID-19 patients, Medicare currently pays 20% more. This is only for the duration that the emergency lasts.
Medicare enrollees will have to go through more steps to be approved for rehabilitation in a nursing facility. The suspension of a Medicare rule that required a three-day stay in a hospital would be reinstated.
Xavier Becerra, Health and Human Services Secretary, recently stated to The Associated Press that his department was committed to giving "ample notice", when the public health emergency is over.
Becerra stated, "We want make sure that we're not putting Americans in a negative position who still need our assistance." Medicaid is the one people are most concerned about.
