By Mahlon Meyer
NORTHWEST ASIAN WEEKLY
A whole hail of changes may come on May 11—particularly to those who are going to lose their health insurance—when the Biden administration ends the COVID-19 federal Public Health Emergency.
At the very least, individuals will have to shift the way they approach protecting themselves from the disease, according to a leading public health researcher.
While COVID-19 vaccines will remain free to all people as long as federal supplies last, the requirements for insurance companies to cover COVID-19 related costs and keep people continuously enrolled in Medicaid is going away.
This means researching your own health plan, in advance of getting a shot, checking if the provider of the vaccine offers free federally purchased vaccines, and taking all the usual steps to check if you are covered before going out to get protected as you would for any other illness.
“Covid vaccines are now entering the orbit of regular health care,” said Joshua Liao, the associate chair for Health Systems, faculty in the Schools of Medicine and Public Health, and the enterprise medical director of Payment Strategy at the University of Washington.
Whom do we have to thank for this?
Last year, the U.S. Congress ended funding of federal measures to combat the coronavirus. While the Biden administration has sought other measures for its 2024 budget to allow all adults of any background—insured or not, impoverished or not—to be vaccinated, it is uncertain if the measure will pass Congress.
At the same time, however, Liao stated that this kind of public health emergency, and the federal response to it, was “unprecedented.”
In other words, the return to a usual health care approach for the once-in-a-generation phenomenon of COVID-19 is something that had to happen at some point.
“There is no perfect moment to end a public health emergency for a condition like COVID-19,” he said.
Still, the effects are going to be major for the most impacted Americans. Between 5 million and 14 million are losing Medicaid coverage after the Families First Coronavirus Response Act continuous enrollment provision ended, according to the Kaiser Family Foundation. While many may enroll in the Affordable Care Act, many may not, for structural or psychological issues or simply because they don’t hear about their disenrollment.
According to the USC Annenberg Center for Health Journalism, the most impoverished people and people of color are also at high risk. Those who move may not receive information about changes, putting them further at risk.
Free vaccine shots available until federal supplies run out
For some, the return to normal may seem discouraging—and signal the many structural problems in our health care system.
But Liao, who describes himself as an optimist, said our health care system will improve, even if incrementally.
For instance, the Affordable Care Act seemed to come from a single administration, he said. But the groundwork was laid over many previous administrations researching and advocating for a similar system. In the same way, changes to the many disincentives that exist in our health care system for people to get care—such as long wait times for an appointment—are already being looked at by researchers today.
“I believe change will happen, but perhaps not at a flip of the switch,” he said. “When it comes to health systems change, I think you’ll see improvements—multiple improvements—over time.”
In the meantime, it might be a good idea to get any vaccine or booster needed before May 11.
Most people will still be covered fully—but it will no longer be simply finding a place to get a shot and going there. Luckily, there are still free vaccine shots available after May 11, through organizations and providers participating in the Centers for Disease Control (CDC) COVID-19 Vaccination Program.
How did we get here?
During Operation Warp Speed, under the Trump administration, billions of dollars were given to pharmaceutical companies to develop the vaccine. But no negotiations were done to ensure that, when the public health emergency ended, these pharmaceutical companies, such as Pfizer and Moderna, would provide free or even discounted vaccines to the public.
According to research done by Kaiser, the price of the vaccine has steadily climbed.
The good news is, as long as federally purchased vaccines last, COVID-19 vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s coverage or network status.
Check your coverage
Pfizer and Moderna have indicated they may make vaccines and boosters free to those who are uninsured. But this involves going through their patient assistance programs, which involve many hoops, according to the Kaiser Family Foundation, nor is it clear how this would work. No details have been provided, as yet.
Although insurers are no longer required to reimburse out-of-network providers for vaccine administration, free vaccine access will be unaffected, as long as federal supplies last, because vaccine providers are not allowed to deny anyone a federally purchased vaccine based on the recipient’s coverage or network status and must not charge any out-of-pocket costs.
After that, however, consumers need to check with their insurance companies for coverage policy.
At the same time, according to Liao, there may very well be an administration fee—what the consumer pays a physician or medical provider to actually give the shot.
According to Kaiser, in some cases, there may in addition be a hospital fee.
Check if your pharmacy still provides free COVID-19 vaccines
Liao urges consumers to be careful in checking their insurance benefits before going to get a shot.
For instance, one has to check if the provider administering the shot is part of the CDC COVID-19 Vaccination Program. You can find the list of pharmacies enrolled in this program on the CDC website.
To put it in context, however, Liao said getting a COVID-19 shot will now be similar to getting other vaccines, such as a flu shot.
It is not clear when the federal supplies will run out and how the cost of getting COVID-19 vaccines or boosters will be affected after that.
Structural issues among insurance companies and the way the government medical programs choose to classify COVID-19 vaccines or boosters will determine this.
“The point is that like flu shots, there can be limitations on the options for free vaccinations,” said Liao.
Time for a shot
Nevertheless, experts are encouraging individuals to get up to date boosters and if anyone is not vaccinated, to go ahead and do it.
“Yes, absolutely,” said Amy Chang of Stanford University Medical School, department of infectious disease. “Even though COVID National Emergency is ending, this does not mean that the virus itself is gone. People are still getting COVID each day—maybe fewer people than before at this moment, but it is still happening. Widespread use of the vaccine has helped to prevent disease and to reduce the severity of symptoms when people do get COVID.”
Liao goes even further. The end of the emergency has nothing to do with how we approach vaccination, he said.
“The end of this doesn’t change my opinion about how I would approach vaccination whether it’s the primary series or boosters,” he said.
When to get an updated booster—or not
The CDC has released guidelines about when you need a booster, including the new bivalent booster that protects against both omicron and the relatively non-mutated strain.
“The updated boosters are called ‘updated’ because they protect against both the original virus that causes COVID-19 and the Omicron variant BA.4 and BA.5,” according to the CDC.
The updated boosters, made only by Pfizer and Moderna, became available on:
- September 2, 2022, for people aged 12 years and older
- October 12, 2022, for people aged 5–11 years
- December 9, 2022, for children aged 6 months–4 years who completed the Moderna COVID-19 vaccine primary series
- March 17, 2023, for children aged 6 months–4 years who completed their 3-dose primary series with the original Pfizer-BioNTech COVID-19 vaccine
So, if you’ve received your booster after the date applicable to you, above, then the CDC is not recommending another booster.
Conversely, if you received a booster before those dates, the CDC is recommending you receive a booster. Experts recommend consulting with your personal medical provider for other questions.
Vaccines will still be available for those who are uninsured through Vaccines for Children and Vaccines for Adult programs. No one will be left behind. Here are the links to read more about the vaccines programs and the locations of vaccines provider through Apple Health.
Vaccines for adults: https://doh.wa.gov/public-health-healthcare-providers/public-health-system-resources-and-services/immunization/adult-vaccine-program
Vaccines for children: Childhood Vaccine Program | Washington State Department of Health
Adult provider maps: Vaccine Provider Locations (wa.gov)
Children provider maps: Vaccine Provider Locations (wa.gov)
Health Care Authority: Apple Health and the public health emergency | Washington State Health Care Authority
Apple Health Guide to unwinding from the Public Health Emergency: External Guide to Washington Apple Health (Medicaid) Post-PHE
Mahlon can be reached at email@example.com.
Made possible in part by the Washington State Department of Health through a grant from the Centers for Disease Control and Prevention. This information does not necessarily reflect the official policies of the Washington State Department of Health or the Department of Health and Human Services.