Time may be running out for free COVID testing, treatments and vaccines with Andrea Garcia JD, MPH


AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, monkeypox, medical education, advocacy issues, burnout, vaccines and more.

In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses how the Biden administration's decision to end the COVID-19 national emergency and U.S. public health emergency on May 11 will affect hospitals, physicians, as well as insured and uninsured patients. AMA Chief Experience Officer Todd Unger hosts.

Access updated information for hospitals, and other types of Medicare & Medicaid providers on the status of COVID-19 blanket waivers and flexibilities.

Learn more at the AMA COVID-19 resource center.


  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

AMA Recovery Plan for America’s Physicians

After fighting for physicians during the pandemic, the AMA is taking on the next extraordinary challenge: Renewing the nation’s commitment to physicians.

Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago. Welcome back, Andrea.

Garcia: Thanks. Good to be here with you.

Unger: Well, we'll have our update as normal today. But next week, just for a quick note, on February 15, Wednesday, we'll be airing a special AMA update with the AMA senior vice president of advocacy, Todd Askew, live from the AMA's National Advocacy Conference in Washington, D.C. We'll be back with Andrea the following week on February 22.

So Andrea, let's start with the numbers. Where do things stand this week and do we continue to see the declines that we spoke about last week?

Garcia: We do. In fact, if we look at the New York Times data, those conditions are improving around most of the country with reported COVID cases falling about 14% nationally over the last two weeks. We've also seen hospitalizations drop about 18% in the last two weeks. And those are decreasing in almost every state at this point.

And those declines in hospitalizations, I think, have been particularly notable. Right now, we're seeing just over 30,000 people currently hospitalized with COVID nationwide. And that's down from almost 50,000 in early January. Test positivity is also—it's around 10% and that's a decrease of about 8% over the past two weeks. Deaths have decreased but are still hovering a little more than 450 per day.

Unger: Still at a very, very high level. And that's interesting, too, because we talked a little bit last week about both the national and the public health emergencies ending on May 11. Anything new based on what's transpired since then or about what that's going to mean for physicians and patients?

Garcia: Well, that transition and what exactly it's going to look like continues to unfold. And I think there are still some questions out there and some confusion. I think what we do know is that decision carries both symbolic weight and real-world consequences for millions of people in the U.S. And if you listen to a recent episode of The Daily with Apoorva Mandavilli, who's a science and global health reporter for The New York Times, the chapter is closing on three years of special health measures, but we know that doesn't mean that COVID is over.

And she said that this move will have several major implications. And for one, COVID is now going to be treated like any other disease within our health system, which we know means that impacted individuals will largely rely and depend on what type of insurance that they have. And as a part of this, we know that hospitals won't benefit from that additional funding for treating COVID patients or have those flexibilities around hospital bed capacity, billing procedures. Those are also going to be affected.

Unger: So these are some very, very big differences. And I'd like to get into that more because it can get pretty complicated. We're going to walk through, let's say, different types of groups and how it's going to affect them. Let's start first, Andrea, with a snapshot between the folks that have insurance and those that are uninsured.

Garcia: Yeah. So I want to just start out by saying it is not completely clear how this will all play out. We think that for most people with private or public insurance, like Medicare, those vaccines will continue to be free even after that supply purchased by the federal government runs out. And that is because under the Affordable Care Act's preventive services coverage, immunizations recommended for routine use by the ACA are covered without cost sharing. There are some exceptions to that.

The biggest change that people with insurance are going to notice is that they'll likely no longer be eligible for those eight free at-home COVID tests each month. So it makes sense to stock up on those now. Just be mindful that there are expiration dates. And after that, people likely are going to have to pay full price for those at-home COVID tests at drugstores. People with insurance may also have new co-pays for treatments like Paxlovid and PCR tests even when they're ordered by their physician. And those costs are likely going to vary from plan to plan.

Unger: So that's the Medicare population. What about Medicaid?

Garcia: So people on Medicaid should be able to access COVID tests and treatments at no cost until 2024, and they'll also be able to obtain free vaccines. The challenge that we're expecting to see here is that many people are going to lose that coverage they had through Medicaid when that public health emergency declaration ends. We've talked often about the public health emergency providing administrative and regulatory flexibilities, and that included flexibilities through CMS.

During the pandemic, we know states were given an option to provide temporary Medicare Medicaid coverage for vaccines, testing and treatment to the uninsured and receive a 100% federal match to cover those costs. And we saw states do that. But obviously, those flexibilities are going to come to an end. So people who are uninsured who had access through that temporary option won't have that anymore.

Unger: Andrea, do you have a sense of how many people that could potentially affect?

Garcia: So the Biden administration is predicting that 15 million people or 17% of enrollees will lose coverage through Medicaid or CHIP as that program returns to normal operations. Children who are uninsured will retain access to free vaccines through the Vaccines For Children program or VFC. We talked back in October of last year about how ACIP voted to add that COVID vaccine to the immunization schedule. And at that time, they said it should be included in CDC's VFC program, which we provides millions of kids with free vaccines against a number of infectious diseases every year.

Unger: All right. So let's talk a little bit, though, about those who are uninsured. There going to be a lot more costs here. Can you outline what the impact is going to look like for these folks?

Garcia: Yeah. So adults who are uninsured would have to pay full price out of pocket for those vaccines. The cost of the Pfizer and Moderna vaccines could likely quadruple from the $30 that the government was paying for them to either $110 to $130 per vaccine. We know that limited vaccines and test supplies might be available at low or no cost through community health centers, but treatments will remain free while those government supplies last. But then people are going to have to pay for them out of pocket as well. So those without insurance, we know, are already struggling to access COVID care, and they'll now need to rely on public health programs and safety nets, which vary greatly by state.

Unger: Which is obviously a big problem. Is there anything that's in the works to combat these kinds of obstacles?

Garcia: Well, we know that health officials are working on ways to help people who are uninsured with COVID-related costs, but we don't have any details on that yet. Right now, I think it means we're going to see inequities in access to vaccines, treatments and testing, people who will be completely or mostly covered if they have insurance while others who can least afford it may be paying hundreds of dollars out of pocket. And that means people without insurance may go unvaccinated or may not get tested or treatment.

Unger: Not a good outcome there, so we'll keep our eye on that. And that's really not the only implications that we're looking at here. You mentioned some additional ones. Can you outline for us where you see the biggest changes?

Garcia: Well, something that we haven't talked much about here is that this will mean termination of Title 42. And that's a public health measure that was put in place during the Trump administration that limited the inflow of migrants at the border. It's a public health law, that term Title 42 is, and it's become shorthand for a CDC order that authorizes the government to restrict migration to prevent that spread of communicable diseases—in this case, obviously, COVID. That order allows the government to send migrants back to their home country immediately upon apprehending them, and they're not allowed to seek asylum.

People are passionate about this issue on both sides of the political spectrum. I think the thing they could agree on is that ending Title 42 is likely going to attract thousands of more migrants to the border, which is going to present a humanitarian challenge of caring for a potentially large influx of people. So that's certainly something to watch.

Unger: And that is certainly a big challenge. And you also mentioned that certain flexibilities are going to be ending for hospitals. What do they need to know?

Garcia: So certain waivers tied to that public health emergency have allowed for things like hospital bed flexibilities, expanded access to telehealth, that establishment of hospital at-home programs and the availability of health care professionals to practice across state lines, which I think we've seen a lot of during the emergency, as well as provider relief for administrative burdens. A public health emergency declaration also allowed for several critical coverage and hospital payment policies.

CMS has released fact sheets for hospitals as well as Medicare and Medicaid providers on the status of these COVID-19 blanket waivers and flexibilities, whether or not they will end or continue after the public health emergency. So we'll provide links to those in the description. And those will be a great resource source for physicians and others throughout this transition.

Unger: So definitely some new adjustments there with the ending of the emergencies. And the dual emergencies aren't the only ones in place to respond to the pandemic. The Health and Human Services Secretary also granted emergency use authorization power to the FDA to streamline availability of new COVID drugs. Is that going to be affected by the ending of this emergency declaration?

Garcia: So the short answer here is that it will not. It doesn't affect the EUAs that the FDA granted to some COVID vaccines and antivirals like Paxlovid. Those declarations were made under the Food, Drug, and Cosmetic Act. And the emergency declaration behind that EUA is issued by the HHS secretary. It remains in effect until the secretary decides to terminate it.

If the emergency EUA declaration ends, then any medications authorized under it may no longer be available. Those drugs would have to receive full FDA approval to make it to the market again. FDA did note in a statement that if that occurs, they would be allowing enough time for that transition to help ensure approval of the drugs are forthcoming.

Unger: That is good news. Andrea, thanks so much for all of these updates. Clearly, a lot to contend with as these public emergencies are brought to a close. Thanks for being with us here today.

We'll be back soon with another AMA Update. You can find all our videos and podcasts at ama.assn.org/podcasts. Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.