Many of the pieces I have written about the Covid pandemic over the past three years have been about what Presidents Trump and Biden didn’t do: the missed opportunities that cost thousands of lives, led to millions of unnecessary infections, and left many with lingering complications in the form of long Covid.
But two recent decisions—by a Democratic Congress and the Biden White House—break with that template, because they represent harmful action rather than harmful inaction. The first decision came in December, with the passage of the omnibus spending bill. The second came just this week, when the Biden administration announced that it will soon be ending the Covid-related public health emergency declarations. Both choices by the Democrats will hurt millions of people.
Let’s start with the omnibus bill signed in December. Many people haven’t paid much attention to the provisions of this massive piece of legislation, but one in particular is a disaster in the making. In 2020, Democrats and Republicans—yes, in bipartisan fashion—allowed people on Medicaid to continuously stay on the rolls until the public health emergencies that had been declared at the beginning of the pandemic were lifted. This was a momentous decision and a wise one. According to the Kaiser Family Foundation, “Total Medicaid/CHIP enrollment grew to 90.9 million in September 2022, an increase of 19.8 million or more than 27.9 percent from enrollment in February 2020.” That represents close to a third of all Americans who were protected from losing their health insurance for the past three years.
However, Senate majority leader Chuck Schumer, then-House Speaker Nancy Pelosi, and President Biden decided to do the inexplicable just in time for the holidays: They put a measure into the bill to delink the continuous enrollment provision in Medicaid from the public health emergency and end it as of March 31, 2023. According to Kaiser, “between 5 million and 14 million people will lose Medicaid coverage once the continuous enrollment provision ends.” Some of these people may find a way to get other health insurance coverage, but we are likely to see many who are left high and dry in the months ahead, even as the pandemic marches on. It is incumbent on the White House to tell Americans how it will address this crisis in coverage before the clock runs out in two months.
But the Democrats weren’t finished. On Monday, the White House announced that it will let the Covid-related public health emergency declarations expire on May 11, 2023. Ashish Jha, Biden’s national Covid response coordinator, framed the announcement in true “accentuate-the-positive,” “we’re back to normal” fashion, tweeting that the emergency was being lifted because the country was “in a better place and “getting through the winter without a big surge or run on hospitals.” He even threw in the Biden administration’s favorite line: “We have the tools to manage this virus.”
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Jha can tweet whatever he likes, but as I’ve said again and again, the numbers don’t lie. As Alyssa Bilinski and Kathryn Thompson from the Brown School of Public Health, along with Ezekiel Emanuel from the University of Pennsylvania’s Perelman School of Medicine, wrote in a letter to the Journal of the American Medical Association in November: “The US continued to experience significantly higher Covid-19 and excess all-cause mortality compared with peer countries during 2021 and early 2022, a difference accounting for 150,000 to 470,000 deaths.” Last week, more people died of Covid than perished in the Twin Towers on 9/11.
And these figures don’t account for the other effects of the pandemic, like long Covid, which The New York Times reported last week is “preventing substantial numbers of people from going back to work while others continue needing medical care long after returning to their jobs.” We’ve also seen a surge in hospitalizations, which Jha himself said will be the new normal. As for the tools Jha is so fond of touting, vaccination rates are low in many states, and booster uptake is even lower. So is the rate of Paxlovid use. Taken together, this looks suspiciously like a continuing emergency—but the White House would rather look on the bright side, no matter the facts.
The lifting of the public health emergency will also end a vital series of protections for millions of Americans. Once again, the Kaiser Family Foundation lays it all out in gory detail. First, let’s remember the fact that states get to kick people off the Medicaid rolls in April, and, as Kaiser has reported, “past patterns show that most people disenrolled from Medicaid become uninsured for all or part of the next 12 months.” If you have no insurance, the costs of vaccines, tests, and treatments will be largely yours to bear. Once federal supplies of these commodities run out, limited vaccine access may be provided to a few through a frayed patchwork of federal programs, but millions of uninsured people will have no such fallback option. For those insured—through Medicaid, Medicare, or commercial health insurance—cost sharing will be allowed for some treatments and tests in particular, but at-home tests won’t be covered at all for those in traditional Medicare or with private insurance. And as federal supplies run out, private insurers will have to bear the costs of these commodities, and are likely to pass on those costs to consumers in the form of premium increases. Again, instead of bright-siding us about this brave new era, the White House should lay out explicitly and specifically what it is going to do to protect access to Covid vaccines, tests, and treatments and to keep the economic fallout from burdening millions of people around the country.
Lastly, both Pfizer and Moderna are hiking their prices on Covid vaccines. And this isn’t a little uptick in the price tag—both Pfizer and Moderna are proposing 400 percent increases. Again, this is going to put vaccines out of the reach of many low-income uninsured Americans, dissuade others from getting the jab, and sock insured people with potential premium increases as insurance companies pass on the pain to the rest of us. The White House has issued strongly worded statements about the price hikes, but many have called for bolder action against this predatory behavior. As of now, there are crickets from 1600 Pennsylvania Avenue.
Gandhi once said, “The true measure of any society can be found in how it treats its most vulnerable members.” Those who will become newly uninsured, those who are already uninsured, those with private health plans with high deductibles and co-pays, people on public insurance, and people with limited incomes are all going to suffer with the rollback of the Medicaid continuous enrollment provision and lifting of the public health emergency. The White House owes us real answers about how it will address the plight of these millions of Americans, not sound bites and happy talk.
