The United States government took very specific actions to protect Americans when COVID-19 emerged as a global pandemic. Lawmakers enacted a public health emergency (PHE) declaration with sweeping powers to immediately release strategic resources designed to keep people as safe as possible.
With the third year of the pandemic underway, President Biden has announced end the PHE declaration on May 11, 2023. Ending the PHE will occur in several stages. Patients, providers, and payers can all expect some degree of impact.
Public health emergency declarations circumvent red tape and bureaucracy to quickly release funding and enact supportive measures.
In addition to COVID-19, the U.S. has a national PHE in place for the opioid crisis. There are also active regional PHEs declared in response to natural disasters such as flooding in Kentucky, wildfires in the Southwest, and damage from Hurricane Ian.
However, no PHE in recent American history has been as widespread as the COVID-19 declaration. This declaration included several major pieces of legislation enacted as new information about the novel coronavirus became known.
“No one really knew what the financial and health consequences were going to be with the pandemic,” says Mike Warfel, senior vice president for government affairs at Highmark Health.
“We wanted to provide stability, to keep people covered no matter what kind of plan they had with us. Whether it was through an employer, the Affordable Care Act (ACA), Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).”
“Highmark is also the only Blue Cross Blue Shield plan with an affiliated hospital network. We have 14 hospitals and employ thousands of people. We provide health care solutions in pretty much every way. So, we see things differently than a traditional payer.”
One of the biggest provisions under the COVID-19 PHE was access to free testing, with insurance providers covering the cost. Not only did Highmark move quickly to cover on-site testing, we also guaranteed eight at-home tests per month per member.
“Another thing that was a big change for our members was the coverage of drugs that became available via emergency use authorization (EUA) under the PHE,” says Amy Sawyer, director of health policy at Highmark Health. “EUA enabled the rollout of medications that were not yet approved by the Food and Drug Administration (FDA). That includes all of the vaccines, asas well as some of the COVID-19 treatments.”
“Telehealth is another good example of what came out of this,” adds Greg Englert, director of federal affairs for Highmark Health. Telehealth is greatly beneficial for behavioral health and substance use disorders. It has valuable uses beyond the pandemic, including the opioid crisis.
“Congress passed a number of telehealth flexibilities that they tied to the end of the PHE,” continues Englert. “They said, ‘when the PHE ends, it’s going to go back to the way it was.’”
However, Congress passed a large omnibus bill at the end of 2022, part of which disentangles telehealth from the PHE. This is good news for patients, because while some states require insurers to cover telehealth others do not.
“Telehealth also offers an important benefit for people covered by employer-based high deductible plans,” adds Englert. “Congress created a safe harbor that allows these plans to cover telehealth costs on a pre-deductible basis from day one. We’re working to have Congress and the Biden administration make permanent changes in telehealth availability.”
The Biden administration provided states with 90+ days of advance notice regarding the end of the PHE in May 2023, after which coverage mandates will begin to cease. Insurers like Highmark will then have greater flexibility in designing cost-sharing programs and out-of-network provisions for certain types of COVID testing, vaccines, and treatment.
* Stops on day one, unless otherwise noted. This chart reflects changes to individual and group plans, although there may be overlaps with other types of insurance (Medicare, Medicaid, CHIP).
“Our engagement with regulators and legislators, both at the state and the federal level, is absolutely necessary,” stresses Warfel. “We work on behalf of our members to make sure that policymakers understand the impacts of their actions.”
Highmark’s experts — actuaries, clinicians, financial analysts, and others — look at proposed rules, regulations, and legislation. We advocate for our members, as we educate our customers and insurance brokers on what is happening in government.
“We provide an informed perspective as a large payer who also happens to own and operate 14 hospitals,” adds Warfel. The most important thing is that people have access to quality health care. It doesn’t matter what side of the political aisle someone is on, if they are rich or poor, or if they have government- or employer-provided coverage. When someone is sick, they want the best care possible. Highmark provides solutions to help people, regardless of their station in life.”
All references to “Highmark” in this communication are references to Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association, and/or to one or more of its affiliated Blue companies.
