White House mulls post-Covid emergency backstop for uninsured

“We know that the end of the [Covid public health emergency] is not the end of our work on Covid,” said one senior administration official, who was granted anonymity to discuss the ongoing deliberations. “It remains a public health priority, and a lot of people will still need these treatments.”

Biden health officials are preparing to unravel a sprawling set of pandemic policies over the next several months, as the administration ends the public health emergency on May 11 and moves toward managing the virus as a long-term disease.

For a White House that has made vaccines and treatments the centerpiece of its pandemic response, preserving widespread access to those tools will rank among the most pressing political and policy challenges.

The administration doesn’t plan to shift responsibility for vaccines and treatments to the private market until late summer at the earliest, giving it time beyond the May expiration of the public health emergency to navigate the handover. Even then, most people would still be able to get shots and treatments through private health insurers or federal programs like Medicare and Medicaid that would be newly responsible for negotiating their own supply deals with Covid drugmakers. A separate pre-existing federal program would continue providing free vaccinations for uninsured children.

But for the roughly 30 million adults without coverage, the changeover means they could be forced to pay out of pocket for drugs that can cost hundreds of dollars per dose — raising concerns among health experts that those most in need of pandemic care will soon be least able to afford it.

“Figuring out a way to ensure that cost is not the barrier for people to access vaccines, tests and treatments is essential,” said Jennifer Nuzzo, an epidemiologist at Brown University. “We have seen throughout this pandemic that income is one of the most important determinants of who has been able to protect themselves and who hasn’t.”

Joe Biden championed the rollout of hundreds of millions of free Covid shots as a hallmark accomplishment of his presidency that allowed people to resume their everyday lives. The availability of treatments, he has said, marked another major step in his administration’s efforts to minimize the public health threat.

“We have broken Covid’s grip on us,” Biden said during his State of the Union address last week. “We’ve saved millions of lives and opened our country back up.”

Wary of allowing the virus to flare up again, the Biden administration has lobbied Congress to create a “Vaccines for Adults” program that would permanently keep Covid shots free for everyone. But there’s little expectation the idea will gain traction with Republicans in control of the House, prompting concerns among public health officials and consumer advocates over how the administration plans to fill the gap.

“They definitely understand that we’re going back to our longstanding so-called medical care system that leaves a lot of people in the lurch,” said Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials. “But nobody’s heard a definitive plan.”

The Department of Health and Human Services has pledged to take care of the uninsured, though it’s so far offered few specifics. The department has instead focused first on preparing the health industry and consumer groups for the official end of the health emergency, health officials said, with plans to roll out more details on commercialization as that process is finalized in the coming months.

But behind the scenes, health officials have accelerated work on a plan to redirect leftover funds and supplies into a temporary program focused solely on getting vaccines, tests and treatments to the uninsured.

The plan is in its early stages, and the people with knowledge of the matter cautioned that several elements could still change. But under the emerging post-commercialization blueprint, the administration would seek to keep Covid care free for uninsured adults through the end of the year and potentially into the summer of 2024.

Health officials have explored extending a partnership with pharmacies to provide no-cost Covid testing into 2024, as well distributing tests from its own federal stockpile to places like homeless shelters, food banks and community centers most likely to work with the uninsured.

Officials also estimate that they can keep enough of the government’s existing supply of the antiviral Paxlovid on hand to cover the uninsured population for months after coverage shifts to the private market for others.

As for vaccines, the administration has discussed setting aside enough money to purchase a small number of doses in the fall, when drugmakers are expected to update their vaccines and the government anticipates handing off distribution responsibilities to the private sector.

That new stockpile could be fewer than 10 million doses, the people with knowledge of the matter said, based on the expectation that demand for Covid boosters will remain low. Fewer than 20 percent of American adults have received the latest booster, according to the Centers for Disease Control and Prevention, a figure that officials estimate is even lower among an uninsured population that skews younger.

The administration is still sorting out several logistical questions, including how much of its network of pharmacies, health centers, local health departments and other community sites it can use to continue distributing vaccines and treatments after commercialization.

Overall, the program will also be sharply limited by Congress’ yearlong refusal to fund the Covid response. The administration has less than $1 billion left over to put toward its uninsured plan, meaning costs could ultimately determine how long the federal aid can last.

But the hope is that the plan would provide a temporary bridge, giving the administration more time to make the case for additional funding — and in the process, fending off concerns that a White House that pledged to prioritize equity in its pandemic might end up leaving the most vulnerable behind.

“There can be no surprises here,” the senior administration official said, acknowledging the stakes for the millions of uninsured and Biden’s own Covid legacy. “And we are working to have no surprises.”