The pandemic isn’t over, but most US states say it’s no longer a health emergency
By Adeel Hassan
When all 50 states, the District of Columbia and United States territories declared public health emergencies in response to the coronavirus pandemic in March 2020, those declarations allowed state officials to lift limits on hospital capacity, expand access to telehealth services and even allow highway weight limits to be exceeded, in case the National Guard needed to quickly move in.
By today, fewer than a dozen states will have emergency declarations in place, according to the National Academy for State Health Policy. States have let the declarations expire even though the omicron subvariant known as BA.5, perhaps the most transmissible coronavirus subvariant yet, is pushing up positive tests, hospitalizations and intensive-care admissions across the country.
The wider latitude conferred by a state’s public health emergency — such as making it easier for out-of-state medical providers to help with in-person and telehealth care and for retired health care workers to return to work — was critical to states’ responses to earlier waves of coronavirus cases.
But as Americans adjust to living with the virus, the country’s governors have increasingly had to justify the extension of such declarations to legislators who consider them an unnecessary use of executive power. On Wednesday, New York Gov. Kathy Hochul said she needed to extend her pandemic emergency powers into the fall in case serious disease and hospitalizations spike higher.
At the same time, the Biden administration last week again extended the federal coronavirus public health emergency, which was first set in January 2020. The declaration means the emergency period will last at least through mid-October.
The federal designation allows millions of low-income Americans expanded access to Medicaid coverage; adds flexibility for telehealth; and grants states access to pandemic-related funds.
Additionally, private insurers and Medicare will continue to cover the cost of at-home virus tests as long as the public health emergency remains in effect.
Hemi Tewarson, executive director of the National Academy for State Health Policy, said that although the federal public health emergency has many benefits for states, they need additional powers to be flexible in shifting resources around within their borders and to manage surges at hospitals. An emergency declaration allows governments to respond to their states’ specific needs.
“Earlier in the pandemic, there were broad statewide actions; now they are more targeted,” Tewarson said. “If you think how emergency orders are used, it makes sense if you see where we are into the arc of the pandemic.”
In some cases, the state must have a declaration in place to receive funding from the federal government. Although Connecticut’s public health emergency ended last month, the state kept a limited version in place so that it can receive more federal money for food assistance for low-income families.
The pandemic has prompted some states to change the regulations surrounding emergency orders during the pandemic, said Andy Baker-White, senior director of state health policy at the Association of State and Territorial Health Officials. Legislatures have amended the process for declaring an emergency, shortened the maximum length of each emergency and reduced the number of times that a governor can renew an emergency declaration. In Arizona, beginning next January, the governor cannot declare a public health emergency without the legislature’s approval.
“With the backlash to the exercise of this authority, there has to be political will, as well as the expense of political capital to bring back a declaration,” Baker-White said. “Some states have taken things that they were only able to do in an emergency and put that action into the law, so they don’t need the emergency trigger.”
Virginia no longer needs an emergency order to allow out-of-state health workers to come into the state to provide care, he said, because it passed a regulation to that effect. Other states have permanently broadened pharmacists’ scope of practice and given health care workers immunity from malpractice liability.
But one effect of the pandemic — the improved access to telehealth — is at risk, since many waivers that allow such care across state borders have expired. And in states that no longer have emergencies declared, hospitals have once again instated capacity limits. Lifting those in the event of another surge would require issuing another declaration.
Public health emergencies are by definition only a temporary solution to states’ health care problems, and the pandemic created an opportunity to reassess their function, according to one expert.
“There’s a rebooting that needs to happen,” said Georges Benjamin, executive director of the American Public Health Association. “The emergency declarations really need to be short term. The fact that they’re going away is good.”