What happens when the COVID national emergency ends

Illustration: Aïda Amer/Axios

While much has been made about the COVID-19 public health emergency, there's another less-discussed emergency declaration that Republicans could target in the next Congress, bringing changes for employer-sponsored health plans, COBRA and flexible spending accounts.

Why it matters: The vote might happen once Republicans take control of the House next year, though President Biden would likely veto it.

• Quick reminder: Lots of health groups are concerned about unwinding the public health emergency, but that's a separate declaration with different implications.

Here’s what you need to know about the national emergency declaration, which then-President Trump declared early in the pandemic and which President Biden extended:

• For the health care sector, its main effect is on deadlines to file claims for COBRA and flexible spending accounts, said Lindsay Wiley, a health law professor at UCLA.
• Specifically, the extensions would be rolled back for certain deadlines for signing up for COBRA health plans, the date for making COBRA premium payments, the deadline for employers telling individuals about their COBRA continuation rights, and the timeframe for filing claims for COBRA, said James Gelfand, president of the ERISA Industry Committee.
• Under the emergency authority, HHS also can waive requirements for federal health programs to make it easier to serve patients, like the rules that require physicians to be licensed in the state where they're providing services.
• States have been kind of expecting these emergency flexibilities to end, so it shouldn't come as too much of a surprise to them to adjust their Medicaid programs back, said Jack Rollins, director of federal policy with the National Association of Medicaid Directors.
• But one issue could be one of the waivers that allows members of households to be paid caregivers for Medicaid home community services.
• "It is less clear that can happen without an emergency authority," Rollins said. "States will have questions about that."

Between the lines: Wiley said lawmakers who might vote to end the declaration probably aren't focused on the programs as much as making a statement that the country has returned to normal.

• That seems to be the case for two of the 12 Senate Democrats Axios spoke to this week who voted "yes" on a measure to end the COVID emergency that passed the Senate in November.

• "[The pandemic] is over. I'm going to keep voting until we get it over," said Sen. Joe Manchin. "We should get back to normal lives."
• Sen. Tim Kaine said the Biden administration didn't provide senators with a good reason to keep it in place — only sending a memo to offices urging a "no" vote 10 minutes after the vote.
• "I just felt like if they didn't care enough to tell us to vote against it, then I'm going to vote for it, knowing the big public health emergency from HHS is still in place," Kaine said. "If there's an effort to do it next year, well, what does the White House have to say?"

The other side: Republicans pushing to scrap the emergency declaration say the move will rein in a massive expansion of government.

• "I am hopeful that terminating the COVID-19 national emergency declaration is one of the very first actions taken up by the new Republican majority in January," said Rep. Paul Gosar (R-Ariz.).

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