Not Ready for the End Game — Why Ending Federal Covid-19 Emergency Declarations Will Harm Access to Care

Abstract

I ncreasing demands that President Joe Biden "end the emergency" reflect political symbolism and understandable longing for normal life. But responding literally, by abruptly terminating federal emergency declarations, will backfire. Doing so will not eliminate the mask, vaccination, and quarantine requirements some Amer-icans oppose-many of which are being discontinued anyway. Moreover, rushed terminations of federal emergency declarations will eliminate regulatory flexibility and financial supports for patients , providers, and the health care system. The response to Covid-19 does not hinge on a single emergency declaration. Overlapping federal, state, and local declarations have triggered executive emergency powers to spend money and issue , suspend, and alter regulations. Most state and local governments have now terminated the declarations that allowed governors and mayors to order travel and business restrictions and mask and quarantine mandates without legislative action. 1 At the federal level, several distinct emergency declarations remain active, but their primary effect is to remove regulatory barriers and address liability concerns that would otherwise impede access to health care and medical countermeasures (see table), not to impose mandates. Because federal agencies have power to regulate patient safety and the interstate spread of disease even without a declared emergency, rescinding federal declarations will have little effect on federal powers to impose vaccination and mask mandates. The vaccination requirement for health care workers issued by the Centers for Medicare and Medicaid Services (CMS) relies on ordinary authority; it does not depend on an active emergency declaration. Similarly, although the Centers for Disease Control and Prevention (CDC) chose to link the duration of its current order requiring masks on airplanes and other public conveyances to the federal public health emergency (PHE) declaration, the order relies on its general powers to control communicable diseases, and the agency could reissue it even if the PHE declaration ends. The Trump and Biden administrations have used emergency declarations to remove regulatory barriers and liability concerns and provide enhanced funding. Ending these declarations will threaten the availability of medical countermeasures and access to care.