A Historic Shift in Pandemic Policy
On May 11, 2023, the United States officially declared the end of its COVID-19 public health emergency (PHE), more than three years after it was first enacted in early 2020. The expiration of the declaration represents a major policy and symbolic milestone in the nation’s long battle with the virus, shifting the federal government’s approach from crisis response to long-term endemic management.
Initially declared by the Department of Health and Human Services (HHS) in January 2020, the public health emergency provided the legal and regulatory framework that allowed for free testing, treatments, expanded telehealth access, increased Medicaid flexibility, and the emergency authorization of vaccines and therapeutics. Over time, it became central to how the government coordinated its pandemic response across agencies and states.
Its conclusion signals confidence in the current state of the pandemic but also introduces a host of new policy, economic, and public health implications that will affect millions of Americans.
What Changes with the End of the PHE?
The expiration of the PHE comes with several immediate changes to COVID-related healthcare access and coverage:
- Testing and Treatment: Free access to at-home COVID-19 tests through federal programs has ended. Individuals with insurance may still receive some coverage, but uninsured Americans may now face out-of-pocket costs for tests, doctor visits, and antiviral treatments like Paxlovid.
- Vaccines: COVID-19 vaccines continue to be available at no cost for most people with private insurance, Medicare, or Medicaid. However, coverage for the uninsured will now depend on state programs, charitable efforts, or manufacturer discounts.
- Telehealth Flexibilities: Some of the emergency-era telehealth policies—such as cross-state care and prescribing rules—are set to be phased out over time. While certain provisions have been extended by Congress through 2024, long-term telehealth access will increasingly depend on state regulations and insurer policies.
- Medicaid Enrollment: The conclusion of the PHE coincides with the “unwinding” of continuous Medicaid coverage, potentially resulting in millions losing coverage as states resume eligibility redeterminations.
Surveillance and Public Health Strategy Post-PHE
Although the formal emergency declaration has ended, the Centers for Disease Control and Prevention (CDC) continues to prioritize COVID-19 monitoring and prevention. The CDC has updated its data collection strategy, shifting from daily case counts to a more sustainable surveillance model, relying on hospitalizations, wastewater analysis, and sentinel site reporting.
Dr. Rochelle Walensky, then-CDC Director, emphasized the agency’s commitment to keeping the public informed. “COVID-19 is not over—it is no longer a crisis, but it remains a serious public health concern. We urge Americans to stay up to date on vaccinations and practice preventive care.”
Vaccination, particularly among vulnerable populations, remains central to federal and state strategies. Public health officials also continue to monitor for emerging variants, which could prompt renewed mitigation efforts if transmission or severity increases.
Public Response and Long-Term Outlook
The end of the emergency has drawn mixed reactions. Some Americans welcomed the shift as a sign of progress and a return to normalcy, while others expressed concern about the potential loss of protections for vulnerable communities, including the uninsured, elderly, and immunocompromised.
Health equity advocates have warned that the cost burden of COVID-19 care could disproportionately impact low-income individuals, particularly in states that have not expanded Medicaid or that lack strong safety-net programs.
Meanwhile, experts urge continued investment in pandemic preparedness infrastructure, including better data systems, vaccine development platforms, and emergency response coordination, to ensure the nation is ready for future infectious disease threats.
A New Chapter in Pandemic Response
As the U.S. turns the page on the COVID-19 public health emergency, the country enters a new phase of coexistence with the virus, one that will require balancing vigilance with normalization. Federal agencies, states, healthcare providers, and the public must now collaborate in building resilient systems that can support routine COVID-19 care without the urgency—and federal support—that defined the past three years.
Source:
CDC – COVID-19 Surveillance After Expiration of the Public Health Emergency
