White House Renews Emergency Declaration for the 12th Time

The Biden administration renewed the COVID-19 public health emergency declaration for the twelfth time since the pandemic began, a move which gives the federal government broader power in a wide variety of ways from leniency in Medicaid enrollment to data tracking to allowing pharmacists to administer COVID-19 shots.

The U.S. Health and Human Services Secretary Xavier Becerra renewed the declaration for January 12, the day it would expire. The emergency will last 90 days, and Becerra says he will give 60 days’ notice before ending it.

While COVID-19 is now accepted by health professionals as “endemic,” meaning the disease exists but is not causing significant disruption, White House COVID-19 Response Coordinator Ashish Jha told CNN “there’s still a lot of COVID out there, and the public health emergency and his (Becerra’s) determination gives us tools to fight this.”

Priorities for Congress

The Biden Administration’s handling of COVID-19 will dominate much of the debate in the new Congress as Republicans lead the House with a slight majority. Health care reform will also be high on the priority list, but the passage of major health care legislation is unlikely due to the divided partisan control of the House and Senate.

Congress could advance measures to reorganize federal bureaucracies and investigate their actions during the COVID-19 pandemic, says Paragon Health Institute (PHI) President Brian Blase, Ph.D.

“[In the House,] Republicans will chair the committees, and … they will be setting the priorities and conducting oversight,” said Blase, on the Heartland Daily Podcast, on December 23. “I think there will be some areas—hospital consolidation and price transparency—where there will be serious conversations.”

One or more House committees could examine the actions of the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) during the national health emergency, says Blase.

“I expect them to carry out investigations into the origin of COVID and the failure of CDC, FDA, and NIH during the pandemic,” said Blase.

Pandemic Emergency Oversight

Congress should begin by focusing on pandemic policy oversight, write Blase and PHI Senior Policy Analyst Drew Keyes in a policy brief, “A Health Care Agenda for the 118th Congress.”

A first step would be for Congress to immediately end the COVID-19 declared emergency, which has led to an “enormous federal role in health care, particularly a massively expanded Medicaid program,” write Blase and Keyes.

Health and Human Services Secretary Xavier Becerra said he would give 60 days’ notice when the declaration would end. The most recent extension in October was to end January 11 and Becerra gave no notice of termination 60 days before that date.

The emergency led to an expansion of the power of bureaucracies, say Blase and Keyes.

“The federal government’s response to the COVID-19 pandemic failed in multiple respects, including the promulgation of policies not based on science, poor communication, and an unprecedented expansion of government authority like the [CDC] eviction moratorium,” write Blase and Keyes. “School lockdowns, based in part on guidance from the CDC, had disastrous results. And social isolation, mental health problems, and drug overdoses have all soared as negative consequences of government-driven lockdowns.”

Scientific Groupthink

Reforms are required at the CDC, say Blase and Keyes.

“Congress should lay out a center-by-center authorization of the agency, reform its emergency powers, cut redundant activities, and reassign functions that may be carried out better by other agencies,” write Blase and Keyes. “Activities that state and local governments are better equipped to do should not be crowded out by federal actions.”

Officials from CDC, FDA, and NIH have “spoken out about the politicization occurring within the federal public health bureaucracy,” and the size of the bureaucracy has become a problem in its own right, with the NIH providing a prime example, say Blase and Keyes.

“What once began as a single institute has proliferated into 27,” write Blase and Keyes. “While the NIH has garnered much public support for much of its existence, scientific groupthink has led to growing frustration and a centralization of public funding. Dissenting views are cast aside, which is unsurprising given that most taxpayer dollars are granted to a small subset of educational institutions.”

IRS Obamacare Subsidies

Another potential target for House Republicans is the Biden administration’s rule that “used the Internal Revenue Service to unlawfully expand ACA subsidies to close the so-called ‘family glitch,’” write  Keyes and Blase.

Congress authorized subsidies based on keeping the cost of individual coverage not exceeding no more than 9.83 of personal income. The Biden rule allows the cost of a more expensive family plan to be factored into the subsidy calculation.

“The next Congress should conduct oversight of the illegal IRS rule and the White House pressure on the IRS to change its implementation of the tax code to further expand government control of health care,” write Keyes and Blase.

Drug Price Controls

Congress should ensure the rebates and drug price controls in the 2022 Inflation Reduction Act (IRA) are implemented in such a way that they don’t reduce access to drugs, say Blase and Keyes.

“The law appropriated $3 billion to CMS, largely to establish a massive bureaucracy to set pharmaceutical prices,” write Blase and Keyes. “The IRA’s price controls and inflation rebates begin in 2024. Congress should ensure the rebates and price controls do not have unintended consequences, beyond the ill-effects of the policies themselves, on the ability of Americans to access innovative cures.”

House Republican Leverage

The loss of trust in the public health community in the post-COVID world could lead to changes, Keyes told the Heartland Daily Podcast.

“Even in the public health community, there is awareness that the public has lost faith in federal health agencies,” said Keyes. “I would be surprised if the CDC did not undergo reform.”

With new leadership on the Senate Health, Education, Labor, and Pensions (HELP) Committee—Chairman Bernie Sanders (I-VT) and Republican Leader Bill Cassidy, M.D. (R-LA)—there are areas of potential agreement, such as Medicare Advantage, says Blase.

“Sen. Sanders does not like private insurance companies, and there are some concerns about how Medicare Advantage is working that Sen. Cassidy is sympathetic to,” said Blase. “There could be some overlap.”

Update, January 31, 2023:  The White House announced on January 30 a plan to end the emergency declaration on May 11. The White House was expected to announce that next week, given its promise to give 60 days’ notice of termination to all stakeholders. Congress was pressuring the White House to end the emergency declaration immediately and it was expected a bill, with bipartisan support, would be imminent. 

Bonner Russell Cohen, Ph.D. (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research. AnneMarie Schieber (amschieber@heartland.org) is the managing editor of Health Care News and contributed to this article.

A portion of this article was published on January 3, 2023.