Will it be “every state for itself” as federal COVID money dries up?

WASHINGTON — State and local health departments remain uncertain about whether they will have to fund their own COVID-19 vaccines and treatments on their own as a congressional deadlock drags on into its fourth month.

The Biden administration sounded the alarm over the risk of inaction after sending Congress a request for $22.5 billion in early March. But U.S. lawmakers have been unable to pass two bipartisan agreements and no negotiations are underway at this time, even as cases rise nationwide and the potential for a big wave of… infections remain this winter.

It has left state and local health departments wondering if they will have to try to compete with each other and even compete with other countries to buy tests, treatments and vaccines – an expensive business that many are unsure of. to be able to afford.

“If we get to a place where every state is for itself, that’s going to cause major problems,” said Marcus Plescia, chief medical officer for the Association of State and Territory Health Officials.

“If you live in New York or California, you will have very good access to these things. If you live in a less affluent Southern or Midwestern state, that’s going to be a real problem for those people,” Plescia said.

“And ultimately that impacts all of us, because we’re one nation, and we travel, and we really have to be careful of all states.”

State and local health departments have invested significant financial resources in the fight against COVID-19, but so far the federal government has borne the cost of free vaccines and treatments as well as a now-funded program to providing health care to uninsured people with the virus. The federal government also offers free testing.

Health safety net

Eryn Hurley, director of government affairs at the National Association of Counties, said that without additional federal funding for safety net health care providers, many of whom are county governments, they “would have to absorb the cost of the provision of these services without any sort of reimbursement mechanism.”

Twenty-six states require counties to provide health care to uninsured or underinsured low-income residents. County governments also own and operate more than 900 public hospitals as well as more than 800 long-term care facilities, she said.

If Congress does not approve funding for COVID-19 services and a state does not purchase supplies, county governments in those 26 states would be required to come up with the money.

“If there’s no additional funding coming from the federal government, the counties are going to have to find that somewhere,” Hurley said. “Often they are mandated to provide these public health services to their residents whether they are insured or not. And so all of those costs are going to be borne by those counties.

Many of those counties, Hurley said, would have to move money around their budgets to buy vaccines, likely upending years of budgeting and planning.

COVID-19 standoff

The Biden administration asked Congress for $22.5 billion for COVID-19 tests, treatments and vaccines in early March. But two bipartisan agreements – the first for $15 billion and the second for $10 billion – failed to pass.

The first bill was removed from a much larger government funding package after several Democrats raised concerns that it would have taken money that Congress had previously approved for states to tackle. to COVID-19.

The second bipartisan measure was stalled after Senate Minority Leader Mitch McConnell, a Republican from Kentucky, said the bill could only move forward if Democrats agreed to hold an amendment vote on one issue. separate immigration card known as Title 42.

Negotiations on some kind of COVID-19 package had briefly resumed, although talks have since stalled.

As the standoff drags on, infections nationwide have steadily increased and Americans traveling for summer vacation are likely to exacerbate case counts and hospitalizations.

The seven-day case average was around 48,000 in early March when Biden asked lawmakers to provide more funding, but it has risen to more than 109,000, according to the Centers for Disease Control and Prevention.

Hospitalizations averaged 3,700 a day in early March before dropping to 1,200 in April. But those numbers are back up to 4,400, according to the CDC.

The imminent end of federal aid

If Congress fails to reach an agreement in the coming weeks on another round of funding, the federal government is unlikely to continue the programs after the fall, according to the White House COVID-19 response coordinator , Ashish Jha.

“I’m very confident that whatever happens this summer, we’ll have enough tools, tests, treatments, vaccines to get through this,” Jha said during a briefing in early June. “As we were planning for fall and winter and looking at a variety of different scenarios, that’s when I started to get very, very worried.”

Jha warned that the US government needs funding in the coming weeks if it is to replenish stocks of tests and treatments and get in line to buy the next generation of COVID-19 vaccines.

Public health officials, he said, are looking at a few different models to determine how many people are likely to pick up COVID-19 infections later this year.

One of the models “suggests that we could have a large wave of infections in the fall and winter, especially if we don’t have a vaccination campaign in the fall and winter,” Jha said.

“If we run out of treatments, if we don’t have enough diagnostic tests, we could be looking at a more complicated situation,” he added.

The federal government, Jha said, has enough funds to distribute free vaccines to children under 5, if the US Food and Drug Administration clears and the Centers for Disease Control and Prevention recommends the vaccines later this month. -this.

A Pennsylvania Department of Health spokesperson said the Commonwealth “will continue to seek long-term assistance from the federal government in the months ahead.”

“Pennsylvania relies on the federal government to fund COVID-19 therapies because we have no existing programs designed to support the purchase of these treatments,” press secretary Mark O’Neill said in a statement.

“Without federal funding, the purchase and distribution of therapeutic products in Pennsylvania would be left to the private health and insurance sectors. Health care providers would likely bill the patient’s insurance or the patient directly for treatments.

A spokesperson for the Oregon State Department of Health said the public health division has several ongoing funding needs, leaving officials uncertain about the long-term availability of vaccines and treatments for the disease. COVID-19 without additional federal assistance.

A spokesperson for the Arizona Department of Health Services said “the state’s response is not dependent on additional federal funding at this time, and we don’t want to discuss what might happen.”

Plescia, of the Association of State and Territory Health Officials, said the biggest concern of public health officials is to ensure there is an adequate and continuous supply of vaccines and therapeutics. .

For now, he said, many officials expect Congress to reach some sort of deal.

“The general feeling or consensus is that Congress and the administration have a responsibility to address this issue,” Plescia said.

Congress stuck

Republican Missouri Sen. Roy Blunt said Tuesday that neither he nor North Carolina GOP Sen. Richard Burr, two key negotiators on coronavirus spending, had heard from the White House in a few weeks on funding for COVID-19.

Although he supports providing more resources, Blunt said, the Biden administration erred when it asked Congress to provide billions more for COVID-19 as it moved to put in place end of title 42.

This Trump-era public health statement from the Centers for Disease Control and Prevention allowed border officials to turn away migrants, including asylum seekers, who attempted to cross the southwest border.

The Biden administration tried to end the program in late May, but a lawsuit from several Republican states kept the program in place.

“It’s a self-inflicted problem that the administration created, and they’re going to have to find a way around it,” Blunt said. “One way around that would have been to not appeal the judge’s decision, but they missed that one.”

Connecticut Democrat Rosa DeLauro, chair of the House committee that oversees federal spending, did not dispute that negotiations have stalled.

When asked what might bring negotiators into a room again, DeLauro replied, “I think the moral imperative since we’re running out of product would be enough, but it doesn’t seem to be.”

Julio V. Miller