WASHINGTON — State and local health departments remain in limbo over whether they will need to single-handedly fund their own vaccines and treatments for COVID-19 as a congressional stalemate creeps into its fourth month.
The Biden administration sounded the alarm about the risk of inaction after submitting a $22.5 billion request to Congress in early March. But US lawmakers failed to pass two bipartisan deals and no negotiations are currently underway, even as cases increase across the country and the potential remains for a big wave of infections this winter.
That has left state and local health departments wondering if they will need to try to compete with each other and even compete with other nations to buy tests, treatments and vaccines — an expensive effort that many are not sure they could afford.
“If we get to a place where every state is for itself, that’s going to cause big problems,” said Marcus Plescia, medical director of the Association of State and Territorial Health Officers.
“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, this is going to be a real problem for these people,” Plescia said.
“And ultimately it affects all of us, because we’re a nation, and we travel around, and we really have to take care of every state.”
State and local health departments have invested significant financial resources in fighting COVID-19, but so far the federal government has shouldered the cost of free vaccines and therapies, as well as a now-unfunded program to provide health care to uninsured people with the disease. virus. The federal government is also making free tests available.
Safety net health care
Eryn Hurley, director of government affairs for the National Association of Counties, said that without additional federal funding for safety net health providers, many of whom are county governments, they “would have to absorb the cost of providing these services without any of refund. mechanism.”
Twenty-six states require counties to provide health care to low-income residents who are uninsured or underinsured. 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 doesn’t pass funding for COVID-19 services and a state doesn’t buy supplies, the county governments of those 26 states would be obligated to find the money.
“If there aren’t additional grants coming from the federal government, counties are going to have to find that somewhere,” Hurley said. “Often, they are required to provide this public health support to their residents, whether they are insured or not. And so all these costs will be borne by these municipalities.”
Many of these counties, Hurley said, would have to move money into their budgets to buy vaccines, likely jeopardizing years of budgeting and planning.
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The Biden administration He asked Congress for $22.5 billion for COVID-19 tests, treatments and vaccines in early March. But two bipartisan deals — the first for $15 billion and the second for $10 billion — did not make it to the floor for a vote.
The first bill was pulled from a much larger government funding package after several Democrats raised concerns that it would have taken money that Congress had previously passed for states to deal with COVID-19.
The second bipartisan measure stalled after Senate Minority Leader Mitch McConnell, a Kentucky Republican, said the bill could only move forward if Democrats agreed to hold an amendment vote on a separate immigration issue known as Title 42.
Negotiations on some sort of COVID-19 package briefly started again, although negotiations have since stalled.
As the stalemate drags on, infections across the country have steadily increased and Americans traveling on summer vacation are likely to exacerbate case counts and hospitalizations.
The seven-day average of cases was about 48,000 in early March, when Biden urged lawmakers to provide more funding, but it rose 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 a low of 1,200 in April. But those numbers went back to 4,400, according to the CDC.
An End Coming to Federal Aid
If Congress fails to agree in the coming weeks on another round of funding, the federal government is unlikely to continue programs beyond the fall, according to White House COVID-19 Response Coordinator Ashish Jha.
“I am very confident that whatever happens this summer, we will have enough tools, tests, treatments and vaccines to help us,” Jha said during a briefing in early June. “As we planned for fall and winter and looked at a variety of different scenarios, that’s when I started to get really, really worried.”
Jha warned that the US government needs funding in the coming weeks to replenish supplies of tests and treatments, as well as lining up to buy the next generation of COVID-19 vaccines.
Public health officials, he said, are looking at a few different models of how many people might have COVID-19 infections later this year.
One of the models “suggests that we may have a considerable 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 in a more complicated situation,” he added.
The federal government, said Jha, have enough funding distribute free vaccines to children under age 5 if the US Food and Drug Administration authorizes it and the Centers for Disease Control and Prevention recommends the vaccines later this month.
Plescia of the Association of State and Territorial Health Authorities said the biggest concern of public health officials is to ensure there is an adequate and continuous supply of vaccines and therapies.
At the moment, he said, many officials are hoping Congress will reach some sort of agreement.
“The general feeling or consensus is that Congress and the government have a responsibility to resolve this,” Plescia said.
Missouri Republican Senator Roy Blunt said Tuesday that neither he nor North Carolina Republican Senator Richard Burr, two top negotiators on coronavirus spending, had heard from the White House in a few weeks about COVID-19 funding.
While he supports providing more resources, Blunt said, the Biden administration was wrong when it asked Congress to provide billions more for COVID-19 as it moved to end Title 42.
This Trump-era public health statement from the Centers for Disease Control and Prevention allowed border authorities to reject immigrants, including asylum seekers, who were trying 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.
“This is a self-inflicted problem that the government created, and they’re going to have to figure out a way around it,” Blunt said. “One way around that would be to not appeal the judge’s decision, but they lost that one.”
Connecticut Democrat Rosa DeLauro, chair of the House committee that oversees federal spending, did not dispute that negotiations stalled.
When asked what might bring negotiators into a room again, DeLauro said, “I think the moral imperative, as we’re running out of product, would be good enough, but it doesn’t seem to be.”