How COVID-19 Has Reshaped Healthcare Policies In The US
COVID-19 has profoundly reshaped U.S. healthcare policies by accelerating telehealth adoption, expanding public health funding, revising vaccine mandates, and emphasizing pandemic preparedness and long COVID care, while highlighting the need to address health disparities and improve access and affordability
Author:Stefano MclaughlinReviewer:Karan EmeryMay 04, 202516.1K Shares293.3K Views
The World Health Organization declared COVID-19 a pandemic 5 years ago, and that moment marked the beginning of many changes, both short-term and long-lasting, to the U.S. healthcare system. Some changes happened right away, while others took time to develop. Even now, the full effects of these changes are still unclear.
Experts agree that while the healthcare system isn’t perfect, it has become more flexible than it used to be. Traditionally, medicine is slow to change, but the pandemic taught everyone how to adapt quickly to new guidelines for treating patients, vaccine recommendations, and infection control.
The pandemic completely reshaped the U.S. healthcare system. It pushed for big policy changes and exposed weaknesses that had existed for years. For example, telehealth expanded rapidly, and significant investments were made to improve public health infrastructure.
Telehealth Revolution and Digital Health Transformation
Rapid Expansion of Telehealth Services
Before the COVID-19 pandemic, telehealth utilization in traditional Medicare was extremely limited, with significant restrictions on geographic eligibility and reimbursement. The onset of the pandemic necessitated immediate policy changes to enable remote care delivery while minimizing virus transmission.
The Centers for Medicare & Medicaid Services (CMS)responded by issuing numerous waivers that dramatically expanded telehealth access. These emergency measures removed geographic restrictions, allowed patients to receive care from their homes, expanded the types of providers eligible to offer telehealth services, and authorized reimbursement for audio-only visits.
The shift to telehealth occurred with remarkable speed. Hospitals and physician practices shifted to telehealth far more quickly than policymakers anticipated as providers and patients adapted to stay-at-home orders and infection control measures.
Extended Telehealth Flexibilities
What began as emergency measures has evolved into medium-term policy extensions and, in some cases, permanent changes. As of May 2025, many of the telehealth flexibilities introduced during the pandemic remain in effect through September 30, 2025. These extensions include:
- The ability for Medicare patients to receive non-behavioral/mental health telehealth services in their homes without geographic restrictions
- Authorization for all eligible Medicare providers, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), to furnish telehealth services
- Continued coverage for audio-only telehealth services, ensuring access for beneficiaries without video technology
Notably, several telehealth provisions for behavioral and mental health services have been made permanent, reflecting recognition of telehealth's particular value in this domain. These permanent changes allow Medicare patients to receive behavioral and mental health services via telehealth from their homes, without geographic restrictions, and permit the use of audio-only platforms for these services.
Future Policy Considerations
While many telehealth flexibilities have been extended through late 2025, their long-term future remains uncertain. There is bipartisan support for proposed legislation to extend these provisions for another two years, and Congress is weighing the potential benefits, risks, and costs of permanently expanding Medicare coverage of telehealth services. Key considerations include patient satisfaction, provider support, impacts on care quality, implications for Medicare spending, and program integrity concerns.
Exposed Vulnerabilities in the US Healthcare System
The Healthcare System of the United States
Coverage Gaps and the Employment-Insurance Link
The pandemic laid bare fundamental weaknesses in the fragmented US healthcare system. As millions of Americans lost jobs during pandemic-related shutdowns, many simultaneously lost their employer-sponsored health insurance, highlighting the precarious nature of tying health coverage to employment.
The pandemic created a twofold crisis for American families: the risk of contracting the potentially deadly virus with the additional costs of testing, treatment, and a possible expensive hospital stay, and the potential loss of employment and employer-sponsored health insurance.
This crisis was particularly acute for vulnerable populations. People with preexisting health conditions faced heightened risks, with approximately one in five individuals with a preexisting condition being uninsured.
Strained Safety Net Programs
The pandemic placed unprecedented pressure on the US healthcare safety net. Programs like Medicaid, the Children's Health Insurance Program, federally qualified health centers, and public hospitals experienced surging demand as unemployment increased and more Americans lost private insurance.
An increase in unemployment to 20% would add millions of people to Medicaid and millions of new uninsured. This influx of new enrollees strained programs that were not well funded in the best of times. The American Rescue Plan (ARP) provided some relief by lowering health insurance premium costs.
Families saw average savings of $40 per person per month on premiums due to the ARP's premium credits, and over a third of customers found coverage for $10 or less per month. These measures helped maintain coverage for many Americans but highlighted the need for more sustainable healthcare financing solutions.
Healthcare Workforce and Infrastructure Challenges
Workforce Shortages and Burnout
The US healthcare system faced staffing shortages, particularly among nurses and physicians, even before the pandemic. COVID-19 dramatically worsened this situation. Healthcare workersreported significant mental health impacts, with 55% indicating their mental health was worse than before the pandemic as of February 2022.
Many cited COVID-19-related anxiety or depression, burnout, workload issues, and reaching traditional retirement age as reasons for leaving or intending to leave their jobs. The pandemic also disrupted healthcare workers' professional and personal lives in unprecedented ways.
Many were furloughed, displaced from their primary practice locations, and experienced isolation from their families due to concerns for COVID-19 transmission. These challenges contributed to an acceleration of workforce departures that continues to affect healthcare delivery today.
Public Health Infrastructure Investment
In response to the pandemic's exposure of critical gaps in public health infrastructure, the Centers for Disease Control and Prevention (CDC)launched the Public Health Infrastructure Grant (PHIG), described as a groundbreaking investment supporting critical public health infrastructure needs across the United States.
As of December 2024, the CDC had awarded $4.8 billion through this program to strengthen the US public health infrastructure, workforce, and data systems. The five-year grant (December 2022 through November 2027) provides flexible funding to 107 health departments and three national public health partners to address specific organizational and community needs.
The program aims to create a stronger, more resilient public health system that is ready to face future health threats, representing a significant policy shift toward greater investment in public health capacity.
Financial Impact and Policy Responses
Hospital Financial Losses
The pandemic inflicted severe financial hardship on healthcare institutions. Early lockdowns resulted in the cancellation of elective procedures, a critical revenue source for many hospitals. Combined with increased expenses for COVID-19 response, hospitals in the United States experienced a total loss of more than $200 billion between March 1 and June 30, 2020. These financial pressures necessitated federal relief funding and accelerated discussions about healthcare financing reform.
Regulatory Flexibility and Value-Based Care
The pandemic prompted a wave of regulatory changes designed to give healthcare providers greater flexibility in responding to the crisis. The Centers for Medicare & Medicaid Services issued more than 100 waivers to give healthcare providers flexibility to respond to emergency community health needs. These changes aligned with the Trump administration's broader deregulatory agenda, exemplified by the Patients Over Paperwork initiative and the Regulatory Sprint to Coordinated Care.
Policy Unwinding and Transition to Post-Pandemic Era
Medicaid Continuous Coverage Unwinding
One of the most significant pandemic-era healthcare policies was the Medicaid continuous coverage requirement, which prevented states from disenrolling beneficiaries during the public health emergency.
This protection contributed to substantial growth in Medicaid enrollment throughout the pandemic, providing stable coverage for millions of Americans. The Consolidated Appropriations Act of 2023 set March 31, 2023, as the end date for this continuous coverage requirement, initiating what became known as the unwinding process.
This process allowed state Medicaid agencies to begin redetermining eligibility for beneficiaries who had maintained coverage throughout the pandemic. Medicaid terminations began as early as April 1, 2023, with the process expected to continue for 14 months.
Balancing Emergency Measures with Sustainable Reforms
As the US transitions from emergency pandemic response to long-term policy reform, policymakers face complex decisions about which pandemic-era changes should be made permanent. While some telehealth provisions for behavioral health have been permanently authorized, many other flexibilities remain temporary.
Similarly, enhanced premium subsidies under the American Rescue Plan have helped maintain coverage but require ongoing funding commitments. The pathway to comprehensive healthcare reform remains challenging.
Today's polarized political system and vested health care interests preclude such a major overhaul. Despite increased awareness of healthcare system vulnerabilities, reform will likely be back to the status that is, incremental reform with expansion of coverage based on limited extensions of existing public programs.
COVID-19 Healthcare Policies In The US
1. Vaccine Policies
- Federal COVID-19 vaccine mandates for healthcare workers, federal employees, and military personnel have been rolled back; vaccination is now voluntary at the federal level.
- The CDC recommends vaccination, especially for high-risk groups such as seniors and immunocompromised individuals.
- Updated vaccine guidelines for 2024–2025 include annual or semi-annual doses for different age and risk groups, with specific recommendations for older adults and immunocompromised persons.
2. Testing and Isolation
- Expanded access to rapid COVID-19 tests through federal partnerships and distribution programs, ensuring availability and affordability.
- Updated testing recommendations for when and how often to test after exposure or symptoms.
- Isolation guidelines have been shortened to 3–5 days for mild COVID-19 cases with improving symptoms; masking is recommended for 10 days post-infection around others.
- High-risk individuals are advised to follow stricter precautions.
3. Telehealth Flexibilities
- Telehealth expansions introduced during the pandemic remain extended through at least September 2025.
- Medicare beneficiaries can receive a broader range of services remotely, including audio-only visits.
- Certain telehealth provisions for behavioral and mental health services have been made permanent.
- Ongoing legislative discussions are about making further telehealth expansions permanent.
4. Public Health Infrastructure and Preparedness
- Major federal investments to strengthen public health infrastructure, including workforce, data systems, and emergency preparedness.
- Increased funding for research on emerging variants and the development of next-generation vaccines.
- Expansion of genomic surveillance programs to detect new SARS-CoV-2 variants early.
- Shift from reactive pandemic response to proactive preparedness strategies.
5. Long COVID Initiatives
- Increased funding for research and treatment programs focused on long COVID.
- Expansion of specialized clinics and new treatment guidelines for persistent symptoms.
6. Medicaid and Coverage Policies
- Unwinding of Medicaid continuous coverage protections began in 2023, with states resuming eligibility redeterminations.
- Concerns about potential coverage losses for millions of individuals.
- Enhanced Affordable Care Act (ACA) premium subsidies are set to expire at the end of 2025, creating pressure for legislative action to maintain affordability.
7. Regulatory and Emergency Waivers
- CMS used emergency authority under Section 1135 of the Social Security Act to waive or modify requirements related to Medicare, Medicaid, and CHIP during the public health emergency.
- Waivers covered vaccines and therapeutics, testing, telehealth, emergency reporting, surge capacity, and long-term care facilities.
- Many waivers have expired or are being phased out as the public health emergency ends.
8. Tax Policy Impact on Healthcare
Expiration of certain tax provisions from the Tax Cuts and Jobs Act (TCJA) will increase health-related tax expenditures significantly starting in 2025, affecting employer-sponsored insurance and health savings accounts.
9. International Policy Shift
The United States officially withdrew from the World Health Organization (WHO) in 2020, reflecting changes in international public health engagement post-pandemic.
Frequently Asked Questions
What is the economic impact of the pandemic on the healthcare system in the United States?
The American Hospital Association estimates a financial impact of $202.6 billion in lost revenue for America's hospitals and healthcare systems, or an average of $50.7 billion per month.
What are the changes caused by the COVID-19 pandemic?
Lockdowns and quarantine caused many to be separated from their families, and with the unknowns of the economy, many Americans found themselves struggling with mental health.
Who did COVID affect the most?
People age 65 and older and babies younger than 6 months have a higher than average risk of serious COVID-19 illness. Those age groups have the highest risk of needing hospital care for COVID-19. Babies younger than 6 months aren't eligible for the COVID-19 vaccine, which adds to their risk.
How did COVID affect the US economy?
Total nonfarm employment fell by 1.4 million jobs in March 2020 and a staggering 20.5 million jobs in April, creating a 22 million jobs deficit since the start of the recession and largely erasing the gains from a decade of job growth.
Conclusion
The COVID-19 pandemic has left a lasting mark on healthcare policies in the U.S., driving significant changes while highlighting persistent challenges. The rapid adoption of telehealth, increased focus on public health infrastructure, and efforts to address healthcare disparities are just a few examples of how the crisis reshaped the system. While some reforms, like expanded telehealth access, are here to stay, others face uncertainty as pandemic-era protections phase out.
Jump to
Telehealth Revolution and Digital Health Transformation
Exposed Vulnerabilities in the US Healthcare System
Healthcare Workforce and Infrastructure Challenges
Financial Impact and Policy Responses
Policy Unwinding and Transition to Post-Pandemic Era
COVID-19 Healthcare Policies In The US
Frequently Asked Questions
Conclusion
Stefano Mclaughlin
Author
Stefano Mclaughlin is a Psychologist focused on mental health, emotional well-being, and healthcare policy. He studied Psychology and Public Health at the University of Massachusetts Amherst, gaining a deep understanding of the intersection between mental health and public policy.
Stefano's mission is clear: he aims to destigmatize mental health discussions, improve access to mental healthcare, and promote emotional well-being for all. Drawing from personal experiences with anxiety and depression, Stefano shares real stories to make mental health topics more relatable and less intimidating.
In addition to his advocacy work, Stefano enjoys delving into books, experimenting in the kitchen, and embarking on new adventures. These hobbies fuel his creativity and inspire fresh perspectives for his advocacy work.
Karan Emery
Reviewer
Karan Emery, an accomplished researcher and leader in health sciences, biotechnology, and pharmaceuticals, brings over two decades of experience to the table. Holding a Ph.D. in Pharmaceutical Sciences from Stanford University, Karan's credentials underscore her authority in the field.
With a track record of groundbreaking research and numerous peer-reviewed publications in prestigious journals, Karan's expertise is widely recognized in the scientific community.
Her writing style is characterized by its clarity and meticulous attention to detail, making complex scientific concepts accessible to a broad audience. Apart from her professional endeavors, Karan enjoys cooking, learning about different cultures and languages, watching documentaries, and visiting historical landmarks.
Committed to advancing knowledge and improving health outcomes, Karan Emery continues to make significant contributions to the fields of health, biotechnology, and pharmaceuticals.
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