For vaccines, underinsurance worse than no insurance
Gaps in Vaccine Financing for Underinsured Children in the United States
By Grace M. Lee, MD, MPH; Jeanne M. Santoli, MD; Claire Hannan, MPH; Mark L. Messonnier, PhD; James E. Sabin, MD; Donna Rusinak; Charlene Gay; Susan M. Lett, MD, MPH; Tracy A. Lieu, MD, MPH
JAMA
August 8, 2007
Children who are uninsured or who have public health insurance, such as Medicaid, can receive vaccines free of charge through the Vaccines for Children (VFC) program.
Only 34% of states had a health insurance mandate that required insurers to follow current ACIP or American Academy of Pediatrics recommendations for children and adolescents. Seventeen percent of states had a health insurance mandate that did not require insurers to cover all recommended vaccines and 49% of states did not have any health insurance mandate.
Limitations in both federal (section 317) and state vaccine financing were reported as the dominant barriers to states’ providing vaccines to underinsured children. Lack of section 317 funding was cited as a barrier for 81% (Tdap) to 100% (pneumococcal conjugate) of state immunization programs that were not able to provide vaccines to underinsured children. State funding was either limited or unavailable for vaccine purchase for 94% or more of programs that were not able to provide vaccines to underinsured children.
The public sector safety net for offering vaccine to underinsured children seems to be under considerable strain. Past studies have suggested that many private clinicians refer underinsured children to public health clinics for vaccination. Unfortunately, a growing number of states are no longer able to provide expensive vaccines, such as the meningococcal conjugate vaccine, to underinsured children in the public sector. Furthermore, the proportion of vulnerable US children whose insurance plans either do not cover vaccines or require families to pay out-of-pocket for preventive care is likely to grow. A recent article by the American Academy of Pediatrics found that 20% of employers are offering catastrophic health insurance plans (high-deductible health plans), up from only 5% in 2003, and only 30% of these plans covered preventive care before the deductible was met. These trends are of concern because inadequate insurance coverage has been associated with forgone health care among families who lack resources.
Despite the ability of vaccines to prevent illness and death, our current system of vaccine financing has resulted in a gap for underinsured children.
http://jama.ama-assn.org/cgi/content/full/298/6/638
Comment:
By Don McCanne, MD
The crisis in the affordability of private health insurance can only result in an expansion in the current epidemic of underinsurance. If insurers are to maintain a market for their products, they must continue to find innovative methods of not paying for health care.
Vaccines for children are so important that we have in place public policies that ensure that children covered by public insurance programs and children without any health insurance at all will still receive their immunizations. Our public policies also presume that vaccines will be provided on a private basis for privately insured children. The response of the private insurers confirms that this latter assumption is not valid, especially considering that the cost to fully vaccinate a child in the public sector is $1170.
There is a fundamental difference between public insurance and private insurance. Public insurance is founded on policies that help to ensure that people receive the health care that they need, when they need it. That includes vaccines for children. Private insurance is founded on policies that ensure success in a competitive marketplace that trades off lower insurance premiums for limiting access to care that people need. That includes limiting affordable access to childhood vaccines.
Leaving policy decisions under the control of the private stewards of a competitive market of underinsurance will result in adverse outcomes such as the preventable deaths of untold numbers of children for lack of vaccines. Isn’t it time for us to dismiss the private stewards and hire our own public stewards who really do care about the health of our children, and the health of the rest of us?