For vaccines, underinsurance worse than no insurance

[RedEarth]

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://www.pnhp.org/news/2007/august/for_vaccines_underi.php

[TechBear_Seattle]

1. "A gap for underinsured children..."

And a vast, gaping hole in public health. Didn't anyone bother to tell the state legislators that measles, mumps, chicken pox, pertussis, polio, etc. are all highly contageous? If one child becomes a carrier, even if that child was immunized, then every un- and under-immunized child in the neighborhood and school are at grave risk. Not to mention the children's parents and the parents' co-workers.