The Affordable Care Act and Its Impact on Immunizations
Oct 01, 2013

The past 24 hours has been a whirlwind of uncertainty and stress for many Americans.  Friends on Facebook and Twitter have been expressing their collective displeasure with our Congressional leaders following the announcement that the government would be shut down due to a lapse in appropriations for fiscal year 2014.  The news has been sharing lists of government services that are no longer available.  And my inbox has been flooded with emails from furloughed employees explaining their absence.
capitolNo matter what your opinions are regarding the Affordable Care Act, and the Congress’s inability to resolve their differences, it’s important that we consider how these political developments will impact the immunization efforts in this country.    One of the most pressing concerns in the fight against preventable diseases has been to ensure that adults and children aren’t missing immunizations due to cost concerns.  While most health insurance plans cover the cost of vaccines, each provider has different policies and copayments and people who remain uninsured or underinsured are often under immunized.
The Vaccines for Children (VFC) Program, created in the early 90’s, is intended to provide immunizations to children whose parents or guardians are unable to afford them.   Known as section 1928 of the Social Security Act, the VFC program ensures that vaccines which are recommended by the Advisory Committee on Immunization Practices (ACIP) are available at no cost to eligible children, age 18 and younger.  Each year the White House Office of Management and Budget (OMB) approves the funding amounts needed for the VFC vaccine purchases and the funds are then allocated through the Centers for Medicare & Medicaid Services (CMS).  The Centers for Disease Control and Prevention (CDC) then utilizes the funds to purchase vaccines at a federal discount and distribute them to state health departments and local public health agencies.  These agencies then distribute the vaccines at no charge to private physicians’ offices and public health clinics that are registered as VFC providers.
While the VFC program helps ensure that children are fully vaccinated, the only program that currently applies to adults is intended for Medicare beneficiaries who are 65 years of age and older.  This demographic currently qualifies for a Medicare payment that covers part, or all, of the cost associated with influenza (flu), pneumococcal (pneumonia) and hepatitis B vaccines.
Since today begins the open enrollment period for all new health plans offered through the Affordable Care Act, we can see that the new plans will go one step further in offering no-cost immunizations.  All new health plans will now be required to cover ACIP recommended vaccines for adults and children of all ages, without charging a deductible, copayment or coinsurance.  These vaccines, to include a seasonal flu vaccine, will be provided at no cost as long as they are administered by an “in-network” provider.
While the Affordable Care Act is expected to expand access to preventive care, and in turn improve health outcomes, it remains to be seen how many people will utilize the Health Insurance Marketplace made available for the first time today.  To find out more about immunizations covered within the Affordable Care Act, click here.  To visit the marketplace and  compare health insurance options, costs and coverage click here. .
Unfortunately, the inability of our government leaders to negotiate their differences has resulted in a government shutdown today and we will likely see an impact on immunization efforts in this country.  The Department of Health and Human Services issued a contingency plan yesterday that addresses how they plan to operate in the absence of full appropriations.  Unfortunately, services that will be interrupted include the Centers for Disease Control and Prevention (CDC).
The CDC will continue to protect the health and well-being of citizens, both in the U.S. and abroad, however they will do so through a significantly reduced capacity to respond to outbreak investigations, processing of laboratory samples, and maintaining the agency’s 24/7 emergency operations center.  The CDC will no longer be able to support the following:

  • annual seasonal influenza program
  • outbreak detection and linking across state boundaries using genetic and molecular analysis
  • continuous updating of disease treatment & prevention recommendations
  • technical assistance, analysis, and support to state and local  partners for infectious disease surveillance.

Fortunately, mandatory funding will support the Vaccines for Children program and allow it to continue despite the government shutdown.
Certainly we can expect a lot of changes and adjustments in the days and weeks ahead.  As immunization policies are impacted by the Affordable Care Act and fiscal budgetary considerations, we will continue to keep you informed.  In the meantime, ensure you are doing your part to reduce the spread of preventable disease and get your flu shot.

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