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Free vaccines are available to children who are uninsured or qualify
for public insurance. But many states can't afford to help
children with inadequate private insurance that doesn't cover new,
expensive shots and even some older shots, the study found. That
puts more than a million children at risk, researchers said.
Illinois, for example, doesn't provide vaccines against
chickenpox, pneumonia, hepatitis A, human papillomavirus and
rotavirus to children with insufficient private insurance. Parents
would have to pay $400 out of pocket for those vaccines.
"Health insurance plans are not necessarily keeping up with the
new vaccines, posing significant ethical dilemmas to public health
clinics," said the study's lead author Dr. Grace Lee of Harvard
Medical School.
The study of the nation's patchwork system of paying for
immunizations appears in Wednesday's Journal of the American Medical
Association.
Childhood shots have become a $1 billion-a-year endeavor for
government since the discovery of polio vaccine 55 years ago. The
per-child cost grew more than sevenfold from $155 in 1995 to $900
for boys and $1,200 for girls this year. Costs in the private sector
are higher.
Lee and her colleagues surveyed states to find out which shots
they provide and to whom. Program managers from 48 states responded.
Lee wouldn't say which states participated because researchers
promised anonymity.
Sixteen of the states require health insurers to cover all
recommended vaccines.
About 55 million employees and their dependents get coverage
through self-insured companies that are exempt from state mandates.
Those people are the most likely to be underinsured for vaccines,
said vaccine policy expert Dr. Matthew Davis of the University of
Michigan.
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According to the research, 17 states reported they were unable to
give a vaccine for meningitis to children with inadequate private
insurance, even if they were seen in public health clinics. And
eight states don't give pneumococcal shots to underinsured infants
and toddlers.
A handful of states don't provide shots for chickenpox and
hepatitis A to the underinsured. Two states don't provide Tdap, the
combined booster shot for tetanus, diphtheria and pertussis
(whooping cough) for 11- to 12-year-olds.
More than 1 million insured children are unable to get the
meningococcal vaccine leaving them vulnerable to potentially deadly
infection, the researchers estimated.
The survey did not ask about two vaccines recommended last year:
an oral vaccine for infants against rotavirus, a common cause of
childhood diarrhea and vomiting, and a vaccine for girls against
human papillomavirus, which can cause cervical cancer.
Workers covered by plans marketed by Aetna and other insurance
companies generally are covered for childhood vaccines, although
they may have to pay co-payments or satisfy deductibles, said Mohit
Ghose, a spokesman for America's Health Insurance Plans.
As costs rise, it may be necessary to decide at a national level
which vaccines are most important, Davis said. He was not involved
in the new study, but wrote an accompanying editorial in the
journal.
Officials at the U.S. Centers for Disease Control and Prevention
oppose prioritizing vaccines and instead favor better coverage by
insurers and more government funding as a safety net, said CDC
immunizations director Dr. Lance Rodewald.
[Associated Press;
by Carla K. Johnson]
Copyright 2007 The Associated Press. All rights reserved.
This material may not be published, broadcast, rewritten or
redistributed.
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