Insurance doesn’t cover kids’ vaccines

More than 1 million
insured children can’t get the meningococcal vaccine.

CHICAGO (AP) — For children whose health insurance doesn’t cover newly recommended shots, it’s better to have no insurance at all, a new study suggests.

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 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 today’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.

Findings

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.

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. More than 1 million insured children are unable to get the meningococcal vaccine, leaving them vulnerable to potentially deadly infection, the researchers estimated.