The Minnesota Vaccines for Children Program’s goal is to make childhood immunizations accessible and affordable to all kids in the state. This year the program was faced with the dilemma of having to curtail services to some of the most vulnerable children in Minnesota. On July 1, MnVFC halted coverage of vaccines for underinsured children at private clinics.

These kids can still receive their vaccines – their parents just have to take them to a public clinic. Consider the implications for a family living in rural St. Louis County. Rather than going to the private clinic they usually go to, which is probably in the nearest town and where they know the nurses and doctors (their “medical home” in healthcare parlance), they instead will have to locate, make an appointment, and drive to one of nine qualified public clinics scattered across St. Louis County. Three are in Duluth, and the others are in Ely, Hibbing, Virginia, Cook, Floodwood, and on the Bois Fort Reservation in Nett Lake. In a child’s first year there are half a dozen vaccines given at various intervals, usually at two, four, and six months, which means these parents will have to make three separate trips to the public health clinic. Among the logistical and scheduling hurdles the new ruling imposes, it is no insignificant matter for an underinsured family that gas now costs about $4 a gallon. “In the last year our discretionary funding for covering uninsured kids was significantly cut by Congress and due to that cut we could no longer afford to buy vaccines for this population, which was very painful for us,” says Minnesota Vaccines for Children Program Coordinator Elizabeth Parilla. “We felt strongly that this was a good population to be covering, but when we did the math for accountability purposes we discovered we could no longer afford to buy vaccines for this population so legally we couldn’t continue to do it.”

It is important to clarify that most children traditionally covered by the MnVFC safety net are not affected by this ruling at all – this includes uninsured children, those eligible for Minnesota Health Care Program (MHCP), and American Indians/Alaskan Natives. They will still be eligible to get their vaccines wherever they chose, whether at a private or public clinic.

As for how many children are affected by the ruling, there is no way of knowing. “It is the biggest question we have,” says Immunization Program Manager Margaret Roddy, “but identification of underinsured children is really difficult to do, in part because the Affordable Care Act is changing the landscape of insurance.”

Although the Affordable Care Act (ACA) technically

calls for preventive services – including childhood and adult vaccinations – to be covered with no deductibles or copayments, the act also allows certain insurance companies with grandfathered status to continue to charge for a portion or all of the cost of vaccines until they make major changes to their benefits plans to come into compliance with the act.

“There are strong indications that the Affordable Care Act is having quite a bit of an effect in moving insurance companies to cover preventive services,” says Parilla. And the American Medical Association backs her up with these findings: In 2011 approximately 50% of plans had grandfathered status with half of those expected to lose that status in 2012. Small plans are likely to lose grandfathered status quicker than large plans and it is estimated that 90% of grandfathered plans will lose their grandfathered status by 2014. In other words, many of the families with underinsured children who suddenly found out they could not vaccinate their kids at their private clinic this year are likely to have improved private insurance coverage for preventive services by 2013 or 2014.

In the Center for Disease Control and Prevention’s most recent study of children born between January 2008 and May 2010, Minnesota had the second highest coverage in the nation (96%) for measlesmumps rubella (MMR) vaccinations, just below Rhode Island. It ranked slightly above the national average in coverage for the entire series of childhood vaccinations, which includes the multiple doses at specific intervals of MMR, DTaP, HepB, polio, varicella, and pneumococcus conjugate vaccine (74.9% in Minnesota versus a national average of 73.6%) High vaccination rates in children by age 2 accounts for our nation’s historically low rates of vaccinepreventable diseases.

“In part because of our successful vaccination campaign, we don’t see these diseases on a regular basis anymore. Families haven’t seen polio and very rarely see measles, so complacency can be a deterrent in maintaining and improving vaccine coverage,” says Roddy.

It is a simple fact of public health: The more children who are vaccinated, the healthier the population is as a whole and the lower the overall cost of healthcare.

Minnesota Vaccines for Children Program Web site:
http://www.health.state.mn.us/divs/idepc/immunize/
mnvfc/basics.html
Affordable Care Act and Immunization information:
http://www.healthcare.gov/news/factsheets/2010/09/
affordable-care-act-immunization.html
Grandfathered Health Plans:
http://www.healthcare.gov/law/features/rights/
grandfathered-plans/index.html