Everett, Wash.
Published: Monday, July 6, 2009

Free vaccines for kids ending

Because of state cuts, no-cost shots won't be provided to some families next year.

By Sharon Salyer
Herald Writer

 The state program that for years has provided free vaccines for childhood immunizations to all Washington children is ending, one more victim of the state's budget cuts.

First to hit the budget chopping block is the vaccine to prevent human papillomavirus.

While effective in preventing cervical cancer, it's also expensive -- about $360 for all three required shots.

Although the vaccine will continue to be provided free for families who have insurance though state-funded plans such as Medicaid, as well as American Indians and Alaska natives, free vaccine will no longer be available to families with private insurance.

"We're trying to reduce the anxiety level of families," said Lynette Wacholz, who orders vaccine for The Everett Clinic. "Unfortunately, we haven't had a lot of time to prepare for this."

Next year, plans call for private insurance to begin being billed for all childhood vaccinations.

Since the vaccines won't be bought through the state's bulk purchase immunization program, families with private health insurance plans could be hit with out-of-pocket costs, such as higher premiums, co-pays or deductibles, said Dr. Deb Harper, incoming president-elect of the Washington State Medical Association. "They have to pass that cost on somehow."

The cuts to the immunization program are expected to save the state $48.5 million over the next two years, said Michele Roberts, who works in the state Department of Health's immunization program.

Last year, the state distributed 215,000 doses of the vaccine, enough for 72,000 girls. This year, the state will buy about 154,000 doses, enough for 51,000 girls, she said.

The human papillomavirus shot is generally recommended for girls between the ages of 11 and 18. Nearly 4,000 girls in Snohomish County got the shot during the first six months of this year.

As of last Wednesday, clinics have to buy the HPV vaccine for families with private health insurance -- and keep that stock separate from the free supplies for people on state health insurance plans.

Before administering the shots, health insurance questions will be asked to determine which supply of vaccine should be used, such as: Does your insurance cover immunizations? Have you exceeded the annual maximum for preventive care? Have you met your deductible? Are you on a state health insurance plan such as Medicaid?

Insurance plans aren't required to pay for childhood immunizations, but many likely will. The shots prevent diseases that are both costly and potentially life-threatening. Public reaction could be strong for any plan that refuses to pay.

Eric Earling, a spokesman for Premera Blue Cross, said the state's change in the vaccine program "will end up adding some costs to health care coverage."

If the changes planned in childhood immunizations take effect next year, "we would cover the cost of those vaccinations based on the importance of preventative care and improving the health of patients," he said.

If private insurance doesn't pay for vaccines, the state will pay those costs, Roberts said.

But some families with private health insurance could still be hit with immunization costs if deductibles haven't been met or an insurance plan's preventive benefits have been exceeded, she said.

Clinics can also charge fees for office visits and for administering the shot.

It's too early to know what the extra cost to families might be. "One of the challenges is people want to say, 'What if?'" Roberts said.

"The problem is … there isn't just one health plan," she said. "It depends on specifics of your health plan."

Some physicians worry that the cost of childhood vaccines will rise next year because they will no longer be bought in bulk by the state.

For example, the cost of the shot to prevent measles, mumps, rubella and chickenpox, purchased through state and federal vaccine programs, is $82.67 a dose, according to federal Centers for Disease Control and Prevention.

Buying that same shot through private distributors would cost $128.90.

The cost of all childhood immunizations bought through federal-state plans, including the HPV shot, is estimated at $1,218, Roberts said. If purchased through private sources, the estimated cost of those shots is $1,720.

Efforts are now under way to try to put together some sort of private statewide buying plan for clinics to keep costs down.

Nevertheless, Group Health told state legislators earlier this year that their costs of buying childhood vaccines could increase about 15 percent, said state Rep. Eileen Cody, D-Seattle.

Some physicians worry that any increase in vaccine costs could result in fewer kids getting immunized.

When Illinois imposed a co-pay on childhood vaccines, "within five years, they had the biggest outbreak of measles in 50 years," Harper said. "Children died from the measles."

The state system of providing free vaccines had a goal of making them easily available and boosting immunization rates.

Yet for years, Washington has been below the national averages in immunization rates, Roberts said, due in part to children sometimes not getting every recommended dose of each vaccine.

"The frustrating part for policymakers is we don't have very good immunizations rates," Cody said. Some states that have dropped the statewide buying programs have higher percentage of kids getting their shots, she said.

Asked whether that means the state can't continue to get immunization rates at least at the level they are now, Cody said: "We don't know -- it's a big question mark."



Sharon Salyer: 425-339-3486, salyer@heraldnet.com.
© 2009The Daily Herald Co., Everett, WA