Rates for adult vaccinations remain low
The United States already does a pretty good job immunizing kids — roughly 90% of them get the vaccines they need, thanks to federal programs and other initiatives that subsidize the shots until children reach adulthood.
But then things change.
“The moment we cross the threshold of the 19th birthday,” says Dr. William Schaffner, president of the National Foundation for Infectious Diseases, “the system is uncoordinated, meager and, it turns out, quite unsatisfactory.”
There are several vaccines that adults need to protect against serious diseases, including shingles, pneumonia, hepatitis and cervical cancer. While rates of adult immunization have inched up in recent years, they are still far below what they should be, according to new data from the Centers for Disease Control and Prevention.
Only a third of all people over the age of 18 got a flu shot last year, for example, despite the CDC’s recommendation that everyone older than 6 months receive it. All adults who are age 60 or older should get the shingles vaccine, but just 10% of that group had received it, according to the CDC. Likewise, only 17% of women ages 19 to 26 had gotten even one of the three doses of the human papillomavirus vaccine, which protects against cervical cancer.
With its emphasis on prevention, the healthcare overhaul law aims to improve vaccination rates by expanding coverage requirements. “It’s a total game-changer in terms of adult coverage of immunizations,” says Sara Rosenbaum, chair of the department of health policy at George Washington University’s School of Public Health and Health Services.
Private insurers cover adult vaccines to varying degrees, often with hefty co-payments. Immunization coverage isn’t required under the traditional Medicaid insurance program for low-income people, leaving decisions up to the states. Medicare, meanwhile, covers vaccines, but getting access to them through physicians can be tough and may be pricey as well, as seniors and disabled people have discovered.
A pair of surveys by the National Foundation for Infectious Diseases found that only 37% of patients said their doctors bring up the subject of vaccines with them, though 87% of physicians said they always did so.
The new health law makes it clear that adult immunizations are a priority. Starting this fall, new health plans are required to cover the full cost of all vaccines recommended by the Advisory Committee on Immunization Practices, a group of 15 experts that evaluates vaccines and makes recommendations for their use.
However, experts caution that the new law leaves some gaping holes.
Medicaid eligibility will expand to cover adults with incomes up to 133% of the federal poverty level ($14,404 in 2010). Immunizations for this group will be covered as an “essential health benefit,” says Rosenbaum. But in a twist, the law doesn’t require immunization coverage for people already enrolled in Medicaid. “So the poorest people may not have full coverage,” she says.
Although Medicare beneficiaries will receive certain preventive services free starting in 2011, vaccines aren’t among them. Making matters worse, most vaccines fall under Part D, the prescription drug portion of the Medicare program. That means they’re not necessarily available at doctors’ offices.
As a result, some Medicare beneficiaries have to “brown bag” the vaccine, says Ilene Stein, policy counsel for the Medicare Rights Center, an advocacy group: They get a prescription from their doctor, go to a pharmacy, pick up the vaccine and carry it back to their doctor’s office so he can administer it. The CDC and professional medical groups strongly discourage this practice because many vaccines are supposed to be kept refrigerated or, in some cases, frozen.
The health law directed the comptroller general to study barriers to Medicare beneficiaries’ access to recommended vaccines. That study is due no later than June 1.
Andrews writes for Kaiser Health News, an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan healthcare policy research organization. Neither Kaiser Health News nor the foundation is affiliated with Kaiser Permanente.
