I’m unhappy of course. And the harms are more in the rhetoric around the recommendations than what they actually are.
The “removal” is labeling as for “high risk” and/or after “shared decision making” with the healthcare provider.
Which in real world terms is what it always is. We recommend them. They can decide to ignore our guidance. We are not being told to not recommend them anymore.
Yes it undermines the societal public health need and undercuts confidence. But they did not actually say to not get them, which they could have.
Do insurers need official government recommendations to make their coverage decisions about preventive medicine? Sincere question, I don’t know, but I was under the impression that insurers lean strongly towards covering routine vaccinations just on cost-benefit grounds. Vaxxes are so cheap compared to having to actually treat somebody with a serious illness.
Poking around on the internet, though, I see a lot of indications that ACIP recommendations are crucial to ensuring vaxx coverage for insurance. I don’t get it: even a serious case of measles can cost tens of thousands of dollars to treat, and it’s hard to imagine that insurers wouldn’t save money by pushing all their clients to get vaxxed, government mandate or no government mandate.
They are still recommended after the shared decision making process. The insurers have all been coming out saying no changes in coverage.
The bigger concern will be for Medicaid. I think still covered there given as part of the process (albeit a barrier placed) but states may be state by state. Dunno.
Yes, that’s what I’ve been hearing about. But as you also say, in the long run it would be more cost-effective for them to cover shots----yet in the short term, they save. And that may rule the day.
My big HMO (Kaiser) published a notice to members several months ago saying (paraphrasing from memory) that they will continue to consult with major medical organizations and follow the best research in making their coverage decisions.
Reading between the pixels, I took that to be a tactful and discreet way of telling HHS they can go fuck themselves.
Rotavirus vaccine, series to be completed by six months, reduces hospital stays for babies and toddlers right off, including the older preschooler siblings by reducing their exposure.
The RSV vaccine given to pregnant women, and the monoclonal antibody, given to babies whose mothers were not vaccinated during pregnancy, are also effective within that first year of life, cost effective that is … baby ICU stays are expensive!
It probably takes a few more years to recoup the costs of many of the others, and the cost savings of childhood influenza vaccine while immediate and real, is more indirect - kids are the vectors spreading influenza around to the high risk (and costly) adults who respond with less strong immune responses themselves. Society gets a benefit but not necessarily the same insurers.
HPV is definitely a delayed cost savings, not likely to the same payer. HepB also delayed.
Ironically (if that’s the right term), a common tactic by antivaxers is to profess outrage at health insurers offering bonuses to physicians for attaining a certain percentage of vaccinated patients - their idea being that it’s nefarious bribery. What they don’t get is that insurers (actually only one regional insurer to my knowledge) offered extra payment because 1) vaccinated kids are healthier, 2) resulting in fewer claims, and 3) saving the insurer money.
The reduction in recommended vaccines is unlikely to sway parents with critical thinking capacity who respect their pediatricians’ knowledge and advice. It probably will help convince doubtful on-the-fence parents who will think “well, they say these 72 vaccines* aren’t necessary, and I worry about the kids’ immune systems being overloaded** and we can save some money, so…”.
And yes, this is an initial step towards a crackdown on other vaccines. Expect a bogus study*** showing 1) autism diagnoses going down, which will “justify” reduced vaccine recommendations, or 2) no change in or increased autism diagnoses, which will be used to justify further reductions or even vaccine bans.
*bullshit
**more bullshit
***Utter from David Geier, who’s been commissioned by RFK Jr. to churn out
^ This, and the other facts you mention, are likely to be uppermost in the minds of insurance-industry decision makers. Which as you note will be good (for all of us) in the case of the Rotavirus and RSV vaccines; less good in the case of the delayed-outcomes vaccines.
I heard a podcast interview with a small-town doctor - maybe This American Life? She said that they lose money on vaccines, because they’re expensive, and to buy enough to keep a stock on hand, the vaccines end up expiring before they get used. Or the flu season ends and the vaccines are of no use since a different flu will be around the next year. So the higher insurance reimbursements are to help compensate them for continuing to provide a product at a loss.
Over the years, I got several phone calls from panicked women who said something like, “I got a flu shot last week, and I think I’m pregnant. Is my baby going to be okay?” I would tell her that flu shots are not only safe during pregnancy, they are RECOMMENDED, because influenza during pregnancy is extremely dangerous.
The only shots I give in the office are Tdap (tetanus/diphtheria/pertussis) and I can’t even give them to Medicare patients any more because they are reimbursed under part D so they have to be given at a pharmacy. I can do OK with flu vaccines but I find patients are more likely to get other vaccines at the same time if I send them to the pharmacy.
Just to demonstrate the financials:
If I want to give pneumonia vaccines they cost me $79 a shot. Medicare will reimburse $67 for the shot and $20 for administration so I make $8 a shot. I have to buy in a package of 10. If I give out 9 before they expire I spend $790 and get back $783. ( These are old numbers from when I stopped giving them. ) It’s just not financially viable unless you have the volume.
An inexplicable truth is that as long as there have been vaccines of any sort, there have also been anti-vaxxers. As crazy as it is, there have always been groups of people who fear, loathe and reject the very idea of vaccines.
In past eras, I suppose some skepticism was understandable, but now, amid the utter plethora of statistical scientific validation, anti-vaxxism is just stupid.
Yes. I also have Kaiser medical insurance, and one thing I really like about it is that they’re extremely focused on preventative practices. That certainly includes vaccines. They make it very easy to get regular flu shots and covid boosters.
I recommend an article called “This is what Destroying the Vaccine Market Looks Like,” focused on RFK Jr. and the anti-vaxxers he’s put into power at the nation’s top health power-centers. It looks at a recent interaction between Moderna, which developed a flu shot using mRNA technology, and the FDA:
(I should add that this is NOT paywalled, but as with most Substack content, they might ask for an email; any old email will do.)
I must have missed that episode. But even if I had seen it, I doubt that it would have induced fond memories of when I was quarantined with four brothers for the protection of our infant sister and the fetus Mom was carrying at the time (who died shortly after he was born, although I can’t say if it was related). My two older brothers liked to gang up on me.
That illness SUCKED (so did chicken pox the following year).
from David Geier, who’s been commissioned by RFK Jr. to churn out