HEALTHY FAMILIES: Vaccine Issue May Hold Up Program
A dispute has broken out between the Health Care Financing Administration and the Wilson administration over "whether the federal government will provide free childhood vaccinations to" the state's new Healthy Families children's health insurance program, the San Francisco Chronicle reports. Free "federal vaccines are only for uninsured kids or kids on Medi-Cal." But since the 600,000 children expected to be covered under the state's new program will receive their care from private health plans rather than Medi-Cal, HCFA is indicating that they will not be eligible for the vaccine program. According to physicians in the state, "without the free federal vaccinations, the economics of the new program" will not work out because vaccinations for a child cost $130 annually and doctors are only being reimbursed $132 per year per child.
Who's To Blame?
Critics of Gov. Pete Wilson contend that his administration should have simply extended Medi-Cal coverage "to include the children eligible for the new program," because "[f]ederal law allows free vaccines for Medi-Cal enrollees." Beth Capell, a lobbyist for the consumer health coalition Health Access, criticized California's preference for a private-insurance model over expanding the Medi-Cal program. "The Feds are holding back because we didn't do a Medi-Cal extension," Capell said. However, Sandra Shewry, executive director of the state agency running the Healthy Families program, said she does not believe the federal government "is pressuring the state to drop its private insurance model in favor of expanding Medi-Cal." Shewry believes that the problem arose because "legislative language [was] drafted in a hurry." The Chronicle reports that "those familiar with the issue say the problem lies in the literal interpretation of the federal law governing the vaccine program." This law "bars coverage of 'insured' children" in order "[t]o keep private insurers from dumping coverage of vaccines." In addition, "vaccine makers have been lobbying Washington to enforce a literal interpretation" of the law because they would be required by federal law to provide the vaccines at a discount, "and drug makers may fear that the commercial health plans in California's program could divert the discounted vaccines to their subscribers who pay full" price.
War Of The Lobbyists
Meanwhile, the California Medical Association is leading a "large-scale lobbying campaign of the state's congressional delegation" to fight HCFA's interpretation of the law. HCFA is expected to issue a final ruling on their interpretation this week (Russell, 3/9).