Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 388-392 (doi:10.1542/peds.2005-1691)
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COMMENTARY

Will Coverage for Child and Adolescent Immunizations Be Mandated for Insurance Plans in 2006? Lessons Learned From the Newborns' and Mothers' Health Protection Act of 1996

Okeoma Mmeje, BAa and Matthew M. Davis, MD, MAPPb

a University of Michigan Medical School
b Divisions of General Pediatrics and General Internal Medicine and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan

Abbreviations: ERISA, Employee Retirement Income Security Act • IOM, Institute of Medicine • VFC, Vaccines for Children • NMHPA, Newborns' and Mothers' Health Protection Act

The first 300 words of the full text of this article appear below.

More than 8 of 10 children in the United States have received their recommended vaccinations by 3 years of age.1 However, as the costs of immunizations increase,2 health insurance plans may be less likely to include coverage for all vaccinations recommended for children and adolescents.3 Such variations in coverage may discourage physicians from administering comparatively expensive vaccine series such as pneumococcal conjugate vaccine4 and also threaten the success of vaccination efforts regarding newly recommended quadrivalent meningococcal conjugate vaccine5 and combined tetanus-diphtheria-acellular pertussis vaccines,6 as well as vaccines that may be recommended in the near future (eg, human papillomavirus vaccine).7

Such economic barriers to childhood vaccination obstruct public health efforts to safeguard children's well-being. Moreover, recent evidence regarding varicella and pneumococcal conjugate vaccines indicates that childhood vaccination programs not only protect children's health but have dramatic positive effects on adults' health and reduce the costs of health care as well.8–13

For these reasons, insurance coverage for childhood vaccinations is the focus of increasing legislative attention. Insurance mandates regarding immunizations in many states require health plans to include children's vaccination benefits, but plans financed by employers themselves ("self-insured" plans) are exempt from such mandates under the federal Employee Retirement Income Security Act (ERISA)14 and may leave children "underinsured" for recommended vaccines. Underinsured children (recently estimated to comprise ~10% of children overall) are less likely to receive recommended vaccines than their more comprehensively insured peers.15 Other childhood immunization challenges, such as recurrent vaccine shortages and a decreasing number of vaccine manufacturers over the last several decades,16 have also been attributed in part to incomplete coverage for childhood vaccines in private insurance plans that reduce vaccine manufacturers' private-sector revenue.

In 2003, an expert panel of the Institute of Medicine (IOM) called for a new federal statute that would override ERISA and mandate coverage for . . . [Full Text of this Article]

Address correspondence to Matthew M. Davis, MD, MAPP, University of Michigan, 300 NIB, 6C23, Ann Arbor, MI 48109-0456. E-mail: mattdav@med.umich.edu


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