RFK Jr.'s latest big move could leave you paying more for vaccines

Yahoo

2 days ago

Health Secretary Robert F. Kennedy Jr. sent shockwaves through the scientific community this week when he fired all 17 members of the federal government's key vaccine advisory board, raising concerns that he might try to replace them with immunization skeptics.
Those fears were confirmed for many on Wednesday when Kennedy unveiled eight new members who included some of the most prominent critics of the COVID-19 vaccines.
The swap could have wide-reaching public health consequences. But one of the most straightforward impacts may be on consumers' wallets.
That's because recommendations by the board — known as the Advisory Committee for Immunization Practices, or ACIP — determine which vaccines most insurance plans are required to cover at zero cost, such as inoculation against measles or your annual flu shot. If the new members decide to reverse the panel's old guidance, patients could find themselves paying out of pocket for vaccines that were once available for free.
'For the average person who has never heard of ACIP before, this could affect their access to vaccines,' said Jennifer Kates, a senior vice president at the healthcare think tank KFF.
Created in 1964, ACIP is the official outside panel of medical experts responsible for advising the Centers for Disease Control and Prevention (CDC) on what to include on its lists of routine shots for both children and adults. While its recommendations aren't binding, federal officials have typically adopted them.
As a result, the board's decisions carry enormous weight, affecting patients and parents, as well as the vaccines schools require for students. Over the years, the panel has played a growing role in determining insurance coverage as well.
By law, shots recommended by ACIP must be covered by the free Vaccines for Children program, the Children's Health Insurance Program, Medicaid, and Medicare Part D. The Affordable Care Act also requires private insurers to pay for vaccines with no cost sharing if they have the panel's seal of approval. (Past administrations have said the rule only applies if the CDC also adopts the board's recommendation.)
In a Wall Street Journal op-ed this week, Kennedy said his decision to replace the board was meant to fight a 'crisis of public trust' in vaccines by ridding the committee of what he described as 'persistent conflicts of interest.' (Kennedy's critics have argued that his allegations against ACIP's former members are unfounded.)
His new picks for the panel include several figures who rose to national fame by casting doubt on the safety of COVID-19 vaccines. Among them is Dr. Robert Malone, an accomplished scientist who did pioneering work on mRNA technology but later attacked its use in shots during the pandemic and who was at one point banned from Twitter for spreading COVID misinformation.
He'll be joined by Retsef Levi, an MIT business school professor who gained attention in 2023 for claiming there was 'indisputable evidence' ​​that 'MRNA vaccines cause serious harm including death,' and Dr. Martin Kulldorff, who advocated letting COVID spread among younger Americans to achieve 'herd immunity' and was later let go from Harvard Medical after refusing to be vaccinated.
In his announcement, Kennedy said that each new member of ACIP was 'committed to demanding definitive safety and efficacy data before making any new vaccine recommendations' — suggesting they'll be less likely to add new shots to the government's immunization schedules.
But he added that the board will also 'review safety and efficacy data for the current schedule as well,' raising the possibility that it will scrap some of its old recommendations.
Even before this week's shake-up, the government had already begun changing its recommendations on COVID shots. In May, the CDC dropped its recommendation that healthy pregnant women receive the vaccine and revised its guidance for young children, saying they should only receive it after consultation with a doctor.
Private insurers could still choose to cover vaccines even if the federal government stops recommending them. Whether they will is less certain. 'That's territory we haven't really had to traverse before,' said KFF's Kates.
Sarah Moselle, a vaccine market expert at the health industry consulting firm Avalere, said there may be some 'fragmentation' in how carriers approach the issue. Some may drop coverage entirely or begin requiring co-pays. But many 'do anticipate that they would continue to cover some vaccines,' even if they aren't required to, since it would 'add value' for their customers, she said.
In theory, insurers could also have an incentive to maintain vaccine coverage since it could keep their patients healthier and reduce the costs of their care, though it's unclear exactly how those savings would stack up against the added expense of paying for shots.
For many vaccines, the out-of-pocket cost might be relatively cheap for patients. But others could turn out to be steep.
Take Gardasil, the HPV vaccine that has been the focus of growing safety concerns among patients despite studies suggesting they're unfounded. Some experts told Yahoo Finance they thought the shot could be a target for more scrutiny under Kennedy's new ACIP. Currently, the shot is covered by insurance because it's recommended for pre-teens through young adults. The CDC lists its full price at over $300 a dose.
Even modest costs can dissuade patients from getting vaccinated, according to Loren Adler, associate director at the Brookings Institution's Center on Health Policy. 'We know that folks having to pay $10 for a vaccine limits the uptake somewhat,' he said. As a result, just a small increase in what patients have to pay out of pocket could have ripple effects on public health.
One issue to keep an eye on, according to Moselle, is whether state governments step in to require more extensive insurance coverage of vaccines if the federal government walks back some of its recommendations. If they do, vaccine access could start to vary more by where patients happen to live.
Jordan Weissmann is a senior reporter at Yahoo Finance.
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