AAP-California Sacramento Update: SB 1038 (Polanco) to Address Healthy Families Vaccine Problems

By Kris Calvin, MA Executive Director, AAP-CA, Robert Black, MD
and Quynh Kieu, MD

The California District of the American Academy of Pediatrics (AAP-CA) is a legally constituted joint venture of all 4 California AAP Chapters, including Chapter 1. Under the leadership of District Chair Burton Willis, MD, Alternate District Chair, Robert Adler, MD, and the four Chapter Presidents and Vice-presidents the District has its own office and staff. One of the main activities of the District is to enable the Chapters to work together efficiently and effectively on legislative issues. This year we are sponsoring SB 1038, an important bill aimed at improving the vaccine delivery and purchase mechanism in the Healthy Families Program. We are very fortunate that Senate Majority Leader Richard Polanco has agreed to carry the bill. We also have numerous coalition partners already in support of our effort, and anticipate adding many more.

 SB 1038  (Polanco) would take advantage of a federal option permitting California to purchase vaccines at approximately half the commercial price for children enrolled in Healthy Families. These vaccines would then be delivered to physician offices through an already established state system. This would reduce barriers to immunization and increase overall access to health care in the Healthy Families Program. At the same time, it would save California an estimated 3 million General Fund dollars.

 Problems with the Current Healthy Families Vaccine System

1. Disincentives to immunize

While system wide immunization rates are not yet available for the Healthy Families Program, overall immunization rates of toddlers in California are less than 75%, indicating the need for strong immunization initiatives wherever there is an opportunity. Every unimmunized child increases the risk of potentially devastating epidemics. With over 600,000 children now enrolled, Healthy Families has the opportunity to be a model program for immunization delivery in our state and throughout the country.

Yet currently immunizations for children enrolled in the Healthy Families Program are provided in an inefficient and unnecessarily costly manner. Health plans are required to cover vaccines as part of their contract obligations with Healthy Families. Physician practices must purchase the vaccines themselves and them await reimbursement. The lag time for receiving reimbursement is generally significant. Sometimes the reimbursement is inadequate (less than the cost of providing the vaccine.)

As you know, the cost of nearly $600 per child to be fully immunized, times the number of children in your practice, can be staggering as an “out-of-pocket”, up front expense. Those hit hardest by this initial purchase outlay are practices in underserved areas that provide greatest access to lower-income families. The result is a barrier to timely immunization and proactive immunization practices for Healthy Families physician practices. 

 2. High costs of vaccines

Vaccines for children enrolled in the Healthy Families Program are currently purchased at commercially available prices, up to 50% more than the price the federal government has secured for its bulk buy of vaccines for Medi-Cal and uninsured children. The savings generated by California utilizing the option to purchase Healthy Families vaccines at that discounted price is estimated at over $300 per child. Potential total savings from instituting this bulk purchase of vaccines are estimated at over  $3 million General Fund dollars. (A combination match of federal TITLE XXI funds (65%) and State General Fund (35%) would support the vaccine procurement system.)

 3. Limited access to community providers

When the Healthy Families Program was established it was anticipated that vaccines would be provided free to physician offices through the Federal Vaccines for Children program. Many pediatricians elected to participate in Healthy Families with this expectation. However, a federal ruling prohibited full Vaccine for Children participation for Healthy Families children. As a result, many of you have informed us that you are increasingly unwilling to participate in Healthy Families. The inadequate and inefficient vaccine system is cited as a primary concern. Addressing this problem by enacting SB 1038 would increase the numbers of pediatricians willing to accept Healthy Families children, thereby increasing overall child access to health care, particularly for the underserved.

 The Solution

Through use of an existing distribution system to participate in a readily available federal vaccine bulk purchase program for Healthy Families enrollees, SB 1038 (Polanco) would eliminate current disincentives to immunize, excessive costs for immunization, and barriers to physician participation in the Healthy Families Program, thereby improving children’s preventive health care in a fiscally responsible manner.

 How You Can Help

Robert Black, MD, AAP-CA State Government Affairs (SGA) Chair, Quynh Kieu, MD, AAP-CA SGA Co-Chair and Vaccine Task Force Chair, and Robert Farrell, MD, SGA Co-Chair, will oversee and coordinate our advocacy efforts on SB 1038. Given the relatively low attention to health care issues this year in Sacramento (priorities are “energy, energy, energy”), enactment of this bill will be an uphill battle. There are many ways that you can personally help:

1.        Contact Senator Polanco’s office and thank him for authoring SB 1038 on behalf of AAP-CA.

2.        Let the District office know of your willingness to be on our “SB 1038: Pediatric Advocates Roster” so that we can provide you with updates on the bill and ask for your direct involvement (letters, calls, testimony).  To be added to the roster please provide your name, e-mail (if available), phone and fax numbers to aapcalifornia@aol.com, or call 510-559-8383.

3.        Educate your colleagues about the need for this legislation. Suggest that they also join our SB 1038 advocates’ roster.

 Please do not hesitate to contact me your Chapter President or SGA Committee Representative if you have any questions. It is only through joint, focused action that we can make a difference in policy that affects children and pediatricians.