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House Health Debates Forcing Reluctant Insurers to Cover Meningitis Vaccines

Faced with a $2.6 million bill for inoculating Oregon State students with an expensive new vaccine amid a meningitis outbreak, public health workers have struggled to get insurers to cover the students. The Senate at the same time debated informed consent for vaccinations.
March 29, 2017

While the House Health Committee considers a bill to help pay for mass vaccinations for meningitis outbreaks on college campuses, the Senate Health Committee debated three vaccine-related bills that public health advocates say could lower the immunization rate and erode herd immunity.

Oregon State University has been the site this school year of a meningitis outbreak, with three students infected. The outbreak of the contagious and deadly bacterial pathogen comes two years following a similar outbreak at the University of Oregon.

A new vaccine could inoculate the student body but the steep price charged by the pharmaceutical manufacturer -- a two-dose regimen at $185 a dose, has led health insurers to avoid payment with the university worried about forgoing inoculation or eating the cost for a mass vaccination that would total about $2.6 million for 7,000 students.

House Bill 3276 forces health insurers to pay claims for vaccinations if a local public health official has declared an emergency. This bill became necessary after several insurers as well as coordinated care organizations refused to automatically pay for shots given by OSU’s student health center, which tried to vaccinate all the students.

Charlie Fautin of the Benton County Health Department said some insurers had forced the student health center to administer the vaccine from a pharmacist and others from a nurse if they wanted to get reimbursed. Others wouldn’t pay for the inoculation at all, citing the need for the students to return home -- across the state or across the country -- to their primary care doctor to get the vaccine.

The bureaucratic hurdles greatly slowed OSU’s ability to mass-vaccinate the students amid the outbreak. “It’s a huge cost, and they were trying to recover the billing costs,” Fautin said. “We did not expect this much trouble,” adding that previous mass inoculations for outbreaks of the H1N1 flu went smoothly.

“During an outbreak is not the time to get in the weeds about what’s covered,” said Rep. Nancy Nathanson, D-Eugene, whose district includes the University of Oregon campus. “As long as the vaccine or other prophylactic measure is FDA approved, the insurer should cover it.”

Rep. Mitch Greenlick, D-Portland, agreed: “You have to make sure these kids get vaccinated.”

While Oregon has no authority over out-of-state insurers, this bill would force the hand of insurers that operate under the regulatory authority of the Department of Consumer & Business Services. Regence BlueCross BlueShield is opposing the bill, claiming it would compound bureaucratic hurdles.

Senate Bills

The Senate Health bills were introduced by Republican Sen. Tim Knopp, R-Bend.  Sen. Laurie Monnes Anderson, D-Gresham, said she opposed all three bills but wanted to allow hearings out of bipartisan courtesy to Knopp.

Senate Bill 869 requires healthcare practitioners to get clearer informed consent from parents before administering vaccines to children, Senate Bill 580 requires written notice of whether the vaccine is required for public schools, and Senate Bill 914 bars employers from requiring that employees be immunized.

Vaccine skeptics were led by long-time activist Robert Snee of Oregonians for Medical Freedom, who claimed that patients currently are not fully informed of the risks and benefits of vaccines. “OHA lies to people by telling them about the need to get vaccines but gives next to nothing about the possibility for a non-medical exemption,” for school children, Snee said.

Snee questioned the neutrality of the Centers for Disease Control as well as the herd immunity argument, which he said was not an ample justification for forcing an individual to risk a vaccination.

The U.S. Supreme Court has differed with Snee’s position, arguing that parents do not have the right to unnecessarily expose their children to contagious diseases.

Public health advocates, the Oregon Medical Association and the Oregon Association of Hospitals and Health Systems all affirmed their opposition to all three measures, arguing that they would lower the immunization rate and put Oregon at greater risk of outbreaks of preventable infectious disease. “The benefits to the individual and the community outweigh the risk,” said Dr. Janet Patton. “It is not good public policy to encourage exemptions.”

Patton said SB 869 and SB 580 would create unnecessary paperwork for medical providers and give patients redundant information, since providers already discuss the risks and benefits of vaccinations.

The most troubling of the bills is probably SB 914, which would allow even healthcare workers handling vulnerable patients to avoid vaccination and potentially expose patients to measles or whooping cough. Ryan Day of the March of Dimes, a charity founded to eradicate polio, said people working in pediatric intensive-care units must be immunized to protect their fragile patients, and SB 914 would put these kids at risk.

“These bills will chip away at our ability to protect the most vulnerable -- babies, the sick and the elderly,” Day said.

Vaccines, like many other public health achievements, have largely been a victim of their own success. Most of the critics of vaccines aren’t old enough to remember when childhood illnesses like polio, measles, rubella and mumps were widespread, often leading to lifelong health problems if not death.

Knopp has fought Sen. Elizabeth Steiner Hayward’s attempts to curtail non-medical vaccine exemptions for school children. Oregon has one of the lowest rates of vaccination in the nation.

The libertarian argument towards vaccines has been limited to the Oregon Senate. In the Oregon House, opposition to the bill limiting non-medical exemptions crumbled after the elderly Rep. Bob Jenson, R-Pendleton, emotionally recounted on the House floor how polio, a disease that crippled his father, would come in waves each summer in the 1950s and early 1960s, putting his children at risk.

Chris can be reached at [email protected].

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