Tag: CHIP

What Ronald Reagan Can Teach Us About Vaccine Policy

Many U.S. Presidents, even George Washington, worked to get people vaccinated and protected. Well, Washington got them variolated and protected against smallpox, but that still counts.

As can be expected, some Presidents did a better job than others.

“Government’s first duty is to protect the people, not run their lives.”

Ronald Reagan

Do you have to run someone’s life to prevent outbreaks and help make sure folks get protected against vaccine-preventable disease?

Ronald Reagan’s Vaccine Policy

A lot happened in regards to vaccines when Reagan was President. After all, he was the President who signed the National Childhood Vaccine Injury Act (NCVIA) of 1986, which created VAERS and the NVICP!

What else happened?

“…the Reagan Administration starved the Federal program for childhood immunization…”

The Shame of Measles

That’s right, Federal support for vaccine programs reached a low point during Reagan’s years in office, as rates of children living in poverty and without health insurance also increased.

That’s not a good mix!

“During the Reagan years, the price of vaccine went up and Federal funding for childhood immunization went down.”

The Measles Menace

Not only did the price of vaccines go up, but new vaccines were added to the immunization schedule in the mid-1980s.

So even if Federal funding for vaccines had stayed the same, it would essentially have been a big cut!

“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”

Panel Ties Measles Epidemic to Breakdown in Health System

All of this followed President Jimmy Carter’s National Childhood Immunization Initiative in 1977, which reached its goal of immunizing over 90% of children!

Not surprisingly, this followed a growth in federal grants from $5 million to $35 million towards state immunization budgets. Yes, it costs money to get kids vaccinated and protected. But don’t forget that it costs even more money to control outbreaks once they start.

“Immunization policy during the Carter Administration demonstrated that when both an administration and key congressional actors viewed immunization as a priority and made sufficient funds available to support the public health delivery system and its infrastructure, coverage levels would continue to rise and disease levels continue to decline.”

Johnson et al on Federal immunization policy and funding: A history of responding to crises

Unfortunately, the coverage levels and growth during the Carter administration weren’t sustained for very long after Reagan took office in 1981.

As can be expected, neither were declines in rates of measles.

Instead, we eventually saw big outbreaks of measles across the United States. From 1989 to 1991, at least 123 people died among 55,000 cases, with another 11,000 hospitalized.

“The measles outbreak of 1989–1991 exposed many incorrect assumptions behind the belief that low levels of coverage were sufficient to control the transmission of infectious disease. The changing demographics of society, the mixing of young children in day care settings, new patterns of health care delivery, high rates of uninsured children, and the shrinking size and morale of health departments all fostered circumstances in which disease transmission occurred within major metropolitan areas even though disease reports were low, and state health officials believed statewide immunization coverage was at acceptable levels.”

Calling the Shots: Immunization Finance Policies and Practices

How did it get fixed?

President George HW Bush announced his own immunization action plan to raise vaccinated rates, and we once again put more Federal money into our immunization programs.

The result?

Immunization rates went up and the outbreaks stopped.

The President and the Children

Outbreaks that didn’t have to happen.

A 1987 op-ed in the New York Times warned about was coming and how to prevent it…

“Each dollar spent to immunize young children saves $10 in later medical costs. Yet in 1985, one of four children between ages 1 and 4 was not immunized for rubella, mumps, polio or measles and 13 percent lacked immunization for diphtheria, tetanus and pertussis. Congress would increase funding by about $20 million, enough to immunize 600,000 more youngsters.”

The Reagan administration didn’t listen.

The Children's Defense Budget analysis details how Reagan proposed cutting $2 to $3 million a year from the immunization program beginning with his 1982 budget.
The Children’s Defense Fund budget analysis details how Reagan proposed cutting $2 to $3 million a year from the immunization program beginning with his 1982 budget.

Are we headed for something similar in the years ahead?

Consider that:

  • the Children’s Health Insurance Program (CHIP) expired on September 30 and it has yet to be reauthorized
  • the short-term CHIP “fix” took $750 million cut from the Prevention and Public Health Fund, which provides 40% of the total funding for the CDC’s immunization program
  • the Section 317 Immunization Program was already slated for a big drop in President Trump’s FY 2018 Budget

So we may have fewer kids with insurance and less money for immunization programs.

When did we last see that scenario?

Take Action and remind Congress and our President of the “critical role” they play in protecting our children and that they should #PutKidsFirst.

“As Members of Congress, we have a critical role to play in supporting the availability and use of vaccines to protect Americans from deadly disease.”

Sens. Lamar Alexander et al Dear Colleague Letter

“Supporting the availability and use of vaccines” does not mean decreasing funding for vaccine programs!

And protecting “Americans from deadly disease” certainly does not mean having fewer people covered on insurance plans.

What to Know About Ronald Reagan’s Vaccine Policy

Ronald Reagan essentially starved the Federal program for childhood immunization, which led to lower vaccine rates and deadly outbreaks of measles. Let’s not allow history to repeat itself.

More on Ronald Reagan’s Vaccine Policy

What Does the CHIP “Fix” from Congress Break?

Breaking something else, seems like a poor way of fixing something.

But that seems to be the way that Congress chose to go with their short-term fix for CHIP – the Children’s Health Insurance Program.

Before leaving Washington for the holidays, Congress passed a stop-gap spending bill to keep CHIP and the rest of the government going.
Before leaving Washington for the holidays, Congress passed a stop-gap spending bill to keep CHIP and the rest of the government going.

Remember that instead of simply reauthorizing CHIP when it expired on September 30, as has been done with broad bipartisan support in the past, this Congress chose to let it expire. That has left several states freezing enrollment and sending warning letters to parents that their kids might soon lose their insurance.

Children’s Health Insurance Program

Do you even know what CHIP is?

The Children’s Health Insurance Program (CHIP) is an insurance program that covers 9 million kids in the United States. It also covers about 370,000 pregnant women.

Who has CHIP?

Lower and middle income families that don’t qualify for Medicaid, but don’t make enough money to buy their own, private insurance, have CHIP. And depending on how much a family makes, CHIP is either free, like Medicaid, or is partially subsidized.

Because CHIP is paid for with federal and state funds, most Republicans in Congress don’t want to reauthorize or extend the program unless it’s funding can be cut from somewhere else.

What Does the CHIP “Fix” from Congress Break?

Now instead of finally getting around to reauthorizing CHIP, Congress gave it some money as part of a stopgap spending bill that keeps the government going.

The problem? In addition to the simple fact that they likely didn’t give the program enough money to run for the planned six months – they gave it about half – there is an issue about where they got the money.

Some of the money came from a $750 million cut from the Prevention and Public Health Fund.

What is the Prevention and Public Health Fund?

“The Prevention Fund supports critical public health activities—including lead poisoning surveillance, vaccination initiatives and other programs—in every state and community across the country. Cutting this significant funding source would leave communities without the vital resources needed to keep children and families happy, healthy and safe.

It is even more alarming and contradictory that this cut will be used to provide very short-term funding for CHIP and community health centers. Our organizations are united in support of CHIP and community health centers, which are vital to improving children’s health. But losing the Prevention Fund would just create another hole in the public health support children need.”

Statement from Leading Public Health Groups: Using the Prevention Fund to help fund CHIP: A Serious Mistake

In addition to all of the other important programs that are supported by the Prevention and Public Health Fund, it has helped protect children by:

  • providing 40% of the total funding for the CDC’s immunization program, including Section 317 program funds that buy vaccines for underinsured children not eligible for VFC, and uninsured adults.
  • improving HPV vaccination coverage
  • developing school vaccination clinics
  • building local public health infrastructure (your county health department) that can detect, control, and prevent outbreaks of vaccine-preventable diseases.

Cutting these funds could once again could put vaccines on the “chopping block.”

The Section 317 Immunization Program was already slated for a big drop in President Trump’s FY 2018 Budget.

What happened the last time we saw big drops to funding for our immunization programs? When Ronald Reagan was President, federal support for vaccine programs reached a low point, as rates of children living in poverty and without health insurance increased.

It took the immunization action plan of President George HW Bush in 1991 to stop the measles outbreaks that resulted.

Are we headed in that direction? Will it be even worse now, considering that you will be adding that to kids that are already skipping or delaying some vaccines because their parents have been scared by anti-vaccine propaganda?

Current Status of CHIP

CHIP still needs to be reauthorized and fully funded.

Tragically, even with the temporary ‘fix,’ many states are still planning for the worst.

That’s probably a good idea, as the CHIP ‘fix’ only provided about 1/2 of the money that they needed to keep the program going, even temporarily.

“I do not think this is anywhere close to enough money,” Bruce Lesley, the president of First Focus, a child advocacy group, recently told the New York Times.

Others say it is too little too late.

“By failing to extend long-term funding for the Children’s Health Insurance Program (CHIP), Congress falls far short of the reassurance and relief families deserve. Instead, they will enter into a new year with no assurance that CHIP will continue to be there for them in the months ahead. What should be a time of comfort, celebration and reflection will instead be one of anxiety, fear and stress.

Congress also failed to fund the Maternal Infant, and Early Childhood Home Visiting Program (MIECHV), which serves at-risk pregnant women and parents with young children, and several other vital public health and safety net programs. The communities these programs serve already face uncertainty when it comes to their health care, which is now exacerbated by Congress’ failure to extend the programs long-term.”

Fernando Stein, MD, FAAP, President, American Academy of Pediatrics

What is going to happen to CHIP, the 9 million children on CHIP, and their families?

“Congress’ failure to extend CHIP funding long-term has resulted in a manufactured emergency that has real consequences for children, families and pregnant women. It doesn’t have to be this way. There is bipartisan policy ready to be passed right now to extend CHIP funding for five years. Both chambers of Congress support it; the only thing preventing it from passing is political will. Congress must take the opportunity to pass a five-year CHIP funding extension on a bill this week to fund the federal government.

Right now, the greatest threat to children’s health care coverage is congressional inaction.”

Statement of Leading Children’s Health, Medical and Advocacy Organizations: Short-Term CHIP Funding Falls Short for Children

Take action and tell Congress to #ExtendCHIP and to #PutKidsFirst. We want a five-year extension of CHIP without harmful offsets, especially any that could lead to fewer kids getting vaccinated and protected against vaccine-preventable diseases.

What to Know About the CHIP “Fix” From Congress

By taking money from other important programs, including many that involve helping kids get vaccines, the long overdue short-term “fix” for CHIP by Congress likely created new problems and it still has many parents worried that their kids could lose their health insurance early next year.

More About the CHIP “Fix” From Congress