Healthcare stakeholders push HHS to tweak ACA vaccine access rules

via Gabrielle Wanneh of Inside Health Policy:

A former Democratic Senate majority leader and former HHS secretary are calling on the Biden administration to correct a longstanding loophole in the Affordable Care Act (ACA) they say is preventing the law from permitting as much cost-free access to vaccines for patients as is intended, joining a bipartisan group of lawmakers and a coalition of health groups that have asked top HHS officials to make the change in recent months.

Tom Daschle, the co-founder of the Bipartisan Policy Center who served as the Democratic Senate majority leader from 2001 to 2003, and Kathleen Sebelius, who served as HHS secretary from 2009 to 2014, wrote an opinion piece published Thursday (June 6) by STAT News that highlights restrictions limiting coverage of some vaccines. Current ACA regulations limit required commercial coverage for vaccines to those that are administered routinely, which prevents the ACA cost-free access requirement for insurers from applying to vaccines that can be critical to some patients for occupational or travel reasons, or during an outbreak.

The loophole also means FDA-approved vaccines meant to prevent the spread of infectious diseases like COVID-19 or monkeypox have been subjected to time-intensive coverage workarounds by Congress or the federal government, the two authors add.

According to the article, this issue was resolved for Medicare enrollees via the Inflation Reduction Act, but that still leaves the tens of millions of Americans with commercial insurance (including ACA individual market enrollees) out of the loop.