Close a regulatory loophole in the ACA to provide vaccine access for all Americans

The Patient Protection and Affordable Care Act, (generally known as the ACA), was signed into law in 2010. It expanded access to affordable, quality health care, and today is helping 45 million people — the highest total on record — be covered by health insurance.

The law included long-overdue policy changes to ensure that Americans have access to recommended preventive care, which is critical to avoiding preventable illnesses and the health care spending associated with them. But the ACA’s provision requiring insurers to provide cost-free access to vaccines has not been fully implemented, leaving millions of Americans with the difficult choice between paying out-of-pocket or skipping recommended preventive care.

Vaccines are one of the greatest public health innovations of all time. A landmark World Health Organization study estimates that global immunization efforts have saved 154 million lives over the past 50 years. Thanks to congressional vision and leadership, the ACA and the 2022 Inflation Reduction Act jointly require Medicare, Medicaid, and commercial health insurance plans to cover all vaccines recommended by the Centers for Disease Control and Prevention’s immunization advisory panel, the Advisory Committee on Immunization Practices, without patient cost sharing.

Unfortunately, the regulations implementing these laws limit required commercial coverage of “routine” vaccines, leaving out a host of critical occupational, travel, and outbreak vaccines. The Biden administration should take action now to correct this long-standing error.

As a result of this regulatory loophole, veterinary technicians are routinely denied insurance coverage of the rabies vaccine, even though the CDC recommends that they be vaccinated prophylactically to protect against exposure from infected animals. Similarly, travelers to certain regions — whether for missionary work, study, business, or visiting family — must generally pay out-of-pocket for CDC-recommended vaccines against yellow fever, cholera, and Japanese encephalitis.

In addition, this loophole means that FDA-approved vaccines for outbreaks of emerging infectious diseases, like Covid-19 and mpox, have been subject to time-intensive coverage workarounds through Congressional mandates or provisions from federal government stockpiles.

This issue has recently been corrected for Medicare and Medicaid. But Americans with commercial (private) insurance have been left in limbo.

The Biden Administration is currently racing to wrap up health care rules before the fall elections and the threat of the Congressional Review Act, which provides Congress with special procedures to overturn rules. As part of this effort, we urge the administration to ensure that Americans covered by commercial health insurance can access all recommended vaccines by making a simple regulatory change to close this loophole.

This regulatory fix is supported by a broad set of more than 30 stakeholder groups, including patients, consumers, veterinary technicians, infectious disease experts, health care providers, pharmacists, and public health officials. And bipartisan congressional health policy leaders have echoed the call for the administration to “address the flawed interpretation of the law which allows commercial insurance companies to charge patients for vaccines that Congress intended to be free.”

All Americans should have equal access to the vaccines their doctors recommend, regardless of what kind of health insurance they have. To miss this near-term policy window would be a serious injustice and a true missed opportunity to improve all Americans’ access to preventive care.

Tom Daschle is a former U.S. Senate majority leader (D-S.D.), founder and CEO of The Daschle Group, and co-founder of the Bipartisan Policy Center. Kathleen Sebelius was the U.S. Secretary of Health and Human Services from 2009 to 2014, and is CEO of Sebelius Resources LLC.