Child vaccine funding sought

The Nevada State Medical Association is seeking state and federal help to ensure that all preschool-age children receive required vaccines.

The association's Commission on Public Health this week urged Gov. Jim Gibbons to seek assistance from the federal Centers for Disease Control and Prevention.

Specifically, a letter sent by the commission -- composed of the chief health officers from Clark and Washoe counties -- asks Gibbons to speak with congressional leaders.

Health officials fear that if the state doesn't act soon, pediatricians could stop providing any vaccines at all, which could affect the overall health care of Nevada's youth.

"We are a city that depends on tourism. We don't want to get Las Vegas placed on a list of cities that has a measles outbreak,'' said Dr. Beverly Neyland, a Las Vegas pediatrician who is concerned about the state's recent decision to provide free vaccines only to poor children starting Jan. 1.

Any disease outbreak could "hurt our economy,'' she said.

The letter, which was sent Tuesday, references the state's move to a Vaccine for Children-only program. Children who qualify for the Vaccines for Children program are those who are underinsured -- they have health insurance but their policy does not cover vaccinations -- or they are eligible for Nevada Check Up, or are American Indian or an Alaska Native.

Nevada now operates as a universal-select program, which means the state provides some of the recommended vaccinations to all children.

Those vaccines are given to physicians, or VFC providers, at no cost to give to poor children as well as children whose insurance plans don't cover the vaccines.

Starting Jan. 1, that changes. Only children eligible for VFC vaccines will get them for free.

"How do you radically change a program to make health care less available?'' said Larry Matheis, executive director of the state's medical association. "This is bad policy.''

Matheis said the policy change will leave parents of insured children, or those whose insurance does not pay for all or part of vaccines, in a bind. They will have to pay out-of-pocket for the vaccines.

If the vaccines are too expensive for those parents, some children might not get them, Matheis said. Currently, Nevada ranks last in the nation for providing vaccines to children ages 3 and under.

Health officials also are concerned that pediatricians will stop providing vaccines all together, which could lead to children having to find other medical caregivers, Matheis and Neyland said.

They said some pediatricians might not want the burden of having to pay for vaccines that aren't fully reimbursed by insurance. Also, they might not want to deal with two inventories of vaccines -- one for children eligible for the Vaccines for Children program and another for the insured.

"Children have to be immunized, and they tend to get their health care in the same location that they get their vaccines,'' Matheis said. "Unfortunately, the health district isn't a primary care provider.''

During a recent Southern Nevada Health Board meeting, Bonnie Sorrenson, director of clinic and nursing services, said 30 of the area's 186 Vaccine for Children providers have dropped out in recent months.

Neyland said her practice is considering such a move. "It's tough because we're a teaching practice. We want to give immunizations, but as a whole entity we have to look at the cost-effectiveness,'' she said.

Neyland, president of the Nevada Chapter of the American Academy of Pediatrics, said insurance companies just don't reimburse completely for the vaccines.

When asked why pediatricians don't just charge the parents for the additional costs of the vaccine, Neyland said "that would be against the law.''

"We have a contract with the insurance company, which means payments have already been established,'' she said. "If you charge the patient more, that would be considered double-billing and is against the law.''

Ryan Nishihara, another Las Vegas pediatrician, said he's in favor of the state's policy change. Too often, he said, insurance plans take advantage of the free vaccines.

"They know if they don't pay, the children could get the vaccines for free through the VFC program,'' he said. "That's not why this program was set up. It was set up to help the underserved -- the children without medical insurance.''

Nishihara did say, though, that insurance plans are notorious for not paying "adequately" for vaccines. He said a pediatrician's largest overhead is vaccine. He said they are expensive and must be stored properly.

Matheis said the state might be able to tap into CDC funding to provide vaccines to all children, which is a reason the letter was sent to Gibbons.

Gibbons' deputy chief of staff, Mendy Elliot, said he has received the commission's letter and he plans to reach out to congressional leaders. Gibbons also plans to work with Mike Willden, administrator of the state's Department of Health and Human Services.

"If there's an opportunity to get more vaccines, then absolutely the governor is on board,'' Elliot said.

State health officials said the vaccine policy change had to be made because Nevada faces declining federal funding, increasing costs for vaccines and a growing population.

Contact reporter Annette Wells at awells@reviewjournal.com or 702-383-0283.