Senator Says Additional Legislative and Executive Action is Needed to Cover Cost of Administering Vaccines

WASHINGTON, D.C. [1/21/21]—Today, U.S. Senator Tina Smith (D-Minn.) called on President Joe Biden and Vice President Kamala Harris to work with Congress to ensure coronavirus (COVID-19) vaccines are free for all Americans. 

Sen. Smith and the Biden-Harris Administration have a shared commitment to making sure that everyone who wants a COVID-19 vaccine is able to receive one free of charge. In her letter to President Biden and Vice President Harris, Sen. Smith identifies some of the barriers preventing all Americans—particularly the uninsured and adults on Medicaid—from a free COVID-19 vaccine or its administration, and outlines what is needed to address these challenges.

“There is still work to be done to make sure that no American falls through the cracks when going to receive their COVID-19 vaccine, and I stand ready to work with you on legislative and executive solutions to address this important priority,” wrote Sen. Smith. “My bill, the COVID-19 Treatment Coverage Act, provides a legislative solution that would protect Medicaid beneficiaries and uninsured individuals from the cost of their COVID-19 vaccine. It would require Medicaid to cover and prohibit cost sharing for COVID-19 vaccines, guaranteeing that no one on Medicaid would be denied access to a potentially lifesaving vaccine during the pandemic. My bill would also provide States with the option and financial incentive to expand Medicaid in order to cover the future vaccine for uninsured individuals.”

Sen. Smith introduced legislation to make COVID-19 vaccines free to everyone, regardless of insurance status, even before vaccines were finalized. Her bill, called the Free COVID-19 Treatment Act, would waive any cost-sharing for COVID-19 treatment and the COVID-19 vaccine for everyone, regardless of how an individual gets health insurance, or whether they have insurance at all. She also spoke with the U.S. Army Materiel Command (AMC) and sent a letter to the Trump Administration highlighting outstanding issues that would result in out-of-pocket vaccine charges for the most vulnerable Americans without additional legislative and executive action.

You can access a copy of the letter here and text of the letter below:

 

January 21, 2021

  

President Joseph R. Biden                                          Vice President Kamala Harris

The White House                                                        The White House

1600 Pennsylvania Ave NW                                      1600 Pennsylvania Ave NW

Washington, DC 20500                                              Washington, DC 20500

 

Dear President Biden and Vice President Harris:  

Thank you for your ongoing commitment to ramp up COVID-19 vaccine distribution and to make sure that all Americans who want a COVID-19 vaccine will get their immunizations.  I commend your American Rescue Plan, your commitment to an effective, equitable distribution of the COVID-19 vaccine, and your emphasis that all Americans access the vaccine cost-free.  I share this priority and believe we must protect all Americans from out-of-pocket charges for their COVID-19 vaccine.  With this letter, I would like to draw your attention to outstanding administrative barriers that may impede individuals who are uninsured or underinsured from their free COVID-19 vaccine without additional legislative and executive action.  

In response to inquiries on this topic, the Trump Administration has informed me that all COVID-19 vaccines purchased by the federal government will be provided at no cost to taxpayers.  Specifically, Surgeon General Jerome Adams stated that the Department of Health and Human Services (HHS), “…is committed to ensuring the vaccine is accessible to every American that wants one and that cost will not be a barrier.  Operation Warp Speed’s purchase agreements for hundreds of millions of vaccine doses ensure that the United States Government will be able to distribute this vaccine to the public at no cost to the patient.” 

However, despite these promises, Minnesota is still seeking federal funding to cover the cost of administering the vaccine, particularly for the uninsured and underinsured.  While it is expected that there will be no cost for the COVID-19 vaccine itself, providers are allowed to charge a COVID-19 vaccine administration fee.  Despite federal rulemaking to clarify this point, it is still unclear that all Americans—particularly the uninsured and adults on Medicaid—will be protected from charges for the COVID-19 vaccine or its administration.   

In October of 2020, the Centers for Medicare and Medicaid Services (CMS) released the relevant federal rule pertaining to out-of-pocket costs for the COVID-19 vaccine.  The interim final rule with request for comments (IFC) discusses CMS’s implementation of sections of the Coronavirus Aid, Relief, and Economic Security (CARES) Act that establish coverage and payment for the COVID-19 vaccine and its administration under Medicare and private health insurance.  However, the IFC leaves several unanswered questions about COVID-19 vaccine coverage for Medicaid beneficiaries and individuals without health insurance.  For these populations, the IFC states, “CMS is only describing current policy and existing law, and is not making any changes to current policy or regulatory requirements for these programs.”   

For Medicaid beneficiaries, the IFC relies on provisions enacted under the Families First Coronavirus Relief Act (FFCRA), which provides State Medicaid programs a temporary 6.2 percentage point increase in their Federal Medical Assistance Percentage (FMAP) during the public health emergency if they meet certain requirements.  One of these requirements is to cover the future COVID-19 vaccine and its administration for Medicaid beneficiaries. 

However, the temporary FMAP increase does not provide permanent, guaranteed coverage without cost-sharing for all Medicaid beneficiaries.  The IFC does not clarify what will happen to coverage and cost-sharing for Medicaid beneficiaries when the temporary increase goes away with the conclusion of the public health emergency.  Furthermore, States need additional federal financial support in order to cover additional costs for their Medicaid programs, which are expanding as more individuals lose their employer sponsored coverage as a result of the economic crisis caused by the COVID-19 pandemic. 

For individuals without health insurance, the IFC still does not provide clarity on their out-of-pocket vaccine costs.  CMS defers to an existing fund, formally called the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured Program, to reimburse for the COVID-19 vaccine and administration for individuals without insurance.  Unfortunately, due to a lack of outreach and education, reports show that uninsured patients and providers who serve them are often unaware of the existence of this fund for COVID-19 testing and treatment.  Furthermore, this fund is a limited pot of funding meant to cover the costs of COVID-19 tests, treatment, and vaccines for a growing number of uninsured Americans.  Without additional funding and intentional outreach and education, this fund does not protect Americans without health insurance.    

Clearly, there is still work to be done to make sure that no American falls through the cracks when going to receive their COVID-19 vaccine, and I stand ready to work with you on legislative and executive solutions to address this important priority.  My bill, the COVID-19 Treatment Coverage Act, provides a legislative solution that would protect Medicaid beneficiaries and uninsured individuals from the cost of their COVID-19 vaccine.  It would require Medicaid to cover and prohibit cost sharing for COVID-19 vaccines, guaranteeing that no one on Medicaid would be denied access to a potentially lifesaving vaccine during the pandemic.  My bill would also provide States with the option and financial incentive to expand Medicaid in order to cover the future vaccine for uninsured individuals.  Regarding executive solutions, I urge you to improve and invest in outreach to health care providers regarding the existing federal fund to reimburse for COVID-19 testing, treatment, and the future COVID-19 vaccine.  These federal dollars should be efficiently utilized for their intended purpose of protecting uninsured individuals from their out-of-pocket COVID-19 expenses. 

Thank you again for your commitment to deliver the COVID-19 vaccine to the American people as efficiently and equitably as possible.  Working together, I believe we can achieve our shared priority of protecting all individuals, regardless of insurance status, from charges for their COVID-19 vaccines. 

Sincerely,

Issues