Crow Wing County ends public health immunization program
Last year, Crow Wing County provided immunization shots for 160 children in families where insurance didn’t cover the shots.
That will end April 30. Crow Wing County commissioners voted unanimously to end its immunization program.
Gwen Anderson, health and social services division manager, said for many years the county had a robust immunization program but the number of people served — without insurance or underinsured — declined.
With the onset of the Affordable Care Act (ACA), Anderson said the hope is more people will now be covered for preventative care with primary care physicians.
Karen McKenna, a health department employee in accounting, has been involved with the immunization program for 20 years. She said ending it won’t affect her job or mean job reductions at the county as employees take on other duties. McKenna said she understood it was a done deal but there will be people who fall through the cracks.
“I think you are doing a great disservice to the community,” McKenna said of discontinuing the program.
The county is changing its role from directly providing the service to one of assisting people on how and where to apply for help.
“It’s important for county residents to receive preventative services from their primary care physicians and one component of that is getting their vaccinations to protect themselves and others from preventable diseases,” the county stated Tuesday in a document prepared for the motion to end the program.
McKenna told the commissioners she knows they are careful with taxpayer money, which is her money as well, but ending the immunizations is a cost neutral proposition.
“I really believe that you are discontinuing a program that is seen by the general public, families, as a positive program in that Communtiy Services building,” McKenna said. “I know it is not going to change anyone’s mind ... but I needed to say this. Sometimes there are positive things that a community needs to maintain and I believe this is one of them.”
Commissioner Rachel Reabe Nystrom thanked McKenna for expressing her feelings before the board.
SERVING THE UNDERINSURED
The county has been a Minnesota Vaccines for Children provider to vaccinate the underinsured children.
“Eventually the number of underinsured children will decrease as the parent’s insurance companies lose their ACA ‘grandfather status,’ which occurs as the company makes a major change. ... At this time it is too soon to know when these adjustments will occur and how many children fall into this category in Crow Wing County.”
Because immunizations are required for school children, the county will be able to track the data from state health reports.
Public health is able to access lower cost vaccine and thus charge less for it than private clinics. A $300 shingles shot for example could be reduced to a $10 cost. As adults obtain insurance coverage they will have primary care physicians and access to immunizations.
“Until this category of adults get other insurance coverage this change will leave some adults unable to afford immunizations,” the county reported. “In the meantime, this will be a population we will continue to provide outreach to so they know where to go to apply for insurance.”
People with Medicare Part B insurance will have limited vaccination coverage for influenza and pneumonia. Shingles, tetanus, diphtheria and pertussis and hepatitis A and B will not be covered. “Ending the immunization program at public health will leave this population without affordable access to these vaccinations,” the county staff reported. “In 2013, we provided direct service to 183 people in this category.”
Anderson said the Merck vaccine patient assistance program will cover certain vaccines, including shingles, for people who meet income requirements.
The county will continue encouraging community resources to offer this service to customers, county staff reported. Last year, the county worked with 24 people to get the shingles vaccine this way.
The county will also stop Mantoux testing and refer people to local clinics or their doctors.
LESS THAN 1 PERCENT
Anderson said there may be a gap in time after public health stops providing services and when people are covered by insurance.
Commissioner Paul Thiede said the number of people affected account for less than 1 percent of the population and it seems the county could provide immunizations to all of them at less than it’s spending now. He questioned why the county needed a program for a population that primary care physicians will see at some point.
Anderson said for some people it becomes an affordability issue, such as the shingles shot, and there will be people who go without. She said the safety net served is small, serving 700 in 2013, but it is still a safety net.
Also 250 county employees received flu vaccine from the county and shingles and pneumonia vaccines.
Board chairwoman Rosemary Franzen said all of the employees have insurance that can cover those shots. Anderson said some part-time employees are not covered. Community Services Director Kara Terry noted there are many providers for immunizations including Walgreens.
WHAT IS CONTINUING
After April 30, the county will continue to:
• provide direct care to people with active tuberculosis.
• maintain the Minnesota Immunization Information Connection record system for county residents.
• follow a state mandate to check with clinics to make sure clinics are providing a standard level of immunization.
• direct employees to their own doctors to provide hepatitis B immunizations for county staff members whose jobs put them at risk as federally mandated. For few exceptions, the county will provide vaccine directly or coordinate with a local clinic.
• provide public health emergency response for large scale infectious disease events such as the H1N1 pandemic influenza.
In her report, Anderson said “with a program change such as this it’s important for the public’s health that we continue an assurance and surveillance role in our community.”