Affordable Care Act (ACA)

The Affordable Care Act (ACA), sometimes negatively referred to as "Obamacare", is aimed at increasing the level of health insurance coverage for Americans while reducing the overall costs of health care. The Health Insurance Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.

The ACA has some key components that impact on immunization delivery to America’s citizens. A key provision in the effort to see that all citizens are immunized with disease preventing vaccines is a provision that took effect on September 23, 2010 to cover preventative services and eliminate cost sharing. Specifically this provision states that all new insurance plans must cover both childhood immunizations and adult immunizations as recommended by the Advisory Committee on Immunization Practices (ACIP) without charging a co-payment, co-insurance, or a deductible when the vaccine is provided by an in-network provider.

Beginning on September 23, 2010 children up to age 18 years that are enrolled in new group or individual private health plans became eligible to receive any of the vaccines that the ACIP recommended prior to September 2009. Any new ACIP immunization recommendations that go into effect after September 23, 2009 are required to be covered by health plans in the next plan year that occurs one year after the effective date of the ACIP recommendation.

In addition to expanding access to immunization, the ACA:

    -provides states with the authority to purchase adult vaccines with state funds from the federally-negotiated vaccine purchase contracts;

    -reauthorized the Section 317 Immunization Grant Program through which 64 grantees including the 50 states, six large cities including the District of Columbia, five territories, and three Pacific Freely associated States receive block grants to run their immunization programs; and

        -requires that the General Accountability Office (GAO) study and report to Congress about Medicare beneficiary access to recommended vaccines under Medicare Part D benefits.


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