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SEN. KASSEBAUM DRAFTING CHILD IMMUNIZATION BILL MINUS FEDERAL PURCHASE

Executive Summary

SEN. KASSEBAUM DRAFTING CHILD IMMUNIZATION BILL MINUS FEDERAL PURCHASE provisions contained in the Clinton Administration immunization plan introduced in Congress April 1. Kassebaum (R- Kan.) could introduce the bill as soon as the week of April 19, when the Senate reconvenes from the Easter recess. Kassebaum's proposal will focus on improving the immunization "infrastructure" and educational and outreach programs. While these strategies are also part of the Clinton plan, Kassebaum's emphasis is primarily on expanding existing programs and taking a "bottom-up" state- based approach, rather than a federally-driven one, aides explain. Discussions at the staff level have considered measures such as expanding Medicaid coverage and patient eligibility and raising reimbursement levels, as well as providing increased incentives for state "vaccine replacement" programs. These could include expanding funding for grants to states to purchase vaccines and making it easier for states to purchase vaccines at the Centers for Disease Control and Prevention's discount rates. Kassebaum could also ask to remove the Medicaid waiver requirement in order to participate in Merck's pilot project to provide vaccines directly to physician offices for immunization of Medicaid patients. Kassebaum will play a key role in debate on the immunization initiative in her role as the ranking Republican on the Senate Labor & Human Resources Committee. Committee Chairman Kennedy (D- Mass.) introduced as S 732 the portion of the Clinton proposal that comes under the committee's jurisdiction, including establishment of a registry to track vaccinations ("The Pink Sheet" April 5, p. 14). Senate Finance/Health for Families Subcommittee Chairman Riegle (D-Mich.) introduced a separate bill (S732) as the portion of the plan calling for HHS to negotiate federal purchasing contracts. Regarding the Clinton Administration plan for universal vaccine purchase, Kassebaum said in an April 1 Senate floor address that this "centerpiece" of the plan "misdiagnoses the causes of the problem and prescribes an ineffective and wasteful remedy." Kassebaum maintained that the "real problem, in short, is that too many parents do not know the value of immunizations, and those that do have a hard time finding accessible providers to deliver them. The supply of vaccines is not the problem. The problem is our lack of basic primary care services -- especially in rural and inner-city areas." Kassebaum added that "with this same $1 bil." that is the estimated cost of the purchasing plan in 1995, "we could nearly triple the number of community health centers currently operating in the United States." Kassebaum aides point to a just-released General Accounting Office report, "Opportunities to Improve Immunization Rates at Lower Cost," as supporting the senator's view that there is room to do more on the state level to improve vaccine supply and lower costs, particularly in Medicaid. "Nine states have established vaccine replacement programs in which health agencies purchase low-cost vaccines through CDC contracts and supply them free to Medicaid providers," a GAO survey found. These states achieved "substantial savings." For example, Illinois saved $1.5 mil. in 1991. Thirty states paid commercial prices for Medicaid-covered vaccines. GAO conducted a detailed review of 22 of these 30, estimating that they could have saved $12.7 mil. in one year if they had purchased Medicaid-reimbursed drugs at the CDC discounted price.
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