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Why So Few Kids Are Getting the HPV Vaccine
Why So Few Kids Are Getting the HPV Vaccine
"Most places don’t like to think about teens having sex." But that's not the only reason.
BY MATTIE QUINN | NOVEMBER 18, 2016 | GOVERNING
In the decade since the U.S. Food and Drug Administration approved the vaccine for the human papillomavirus (HPV), it’s been a tough sell for states, students and their parents.
“It’s a tricky issue to raise. Most places don’t like to think about teens having sex,” said Dorit Reiss, a professor at the University of California, Hastings, who specializes in vaccine law.
As of 2014, only 40 percent of teenage girls and 22 percent of teenage boys have completed the three doses necessary to be protected against HPV, a sexually transmitted infection that most people contract at some point in their lifetime. While it doesn’t cause long-term health problems for most, some strains of the virus can cause cervical cancer.
Only Rhode Island, Virginia and the District of Columbia require the vaccine for students. By comparison, eight years after the meningitis vaccine was approved, 29 states and D.C. had approved school requirements.
The slow adoption isn't for a lack of trying, though. According to the National Conference of State Legislatures, 41 states have introduced legislation that would either require the vaccine or educate students about its benefits.
In Rhode Island's case, it wasn't legislation that required students to get the vaccine. Instead, the health department added the vaccine to the list of mandatory immunizations for middle school students.
So far, the mandate has been successful: 88 percent of teen girls and 80 percent of teen boys received their first dose in 2015.
Rhode Island lets families opt out for religious and medical reasons. So does Virginia, but there, the opt-out option is partially why the mandate hasn’t had much of an impact.
“Opt-outs have been more the rule than the exception,” according to a news release from the University of Virginia.
Virginia also only requires girls to get the vaccine, and in 2014, just 28 percent of teenage girls got all three doses.
Experts blame the low immunization rates, in part, on the fact that the vaccine has to be given in three rounds (unless you're younger than 13). Sometimes, it’s tough to get people back to the doctor’s office that many times in a roughly one-year period.
Despite the low immunization numbers across the nation, Nicole Alexander-Scott, the director of Rhode Island’s health department, is optimistic that states are at a tipping point. She’s been in talks with her health counterparts in New England who are “thrilled with the results we’ve obtained."
"It used to be controversial to give the hepatitis B shot to infants," said Alexander-Scott. "The more we can normalize it for families, I’m confident in time [that] rates will increase.”
But Reiss, the law professor, thinks it will be difficult to raise immunization rates -- especially in socially conservative states.
“When you wage the battle on sexual nature," she said, "it’s going to be problematic."
Friday, November 18, 2016
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As Repeal Looms, Providers Worry About Value-Based Payments
As Repeal Looms, Providers Worry About Value-Based Payments
By Erin Mershon, CQ Roll Call, November 10, 2016
Republicans that will control the federal government are itching to repeal President Barack Obama's signature health care law. That effort, however, potentially could hamstring ongoing bipartisan efforts to transition the way Medicare pays doctors towards payments based on quality, not quantity.
Republicans who talk about repealing the health law (PL 111-148, PL 111-152) traditionally focus on the provisions of the legislation focused on health insurance, like the law's public exchanges and coverage regulations. But the health law also overhauled the way Medicare pays doctors in an effort to encourage efficiency and better control health care costs across the country.
Those efforts are far more popular among Republicans than the rest of the law. Indeed, a bipartisan package of further changes to Medicare (PL 114-10), or MACRA, which replaced a much-maligned physician payment formula, passed with plenty of bipartisan support last year. That law centers on rewarding doctors in so-called alternative payment models, like accountable care organizations, many of which were initially set forth in the health law.
But the uncertainty surrounding repeal has providers' groups and other policy experts worried. With repeal on the table, providers will be reluctant to enter into a new contract with the government to change the way it provides care, several provider groups and lobbyists predicted.
"I wouldn't be surprised if you see a retrenchment among health care players. They're saying, 'I'm not going to make these tremendous investments in this thing called value, given the uncertainty about where 20 million people's insurance coverage is.' If you have some stability in insurance market you can make these investments," said Chet Speed, vice president for public policy at the American Medical Group Association. "But now that that's up in the air, I think you see some people sort of slow down this transition to value and see how things shake out."
Fueling much of the concern is an ongoing, Republican-led effort on Capitol Hill to limit or entirely repeal the Center for Medicare and Medicaid Innovation, which was created by the health law to test ways to improve care and save money. Republicans see it as a representation of the Obama administration's overreach of executive authority, and calls to limit or abolish it had increased before Trump won the presidency.
CMMI is controversial in part because it has proposed a new way to pay for drugs that doctors provide in their offices, the so-called Part B drug model. That and other mandatory models for how hospitals are paid for complicated procedures like hip and knee replacements have angered pharmaceutical companies, hospitals and doctors groups.
The effort to repeal CMMI, which had been something of a nonstarter under Obama, may get a boost as President-elect Donald Trump lays out plans to repeal the health law. Until now, that effort had been stymied in part by Democratic opposition and in part because a federal budget expert determined CMMI would save $34 billion over a decade, making it expensive to eliminate.
"On the one hand, they may be for the same kinds of value-based purchasing, but are they really likely to stick with the current architecture, considering their concerns about the way that CMMI was developed?" asked Chip Kahn, president of the Federation of American Hospitals. "I don't know what they will be able to unroll in the ACA, so I think it's too early to say. There are specific areas where they probably have no policy problem with various reform provisions, but you know, just the discussion that Republicans had around CMMI ... illustrated a basic concern that they have with the architecture of the" health law.
Republicans on Capitol Hill caution that the party's most serious efforts to repeal the health law -- such as the reconciliation bill they passed through both chambers earlier this year -- don't repeal the delivery system reform and cost-cutting parts of the health law. One Senate Republican aide said it was premature to consider what parts of the law might be repealed before lawmakers could meet to discuss the issue.
Retain but Redirect the Center?
Several lobbyists also suggested that Republicans might eye the power available in CMMI and decide to keep it, now that a Republican holds the White House. That broad authority could be used to test Medicare premium support proposals or other GOP policy priorities that haven't gotten attention or support in the past.
It's also possible Republicans could limit the center's more controversial actions or roll back some of the mandatory payment models that have chafed industry groups, several experts said.
Even if they don't repeal major delivery system reform portions of the law, however, Republicans are unlikely to authorize the kind of funding that ongoing delivery system changes need, said Bob Berenson, an Urban Institute senior fellow who sits on an administration panel aimed at helping to implement the Medicare overhaul.
"They could do away with the Innovation Center and they could conceivably substitute an office for managing the [payment demonstrations]," Berenson said. "But MACRA requires a very active innovation center or its equivalent. . . . It suggests that lawmakers want a whole proliferation of models. How do you do that with a little office? If anything, I'm critical of CMMI right now because their evaluations are superficial; they need more resources to do this right. You can't do this on a shoestring out of the old Office of Research Development and Information with a small staff."
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