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In the midst of the country’s worst measles outbreak in 25 years, President Trump made an abrupt about-face on vaccinations.

Before becoming president, he had spread vaccination fears by peddling anti-vaccine tropes on Twitter and meeting with anti-vaccine conspiracists. When faced with the growing measles outbreak, the president seems to have changed his tune and now urges Americans to “get their shots.” Behind the scenes, though, his administration’s efforts could undermine public health efforts to ensure that children and adults get the vaccinations they need to prevent illness.

The current measles outbreak is largely blamed on unvaccinated schoolchildren. Parents opposed to vaccines have taken advantage of state laws that allow kids to skip vaccinations based on personal or religious reasons. This is a significant threat to herd immunity, the idea that the more people who are immune to a disease, either naturally or through vaccination, the harder it is for that disease to spread.


The administration’s anti-vaccine actions come, surprisingly, in a federal lawsuit over health insurance. The plaintiffs in that lawsuit, a group of Republican state attorneys general, are challenging the constitutionality of the Affordable Care Act’s individual mandate — the requirement that all Americans buy health insurance or pay a tax penalty. As a practical matter, the mandate is dead. In 2017, the Republican-controlled Congress reduced the mandate’s tax penalty to $0.

The attorneys general are trying to use the dead mandate to kill off the Affordable Care Act. They claim that the lack of a tax penalty renders the mandate unconstitutional. If the mandate is unconstitutional, they argue, the entire Affordable Care Act must be scrapped. In a stunning decision, a federal judge in Texas agreed and the case is now on appeal.


This case, however, is not just about insurance coverage. The Affordable Care Act also promotes public health by, among other things, requiring health insurance plans to cover federally recommended vaccines with no out-of-pocket costs. In other words, the Affordable Care Act makes essential vaccines affordable by barring insurance companies from applying copays, coinsurance, or deductible requirements for vaccinations.

In a surprising twist, the Trump administration, acting through the Department of Justice, has thrown the full weight of the federal government behind the attorneys general. The entire Affordable Care Act, the administration argues, should be struck down.

If this bid is successful, it will strip 20 million Americans of their health insurance. Without coverage, they will have to pay full retail price for vaccines. Even for families that keep their coverage, insurance companies will no longer be required to pay for vaccinations with no out-of-pocket costs. Since many health insurance policies include a significant deductible, many insured families will bear the full costs of vaccines until they’ve met their deductible limit.

This would make vaccinations a serious financial burden for many families. Vaccine costs have risen over the last two decades. The cost to fully vaccinate a child up to the age of 18 is now more than $2,000. The retail price of adult vaccines for commonly preventable diseases is also quite high. For example, some adults — those born between 1957 and 1989 — may not be adequately protected against measles even if they received measles vaccines as children. Those who want an MMR (measles, mumps, rubella) vaccine will have to pay for it themselves. Some retail prices for the MMR vaccine exceed $100 per dose.

Trump’s actions will also make it harder for older Americans to get other recommended shots, including annual flu shots, tetanus-diphtheria boosters, and shingles vaccinations. A shingles vaccine, recommended for those 50 and older, costs $140. A tetanus and diphtheria booster, recommended every 10 years, can cost $55. The retail price of annual influenza shots ranges from $20 to $40. Yearly flu shots for a family of four could cost $80 to $160.

Many families can’t afford these expenditures.

A report on the economic well-being of U.S. households by the Federal Reserve found that a significant number of Americans are financially insecure. Forty percent of U.S. adults faced with a $400 emergency expense would need to borrow or sell something to pay the bill. Nearly one-quarter of adults forgo payment on some of their monthly bills, even without an unexpected expense. If forced to choose between vaccines and rent or food, the choice for many families is easy: no vaccines.

Immunizations are vital to the public’s health. That’s why the Affordable Care Act required insurance companies to cover vaccinations with no out-of-pocket costs. In light of the resurgence of measles, the Trump administration ought to be taking steps to expand access to vaccinations, rather than trying to make them unaffordable.

John Aloysius Cogan Jr. is an associate professor of law and the Roger S. Baldwin Scholar at the University of Connecticut School of Law.

  • I am not an ANTI VAXXER, HOWEVER I am in favor of CLEAN VACCINES ONLY! So as it stands now with BIG PHARMACEUTICAL COMPANIES BEING PROTECTED BY ILLEGAL LAWS WRITTEN IN 1986 THAT GO AGAINST THE CITIZENS AND ARE FOR BIG CORPORATE INTERESTS, I certainly hope vaccines do take a “hit”, until the pharmaceutical industry is lawfully forced to be accountable for the hazardous pollutants they use to preserve vaccine shelf life – instead of using alternative means of which there are plenty, I stand firmly AGAINST MANDATORY VACCINES! It is not the vaccination itself – not the concept I have trouble with, oh no, not AT ALL!! it is the way they use LETHAL PRESERVATIVES, toxic chemical compounds btw, to produce them cheaply and profit handsomely while never being held accountable! That’s a human rights violation if I ever saw one! Give us clean vaccines and I’ll be the first one in line to get mine!!

  • Vaccine manufacturers are making record breaking profit on vaccines, mostly due to the fact that they’ve paid the government for immunity for all lawsuits. With this in mind, no vaccine should cost more than $10. If it really is a “public good” that tax payers are subsidizing ( and we’ve paid over $4 Billion for all vaccine injury cases), then vaccines should be cheap.

  • If vaccines are so safe, why are the vaccine makers free from liability? All you have to do is read the vaccine label or insert to find out all the possible side effects to the toxic ingredients. The MMR II product insert acknowledges that death is a potential side effect from the vaccine, along with a long list of other potential permanent injuries. Are vaccine injuries or death rare? Are vaccine injuries or death one in a million? Just go to the U.S. CDC’s VAERS Database where you will find for 2018 in the U.S.:
    60,544 Reports of Injuries including:
    443 Deaths
    267 Permanent Disabilities
    4,414 Hospitalizations
    According to a Harvard study payed for by the CDC, less than 1 % of injuries and deaths are reported to VAERS. So the projected actual numbers are:
    44,300 Deaths
    26,700 Permanent Disabilities
    441,400 Hospitalizations.
    Those numbers are not 1 in a million. How many lives must be sacrificed for the mythical herd immunity? The only emergency is that people need to wake up sooner to Big Pharma’s fraud.

    • 1) Vaccine makers are free from liability in order to keep the cost of known safe products down. The margins are not sufficient to defend yourself from all the inevitable nuisance cases which will be filed, 2) The vast majority of reports to VAERS turn out NOT to be related to the vaccine, and 3) Your projections are not statistically valid. The more serious the side effect the more likely it is to be reported. Finally, its been proved over and over again: far more people die from the lack of vaccinations than from getting vaccinations.

  • Trump’s administration hop-scotches through law changes without any decent acceptable replacement presented. Crash and burn fast, and figure out much later how to fix it – which in the interim (with thousands potentially NOT getting vaccinated) renders Herd Immunity dangerously jeopardized. It is shocking that high-earning politicians do not seem to care one iota about those that do not have the same ridiculously deep pockets. TAX THE RICH !!!! and step up on health programs that benefit ALL Americans. Otherwise “the land of the great” won’t be great at all.

    • The Administration’s healthcare proposals were a good starting point (and a major improvement over the ACA). If legislators on both sides of the aisle used it as such and improved upon it we all would have been better off. You are correct about vaccinations being critical but wrong in saying the proposals jeopardized them. Also, you are only partly right about politicians…they don’t care about the average American or people with deep pockets. They only care about themselves and getting re-elected. Unfortunately, that typically means obstruct the party other no matter how harmful the results. “TAX THE RICH” is a very myopic point of view. History has shown that increasing taxes on the wealthy results in job losses and more harm to the less fortunate. While there may be some capacity to raise taxes on the mega-wealthy, it must be done in a careful manner as to not disrupt the rising economy which has resulted in benefits to the vast majority of Americans.

  • Why no mention of the actual number of cases in the measels outbreak? Because it would be so easy to ridicule this propaganda? The author found himself a two-for-one here.

  • Stop trying to scare people with half truths. As you are fully aware, the objective of overturning the ACA is to provide a more efficient replacement. If the litigation is successful, there will be a transition period. Congress will be forced to enact a replacement. There is no way there will be a lapse in coverage. Every proposed legislation from the Republican side over the prior 2 years covered vaccinations as well as pre-existing conditions. Scare mongering is not helpful and will not lead to a much needed solution.

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