Tuesday morning, Senate Finance moved a Committee Substitute for Senate Bill 37 out of committee. The bill reauthorizes the statewide immunization program in the Department of Health and Social Services (DHSS), which purchases childhood vaccines and some adult vaccines for distribution statewide, and is funded by the state’s Vaccine Assessment Account through upfront fees from health plans and insurers. The program is set to expire January 1, 2021.
“Alaska had a universal vaccine coverage program for over 30 years, utilizing federal funds that were secured by Sen. Ted Stevens,” SB37’s sponsor, Sen. Cathy Giessel (R-Anchorage) told colleagues in the Senate Health and Social Services Committee last month. However, when Stevens failed to secure reelection in 2008, that funding went away the following year. This meant that funds used previously by the State to stock and distribute a human papillomavirus (HPV) vaccine and a meningococcal vaccine for all children were no longer universally available in state. In 2012, the State also discontinued supplying pediatric influenza, pneumococcal vaccine, and rotavirus vaccine. In all, federal aimed at keeping vaccinations stocked and accessible dropped from $4.3 million in 2010 to just $700,000 in 2013.
Giessel sponsored SB144 in 2012. The measure served as a stopgap, temporarily reinstating the child and adult immunization program within DHSS with the goal of “[preventing] and [controlling] vaccine-preventable diseases in Alaska.” There was a yearly price tag of $4.5 million to the State.
“SB144 is a short term measure to ensure availability of vaccines until a more permanent solution can be reached,” Giessel said of the bill. “The health and healthcare of Alaskans is an important issue, and SB144 provides a temporary solution for the growing problem of unnecessary exposure to and spreading of disease.” SB144 was eventually passed, via the House version of the bill (HB310). With 24 co-sponsors, it passed unanimously in both chambers.
Giessel followed SB144 up with SB169 in 2014, establishing the statewide immunization program and the State Vaccine Assessment Council. It also passed both the House and Senate unanimously.
“The program began under its own steam on January 1 of 2015,” Giessel continued. “It is due to repeal, or sunset, in 2021. It is a successful public-private partnership.”
The program assessed the costs of vaccines that it planned on purchasing the following year, and then used bulk purchasing to attain them at a 20 to 30 percent discounted rate before distributing them.
“This creates a much smoother system for those health care providers, in terms of the vaccine supply,” Giessel said. “They don’t have to purchase supply on their own for certain types of Alaskans – whether they’re under-insured or whatever – it’s all supplied in one stock.”
The effects are quantifiable. Vaccination coverage for children under the age of two, adolescents between the ages of 13 and 17, and adults 65 or older has markedly increased since 2015, most visibly noted via HPV vaccine rates among adolescents, with one cohort jumping from nine percent coverage in 2013 to 40 percent in 2017 (averaging all cohorts within HPV vaccinations, there has been a 90.5 percent increase spanning the same years).
By the end of 2018, it covered more than 330,000 Alaskans – nearly half the total state population.
“Next to clean drinking water and good nutrition, vaccines have saved more lives than any other public health intervention,” Giessel touted in her sponsor statement. And, according to the Alaska Vaccine Assessment Report, 2017-2018, the program pays for itself, with revenues matching costs dollar for dollar.
Renewing the program in a way that makes it both sustainable and permanent has become an imperative given a recent outbreak of measles in the Lower 48.
Between January 1 and March 7 of this year, the U.S. Centers for Disease Control have received 228 measles cases in 12 states – the largest spike since 2014 (which was anomalous due to a majority of cases being isolated to unvaccinated Amish communities in Ohio). The resurgent disease, thought to be eradicated from the United States, prompted Washington’s governor, Jay Inslee, to declare a state of emergency in January. One out of four people who contract measles will be hospitalized; between one and two out of every 1,000 die.
Alaska has not had any confirmed cases of the measles this year, but is at high risk given outbreaks in Washington, Oregon, and Hawaii, prompting a January Alaska Public Health Advisory to “encourage Alaskans to be up-to-date with [Measles-Mumps-Rubella] MMR vaccination.” That advisory came on the heels of another, issued in February of last year, warning of an in-state outbreak of mumps (there were over 200 confirmed cases in Alaska in 2018).
SB37 switches the vaccine assessment – currently an account – to a fund, a change made at the suggestion of the Division of Public Health. Juli Lucky, staff to Sen. Natasha von Imhof (R-Anchorage), explained that the move would make the program more nimble.
“The assessment council can increase the rate to cover new vaccines or an outbreak without looking for more legislative action, such as a second appropriation,” Lucky explained to Finance Committee members Tuesday morning. “The council can already raise the rates, and so this would allow them to respond to things such as outbreaks or new vaccines as they come available.”
SB37 also gets rid of the sunset date, making the program ongoing.
“The CS for SB37 not only extends the life of the program, it reestablishes it as a fund capitalization rather than it’s current status as a fund transfer. The current method requires the legislature to make an open-ended appropriation to the fund. And that would be the assessments that go into that fund,” Legislative Finance Director David Teal detailed further, saying that a commissioner of the would-be fund would replace the legislature when it came to spending. “If there were to be an outbreak of some – let’s say flu – and they needed more vaccines, this would allow the assessment to increase. If it wasn’t needed, the department could still purchase those vaccines without coming back to the legislature for action, freeing up money for them to make the purchases. So, I think it’s simply an improved fiscal mechanism.”
Teal noted that the CS for SB37 made it a designated – but not a dedicated – fund. The distinction is important: Article 9, Section 7 of the Alaska State Constitution provides that, with exception to the Alaska Permanent Fund, “the proceeds of any state tax or license shall not be dedicated to any special purpose[.]”
“The constitution requires that the general fund and all sub-funds be swept into the Constitutional Budget Reserve [CBR] fund at the end of the year,” Teal said, referring to what is colloquially known as a CBR sweep. “Without a reverse sweep, the Worker’s Safety Fund, the alcohol funds, would be swept into the CBR not available for use for their intended purposes…. This fund would be one of those that’s spendable without further appropriation and would not be swept into the CBR.”
“Does it give you pause that, as we’re looking through this bill, we’re giving more and more power to the administration… to have something like this going on?” Sen. Donny Olson (D-Golovin) asked.
“In this case it does not. The legislature is not removed from the process. You still have to appropriate money to the fund,” Teal responded. “It allows the commissioner to respond rapidly. If there is an outbreak, you don’t need further legislative action…. In this case, I think you have a program that’s proven to work and the fiscal issues of how much is spent on vaccines doesn’t give me pause because the money being spent comes from the insurance providers, not the state.”
Letters of support from representatives of the All Alaska Pediatric Partnership, Aetna, Premera Blue Cross Blue Shield of Alaska, the American Academy of Pediatrics – Alaska Chapter, and others bolstered support for the proposal.
Senate Finance moved SB37 out of committee. It cleared its first committee of referral, Senate Health and Social Services, early last month. Senators David Wilson (R-Wasilla), Tom Begich (D-Anchorage), John Coghill (R-North Pole), Gary Stevens (R-Kodiak), and Giessel all recommended passage. Unless it is assigned another committee referral, the bill’s next stop is the Senate floor.
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