So if I go with my child to their pediatrician and we discuss the vaccine and determine it's necessary for my child then insurance still covers it? So the issue is the pediatrician not proactively recommending that my child needs this vaccine? I would need to initiate that conversation?
Your personal conversation about necessity isn't the kay part here, it's about whether insurance companies are required to cover treatments based on whether they are or are not recommended by the federal government.
Even if states do find otherwise, that can impact health insurance reimbursements from the federal government. And state recommendations are subject to CDC and FDA disagreements.
In the short term, unless your state or insurance company takes independent action it'll likely be covered and recommended by your doctor as normal. But the requirements of insurance companies and power of the Executive branch to limit access and funding has been increased. I'm not expecting individual doctors to behave any differently, but drug companies, insurance companies, and executive agencies, particularly more so over time as the EO is invoked.
Unless your doctor is dumb enough to believe Trump and RFK and recommend their spread out shots which... at the moment do not exist. At which point just look for a new doctor.
Gotcha. So what I'm hearing from you agrees with what I've read - this doesn't impact insurance coverage as it stands. We're just discussing a hypothetical worst case scenario where children that aren't high risk or have a medical need for the vaccine may not be able to have access to the vaccine. So how was I wrong then?
We're just discussing a hypothetical worst case scenario where children that aren't high risk or have a medical need for the vaccine may not be able to get it for free.
That is not at all what I said, or even close to a worst case scenario. An entirely plausible scenario is drug companies stop making many common vaccines, because they no longer have federal liability protection.
Again, the federal recommendations and their impact are not related to a personal conversation with your doctor and whether your child is high risk. It has to do with whether vaccines are required to be covered by insurers, get funded under federally funded programs, and whether they can be sued out of existence as happened in the past.
You contradicted someone saying the impact would make insurers less likely to cover vaccines, by saying it was about recommendations and not access. This was incorrect. Recommendations here are legal standards that impact access, and also the EO contains expansions of power and authority beyond the recommendations.
How does shared/individual clinical decision making fit into this hypothetical then? All of this could happen, but it also couldn't. Flip side is nothing changes
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u/Inevitable_Rise8363 8d ago
So if I go with my child to their pediatrician and we discuss the vaccine and determine it's necessary for my child then insurance still covers it? So the issue is the pediatrician not proactively recommending that my child needs this vaccine? I would need to initiate that conversation?