to be associated with adverse health outcomes (IOM, 2002). The committee believes that it is one of the safest vaccines available. The efforts of groups opposed to vaccination present a serious obstacle to comprehensive vaccination coverage, which is essential for the prevention and control of hepatitis B in the United States.

Payment for Vaccines
Insurance Coverage

Health-insurance coverage for the nonelderly population (less than 65 years old) is provided by employers (63%) and public programs (11% by the Medicaid/Children’s Health Insurance Program and 2% by other public programs) or is acquired by individuals in the private market (5%) (Holahan and Cook, 2008). Some 17% of Americans under 65 years old were reported as chronically uninsured in 2007, but as many as one-third of Americans were uninsured for at least some of the time in 2007–2008 (Families USA, 2009b). Robust coverage for vaccinations, including hepatitis B vaccination, is provided by public insurance plans (Table 4-5). Private insurance plans have variable coverage for vaccinations and various degrees of cost-sharing. Insurance coverage for vaccinations also varies substantially with age: children under 5 years old and people 65 years old and over have high rates of private or public coverage (89% and nearly 100%, respectively). People 18–64 years old have much lower rates (50%) because of lack of insurance, inadequate insurance, and the absence of a public safety net for recommended adult vaccinations (IOM, 2003).

Insurance coverage has been demonstrated to have an important impact on access to preventive and other health services and on health outcomes (IOM, 2009). Studies in children involving various vaccine series, including hepatitis B vaccine, and in adults transitioning to Medicare have shown notable increases in vaccination rates in those with insurance coverage (IOM, 2009). In an NIS sample of children 19–24 months old, recommended vaccination completion rates were found in 76% of the children covered by private insurance, 70% of the children covered by Medicaid or the Children’s Health Insurance Program (CHIP), and 53% of uninsured children (Smith et al., 2006b).

Public Vaccine Programs and Insurance

Vaccines for Children program. Children with no private insurance may be covered up to the age of 18 years by the Vaccines for Children (VFC) program administered by CDC (CDC, 2003). The VFC program was created by the Omnibus Budget Reconciliation Act of 1993 as a new



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