How Trumpcare Will Affect Vaccination Rates

by Keiko Zoll

With the Senate returned from its July Fourth congressional break, the fate of its health care replacement bill remains uncertain. Senate Majority Leader Mitch McConnell failed to secure a critical vote from his Republican colleagues before they departed for the holiday and now that the Senate is back in session on Monday, there's no clear path forward to a successful vote on the critical legislation. According to the Congressional Budget Office, the Better Care Reconciliation Act will leave 22 million more Americans uninsured in the next decade — but it could have even longer lasting and more dire impacts on American public health. Here's how Trumpcare will affect vaccination rates.

According to the Centers for Disease Control and Prevention, the vaccination rate for children in the United States is at 72.2 percent for completed combined 7-vaccine series, specifically looking at kids aged 19 to 35 months old. These seven vaccines target some of the worst childhood diseases that can easily be prevented by proper immunization, including measles, pertussis, and polio. Under the Affordable Care Act, CDC-recommended vaccines had to be covered by health insurers, at no cost to the patient through co-pays or deductibles. Vaccination coverage is part of the ACA's essential benefits that fell under preventative care. The Senate health care bill guts essential benefit coverage, putting vaccination rates at critical risk.

As of 2015 data from the CDC, the vaccine rate for the DTaP vaccine that protects against diphtheria, tetanus, and pertussis approaches 85 percent. The MMR vaccine rate — measles, mumps, and rubella — is nearly at 92 percent. These are incredibly important numbers, where even one-tenth of a percent can make a world of difference within local communities. It all comes down to herd immunity, which those who are too young to be vaccinated or are otherwise medically compromised to receive vaccines must rely on in order to prevent contracting these vaccine-preventable diseases.

Different diseases have different herd immunity thresholds at which vaccination rates make it extremely difficult for the unvaccinated to contract these diseases. Diphtheria only needs an 85 percent vaccination rate to trigger herd immunity in any given community, while pertussis — more commonly known as whooping cough — needs as much as 92 to 94 percent, according to NOVA. Meanwhile, measles has a much broader herd immunity threshold, from 83 to 94 percent.

According to Scientific American, the risks posed by lowered vaccination rates as a result of the Affordable Care Act health care replacement bill far outweigh the cost savings the GOP has proposed. In addition to allowing states to apply for essential benefit waivers, there's an even more direct assault on vaccination funding within the Senate bill: It would slash all funding from the Prevention and Public Health Fund, a fund that helps finance childhood vaccinations. Study after study shows that when health care is too costly, people don't go to the doctor — even for something as critical as childhood vaccines.

Even though President Donald Trump claimed "Nobody knew health care could be so complicated," vaccination rates and health care outcomes are all a numbers game — and it's nothing more complicated than simple math. When vaccinations go up, the spread of vaccine-preventable diseases goes down. If we make it harder for Americans to vaccinate their children due to cost, then the spread of these diseases are likely to increase.

With Trumpcare gutting funds and health care coverage, there will be little to no money left in public health coffers to fight community outbreaks — much less in parents' wallets to treat sick children who should have never contracted these preventable diseases in the first place.