Image: Chris Nicholls/ALM
The new battle over what people under age 65 have to do to get a COVID-19 vaccine shot this year supports an idea that I wrote about in June: Health policy shapers just aren't that into employers.
Employers account for about 27% of U.S. health care expenditures, and patients' own pockets account for about 10%, according to government national health expenditure projection tables.
But members of Congress rarely talk much about fully insured group health coverage these days, let alone employers' self-funded health plans, when they hold general hearings about health care, health care costs or nominees to run federal agencies that have something to do with health care costs.
Robert F. Kennedy Jr., the secretary of the U.S. Department of Health and Human Services, has serious concerns about U.S. vaccination programs and wants to put them on a course.
He is trying to eject Susan Monarez, the director of the U.S. Centers for Disease Control and Prevention, because she disagrees with the vaccination program changes, according to press reports.
Related: Trump Administration ousts CDC director over vaccine policy
Certainly, cabinet secretaries have shaken up federal policies before and will again.
Kennedy must have engaged in discussions with a wide range of stakeholders, including employers, benefit plan groups and patient advocacy groups, when preparing for this change, and HHS must have posted many big PDF files full of accounts of those conversations. Right?
So far, I haven't found those PDF files.
Kennedy seems to be reshaping U.S. vaccination programs by putting the U.S. Food and Drug Administration on a new course and by replacing many members of the Advisory Committee on Immunization Practices.
The Democrats are out, the Republicans are in, and Kennedy must have used the ACIP membership overhaul to add members from the U.S. Chamber of Commerce, the American Benefits Council, the ERISA Industry Committee or, maybe, the National Association of Benefits and Insurance Professionals, right?
As far as I can tell from looking at the ACIP member list website, there's no clear indication that any ACIP member has ever held a significant job outside of the worlds of government, health care delivery, academia or medical research.
The situation seems to be similar in the area of medical research policy advice.
The administration of President Donald Trump has reduced spending on many types of medical research mid-project and moved to cancel long-running medical research programs at some universities.
The closest thing the CDC's Advisory Committee to the Director has to an employer or patient representative is the chief health officer of Kaiser Permanente, a managed care company.
At the National Institutes of Health, the Novel and Exceptional Technology and Research Advisory Committee, or NExTRAC, includes no employer or patient advocacy group representatives.
Maybe, after reviewing all of the evidence Kennedy considered, employer representatives on advisory bodies like those would have ended up coming to similar conclusions. Or, maybe they would have suggested that, as much as they hate tax bills and federal budget deficits, they still want to provide generous funding for cancer research and Alzheimer's research.
But employer reps apparently had little official chance to weigh in, either way, because, officially, at least, the employer reps haven't been much of a presence in the highest-level rooms where the vaccine-policy and research-funding advice creation happens.
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