Some May Struggle to Get a Free COVID Vaccine

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It’s fall vaccine season and once again, it is recommended that all adults (and kids) get vaccinated against COVID-19 (as well as flu and, for some, RSV).  Due to the Affordable Care Act and the Inflation Reduction Act, almost everyone with private or public insurance is guaranteed free access to any CDC-recommended vaccine, including COVID-19. However, for the more than 21 million uninsured non-elderly adults, there is no such guarantee. An exception was made during the COVID-19 public health emergency, with emergency funding enabling the federal government to purchase all COVID-19 vaccine doses and make them available free to everyone. After the emergency ended, the government set up a temporary “Bridge Access Program” to provide COVID-19 vaccines to uninsured adults, but that program has now ended.

For adults who are uninsured, there are limited options for getting a free COVID-19 shot. Section 317 of the Public Health Service Act authorizes the Secretary of Health and Human Services to purchase vaccines for uninsured adults, but it is a discretionary program, dependent on annual appropriations from Congress, and funding for the program has been mostly flat for years. It also is intended to support all recommended vaccines, not just COVID-19, as well as vaccine infrastructure at the state and local level. Because of the limited funding, providers participating in the Section 317 program are also limited to local health departments, federally qualified health centers, and a small number of private providers, and do not include pharmacies (who were included in the Bridge Access Program.  States can choose to supplement their Section 317 funds with their own funding in order to reach more people.  While CDC reports that it did identify an additional $62 million in unspent funds to support COVID-19 vaccine purchasing by states and local jurisdictions, based on the current CDC price, this will only cover a million people at best. Last year, Pfizer and Moderna, two of the main COVID-19 vaccine manufacturers, announced that they would provide their vaccines at no cost to uninsured individuals, but details of those programs are not readily available.

Without insurance coverage, COVID-19 vaccines are pricey for someone who has to pay out of pocket. The market price, as posted by CDC, ranges from $136.75-$141.80 per dose but could be higher, and that price does not include any costs associated with administering the vaccine.  Of course, price isn’t the only barrier the uninsured may face and even when COVID-19 vaccines were free, their uptake lagged behind those with insurance.

More generally, to address the vaccine coverage gap faced by uninsured adults for COVID-19 and other vaccines, the Biden-Harris administration has proposed a new, mandatory, federal “Vaccines for Adults” program, modeled after the successful “Vaccines for Children” program. Congress has rejected this proposal for the past three years.