On Wednesday, the Centers for Medicare and Medicaid Services announced rules for insurers to cover the cost of administering a Covid-19 vaccine when one is approved by the Food and Drug Administration.
Yet on the campaign trail, former Vice President Joe Biden has been warning that if the Affordable Care Act is overturned, as the Trump administration is attempting to do, vaccines would not necessarily be covered by insurance, and that many people will have to pay for them out of pocket.
“[O]verturning the ACA could mean that people have to pay to get Covid-19 vaccine once it’s available,” Biden said Wednesday. “That’s right. The law that says insurers are required to cover vaccines for free is the Affordable Care Act.”
When asked whether the authority to require that health plans cover a Covid vaccine depends on the ACA, a CMS spokesperson told CNN that its commitment to provide free vaccines “is unwavering and would remain in place regardless of future court actions.”
Facts First: According to health experts, Biden is correct when it comes to private insurance. Without the ACA, experts say there is no mechanism for the federal government to guarantee that Covid-19 vaccines will be covered by private insurance plans. Trump’s Justice Department is trying to overturn the ACA, a case for which the Supreme Court will hear oral arguments in November.
Experts say the administration’s Wednesday announcement depends on the ACA as a legal framework, and that private insurance wouldn’t be required to cover a Covid vaccine if the law were overturned.
The ACA requires private health plans to cover a range of preventative care, including vaccines recommended by a committee in the Centers for Disease Control and Prevention. Under the ACA, health plans have one year to cover these services after a vaccine is recommended.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act – the $2.2 trillion stimulus bill passed in March – reduced that time for a coronavirus vaccine to just 15 days.
According to health insurance expert and associate professor at the University of Connecticut School of Law John Cogan, this was the only significant change the CARES Act made to the existing law. “[E]very other part … relies completely on the ACA,” Cogan told CNN.
Cogan, along with two other health experts CNN spoke with, also said that if the ACA were overturned it’s unclear how health plans would be forced to cover a coronavirus vaccine.
“If the ACA goes down the tubes, it’s going to be a complete statutory mess,” Cogan said.
“[If] the underlying ACA requirement were to go away, health plans would not be required to cover preventative services,” Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told CNN.
“The former vice president’s statement is correct,” Linda Blumberg, an institute fellow at the Urban Institute’s Health Policy Center, told CNN. “The authority comes from the ACA. The CARES Act references the ACA - if the ACA is no longer law, the CARES Act would not provide the federal authority to require insurers to [provide coverage for a coronavirus vaccine].”
In June 2018, the Trump administration chose not to defend key provisions of the ACA in a lawsuit brought by Texas and other Republican-led states, saying the law’s individual mandate is unconstitutional. The Supreme Court will hear oral arguments over the future of the ACA on November 10, one week after the presidential election.