KEY POINTS

  • The administration has promised a coronavirus vaccine would be free for all Americans
  • Congress may have to take action to change Medicare rules on paying for treatments still under investigation
  • There are some 40 vaccine candidates currently undergoing human trials

Despite Trump administration promises that a coronavirus vaccine would be free for all Americans, government policy excludes one of the most vulnerable groups: those on Medicare.

The problem is the way any vaccine would be approved in the near term. The Food and Drug Administration is expected to issue an emergency use authorization to allow for the quick distribution of a vaccine. Such a designation, however, is not covered by Medicare although the Centers for Medicare and Medicaid services says on its website: “At this time, there's no vaccine for COVID-19. However, it will be covered if one becomes available.”

The Wall Street Journal, quoting government officials, reported Monday the administration has concluded millions would be left to pay vaccine expenses out-of-pocket unless action is taken to alter the rules. That means a patient would have to pay for the cost of administering the shot and a doctor’s visit.

The CARES Act, passed in March, provided for quick emergency use of coronavirus treatments, and CMS said it would cover lab tests, antibody tests and “all medically necessary hospitalizations” for Medicare beneficiaries. The legislation, however, did not contain explicit language on federal coverage of drugs and vaccines that still are under investigation, as any early vaccine would be. Private insurers usually take their cues from the government.

To complicate matters, the change needs to be made by Congress and cannot be accomplished through executive order. Democrats and the White House already are at odds over the next round of coronavirus stimulus, talks on which stalled Aug. 7.

President Trump is pushing for a vaccine to roll out within weeks, but Larry Levitt, executive vice president of the Kaiser Family Foundation, said uncertainty over coverage is just one more barrier to a quick rollout.

“It’s one more concern about trying to roll out a vaccine outside the normal approval mechanisms,” Levitt told the Journal. “People are already concerned about getting a vaccine before it’s fully vetted, and if cost is a barrier as well, that could be one more stumbling block for broad acceptance.”

Americans are split nearly evenly over whether they would take the vaccine if it were available today, a Pew Research Center poll indicated. Just 21% said they’d definitely get inoculated and 30% more said they probably would. Nearly a quarter said they definitely would not.

To achieve herd immunity, at least 80% of people would need to be vaccinated or acquire immunity through exposure.

There currently are 40 vaccines undergoing human trials and dozens more in development. Vaccines normally take years to develop. Work on a coronavirus vaccine began in January although some of the research was based on earlier efforts to develop a vaccine for SARS.

Nearly 7 million coronavirus cases have been confirmed in the U.S. while nearly 200,000 have died from COVID-19, Johns Hopkins tracking data show.