Dozens of Illinois pediatricians are warning Gov. JB Pritzker about a potential health crisis from reduced access to vaccines for potentially thousands of children.
Their pleas come as states around the country grapple with measles outbreaks.
Local doctors say a particular group of Illinois kids is at risk of triggering an outbreak — those who are covered by the state-run Children’s Health Insurance Program, known as CHIP. There were about 324,000 children in Illinois enrolled in CHIP at some point in the 2017 fiscal year, the sixth highest amount in the nation, according to the nonprofit Kaiser Family Foundation, which tracks health care issues.
Doctors say this large group of kids is vulnerable to an outbreak because some physicians stopped vaccinating them after a major policy shift by the Rauner administration in 2016 made it too expensive. Doctors at the time were already grappling with not getting paid, or waiting for months, during the state’s epic budget battle.
This includes Dr. W. Daniel Perez, a west suburban pediatrician.
“I hate to make that decision, but there’s really no way I can give vaccines to those children,” Perez said. “My practice, like many other practices, are way in the red.”
Consider the cost. Babies can receive more than a dozen immunizations in the first year of their lives, costing at least $1,500 to $2,000 per child.
Perez is among physicians who outlined their concerns to state health care leaders last year when Rauner was governor, but they say little changed.
Now Pritzker leads Illinois, and doctors hope to get his administration’s attention. On April 10, Perez was one of 54 physicians who signed a letter to Theresa Eagleson, director of the Illinois Department of Healthcare and Family Services. The agency oversees CHIP.
“Many providers have stopped vaccinating (CHIP) patients altogether and direct them to the Board of Health clinics,” the letter said. “These patients experience fragmentation of care and missed opportunities to be vaccinated and end up in our offices missing multiple vaccines. In light of the current measles outbreak, this could lead to a public health crisis with disastrous consequences.”
In a statement, Pritzker spokeswoman Jordan Abudayyeh said the administration is leading efforts across various agencies to change how doctors are paid for immunizations.
“Governor Pritzker believes every child should have access to lifesaving preventative healthcare,” Abudayyeh said in the statement.
There have been roughly 555 confirmed measles cases from Jan. 1 to April 11, the second-highest number in the nation since the disease was eliminated nearly 20 years ago, according to the federal Centers for Disease Control and Prevention. This includes seven cases in Illinois.
It’s not clear how many Illinois children on CHIP haven’t been vaccinated or are getting shots later than doctors recommend. Physicians aren’t required to report it, according to Melaney Arnold, a spokeswoman for the Illinois Department of Public Health.
And while Illinois requires children to be vaccinated, or at least start their series of shots, once they enter school (that includes day care), the state doesn’t police it, Arnold said. Families also can request exemptions.
The CHIP program covers kids whose parents make too much money to qualify for Medicaid, a government-run health insurance program for people who are low-income and disabled. But they don’t make enough to afford more expensive private insurance.
Local doctors say they’ve struggled since Rauner’s policy shift in 2016 to buy pricey vaccines for children on CHIP, then wait sometimes months for private Medicaid insurers to reimburse them, if they do at all.
Before the rule change, physicians got vaccine for free from the state for kids on CHIP as part of the Vaccines for Children program, where the federal CDC buys vaccine at a discount and distributes it to agencies including state health departments.
But doctors say Illinois wasn’t supposed to give vaccine from the CDC to CHIP patients for free. So Rauner changed the rules.
Now physicians must buy it from manufacturers, then file claims with private Medicaid insurers in Illinois to get reimbursed.
Physicians say many kids on CHIP are clustered in counties that ring Chicago. Some of their doctors and public health departments used to send them to the Chicago Department of Public Health to get their shots, but the city stopped taking them in 2018.
“We realized we could no longer ask Chicago taxpayers to foot the bill for children who live outside the city of Chicago,” said Dr. Marielle Fricchione, medical director of the department’s immunization program and a pediatrician who specializes in infectious diseases.
The city public health department gave more than 9,000 doses of vaccine to CHIP patients from the time the state changed its policy in 2016 until October 2018. The cost of all that vaccine was more than $600,000. About 30 percent of these children came from outside of Chicago from 2017 to 2018.
“We know that there are children out there who are going unvaccinated,” Fricchione said, but added that Chicago childhood vaccination rates in general are high.
Still, doctors describe frazzled parents trying to find physicians to immunize their children.
Dr. Eddie Pont, government affairs chairman for the Illinois Chapter of the American Academy of Pediatrics, is hopeful the Pritzker administration will help. But he wonders how much damage has already been done.
“It’s not like they’re just going to come back immediately,” Pont said of doctors who have stopped vaccinating kids on CHIP.