| Very few things in America’s $5 trillion health-care economy are guaranteed to patients for free. Many vaccinations, though, have been made widely available for no out-of-pocket costs for most adults who have insurance, and for children even if they’re uninsured. Now that’s in doubt. Secretary of Health and Human Services Robert F. Kennedy Jr., picked by President Donald Trump to “go wild” on health, fired the director of the Centers for Disease Control and Prevention less than a month into her tenure. He also replaced the entire roster of a committee that advises the CDC on vaccines. The dismissals from Kennedy, who has a long record of promoting debunked theories and said he believes “autism does come from vaccines,” raised fears that it might get harder to get the shots. A core question is whether insurers will continue to offer them without making people pay if they’re no longer recommended by the federal government. An early test case will be the Covid-19 shot. The vaccines and boosters thus far have been widely recommended. But under Kennedy, the Food and Drug Administration said the latest versions aren’t indicated for healthy people younger than 65. “There’s going to be a lot of confusion,” said Jen Kates, senior vice president at health research group KFF. “It’s unraveling what has been essentially universal access to Covid vaccines, except for uninsured adults.” The Advisory Committee on Immunization Practices helps select the vaccines insurers must cover at no cost to patients. That committee, reconstituted with some members whose views more closely align with Kennedy’s, is set to meet this month. Beyond Covid, it may also vote on immunizations to protect against hepatitis B, chicken pox, RSV and a combination shot that covers measles, mumps and rubella. If the committee withdraws recommendations for Covid or other shots, that will set up questions for health insurance companies: Will they continue to cover the immunizations? Will they ask patients to cover some costs or pay outright? Most insurers haven’t revealed their plans. Industry groups like AHIP and the Blue Cross Blue Shield Association offered statements that broadly express support for vaccines and preventive health, but stopped short of commitments to continue coverage without adding costs for patients. Some of the largest health insurers — companies like Elevance Health, Cigna Group, Humana and CVS Health — had no comment or didn’t respond. A UnitedHealthcare spokesperson said in an email that standard plans will keep covering Covid shots without cost sharing, though employers that set their own benefits may have different coverage. The American Academy of Pediatrics has urged insurance companies to cover vaccines it recommends, including Covid shots, regardless of what the CDC says. Some states including Massachusetts are promoting alternatives to the CDC recommendations. They can set the rules for state-regulated health plans, though that excludes many offered by big companies. Before the Affordable Care Act passed in 2010, Kates said, insurance coverage for vaccines wasn’t a given. “They weren’t required to do it, and a lot didn’t,” she said. Insurers are now waiting for the official recommendations from CDC and the advisory committee before making any changes. “It’s TBD as to what they’re going to do,” she said. — John Tozzi | 
