Richard H. Hughes, IV, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Bloomberg Law, in “RFK Jr.’s Moves Leave Insurance Coverage of Vaccines in Doubt,” by Rachel Cohrs Zhang, Jessica Nix, and Gerry Smith. (Read the full version – subscription required.)
Following is an excerpt:
Legal requirements for insurers are a gray area if ACIP moves away from recommending vaccines for routine use for kids, health-care attorneys told Bloomberg.
The Affordable Care Act requires them to completely cover vaccines recommended for routine administration, including those in consultation with their doctor, according to the CDC website. However, attorneys told Bloomberg the reality is more murky.
Richard Hughes, an attorney at the law firm Epstein Becker Green and former Moderna executive, said: “The bottom line is expect variability in coverage, prior authorization and out-of-pocket [costs], all of which will discourage uptake.”
Related reading:
- June 13, 2025: Bloomberg, “RFK Jr.’s Upending of Vaccine Procedures Rattles Insurers, Health Officials,” by Kelly Gilblom. (Read the full version – subscription required.)
Some insurers have refused to cover other vaccines under that type of recommendation in the past. Others say they’ll still pay.
Insurers’ legal requirements are a gray area if ACIP moves away from recommending vaccines for routine use for kids, health-care attorneys told Bloomberg.
People should expect variability in coverage, prior authorization and out-of-pocket costs, “all of which will discourage uptake,” says Richard Hughes, a lawyer at Epstein Becker Green and former Moderna executive.
