How uninsured adults can still get vaccinated against COVID

One in six Americans have received their updated COVID vaccine so far this year, and federal data show people with little to no health insurance are far less likely to have that level of protection against severe COVID illness or death.

According to data from the Centers for Disease Control and Prevention, 16 percent of U.S. adults overall had received the updated COVID vaccine as of Nov. 25. With the once-free pandemic tool now available commercially, stark differences emerged between the insured and uninsured: About 18 percent of adults with insurance had gotten the latest COVID vaccine, compared to roughly 4 percent of those without coverage, the CDC found. Uninsured people under age 65 experience some of the lowest levels of COVID vaccine protection in the U.S., according to a recent KFF survey.

To address that gap, in September the CDC launched the Bridge Access Program, a $1 billion effort to deliver free COVID vaccine doses to adults who are uninsured or underinsured – a group of people who have historically fallen through the cracks in the nation’s health care system.

There are no hospitals in Moultrie County, Illinois, a small, rural community that nearly 15,000 people call home. It’s a place where people know each other, said registered nurse Angela Hogan, who leads the county’s public health department. Residents there have suffered during the COVID pandemic, she said, along with the rest of the country. In a week, four people were newly hospitalized with confirmed COVID cases, according to federal data, marking a recent improvement.

READ MORE: Rise in U.S. life expectancy is ‘good news,’ but gains aren’t enough to wipe out COVID losses

When she learned of the CDC’s new program to make updated COVID vaccines free and more accessible, she signed her county up for it, wanting to do whatever she could “to reduce the impact” of the virus on her community and prevent more pandemic losses.

“We chose to do that because it provides better access to the vaccine for anyone who might want it,” Hogan said. “The people who want the vaccine are going to get that vaccine, but removing financial barriers is a positive.”

The U.S. health care system is the most expensive in the world, yet produces some of the lowest life expectancy rates among developed nations. About 30 million Americans have little to no health insurance, making vaccine access difficult in the nation’s largely commercialized health care system. When the COVID public health emergency ended in May 2023, funds began to dry up that had covered hundreds of millions of vaccine doses and enabled communities to set up free clinics. In many ways, the nation’s health care system returned to its pre-pandemic woes.

Once private insurance companies and public insurance programs like Medicaid and Medicare started footing the bill for COVID vaccines, individuals found themselves caught in the middle. Insured Americans were not immune to the challenges, like setting up appointments at pharmacies but unsure if their dose would be covered. Some patients faced questions over reimbursements, receiving billing notifications that their once-free COVID vaccination could cost them hundreds of dollars.

“It shouldn’t be the case that your ability to pay for a vaccine governs what your ultimate outcome might be if you get COVID,” said Dr. Nirav Shah, the CDC’s principal deputy director who is overseeing the Bridge Access Program.

If everything goes well with the Bridge Access Program, public health officials hope to see the program extend beyond COVID to improve vaccine access more broadly for adults in underserved communities.

How we got here

When federal regulators first authorized COVID vaccines for emergency use in December 2020, the U.S. government paid for all of those doses in an effort to pave the way for easy vaccinations and protect as many people as possible against the virus.

That changed in the fall of 2023, when COVID vaccines went commercial.

“The U.S. government is no longer responsible for purchasing or distributing these vaccines,” epidemiologist Dr. Katelyn Jetelina told the PBS NewsHour in October. “So this means we have now multiple payers, i.e. insurance companies, and changes to the delivery system, which has unfortunately resulted in this slow rollout and fragmented, inequitable and, quite frankly, imperfect system.”

For weeks, people reported problems with getting the updated COVID vaccine. Retail pharmacies cited delays in getting any or enough doses. People’s scheduled appointments were canceled due to vaccine supply issues, sometimes with little to no warning. Those hurdles occurred alongside common life logistics, such as securing transportation or taking time off of work to get to a vaccine site.

Each layer of complication created a barrier to access and affordability for many people with insurance. It was that much more insurmountable for those without. On top of that, getting vaccinated against COVID slipped to a lower priority for many people amid the collective rush to return to life the way it had been before the pandemic.

Nationwide, “there’s a low demand” for the updated COVID vaccine, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, adding that the Bridge Access Program overall offered 6 million doses. As of Nov. 28, more than 550,000 doses had been administered through the program, the CDC told the PBS NewsHour.

The program “was never intended to be the overarching solution, but it was meant to bridge the gap,” Freeman said. “It’s rather distressing that even with that low number of vaccine doses available, we still don’t have the uptake that we want.”

Making vaccination easier for patients

Across the country, the Bridge Access Program has been deployed through a network of retail pharmacies, like CVS and Walgreens, community health clinics and local and state health departments. In Moultrie County, according to Hogan, roughly 150 people have received their updated COVID vaccine through the since November.

Hogan said the onus is on the health provider to determine if a patient has insurance that would cover the vaccine’s cost, a process that has been “very seamless and very easy” for patients who only need to show up, she said.

During Medicaid’s historic unwinding after the public health emergency ended in 2023, roughly 12 million people have been disenrolled from their public insurance coverage. Many of them don’t discover this change in status until they are in need of medical care or show up for a doctor’s visit or vaccine appointment, said Dr. Kyu Rhee, CEO of the National Association for Community Health Centers.

A quarter of all doses in the program went to community health centers at nearly 1,500 sites across the United States, according to Rhee. These centers treat more than 31 million patients, and of those patients, one in five have no insurance, and six in 10 are covered by Medicaid.

Millions of Americans trust and rely on community health centers to help them patch through a fractured health care system, especially when they are uninsured or newly disenrolled, Rhee said.

“Many of those folks are working poor, and many of those are in communities that need it the most,” he said.

What’s next

Public health advocates say they expect to see more uptake of the Bridge Access Program and the updated COVID vaccine overall as the nation moves deeper into winter. It is not too late to get vaccinated against COVID, influenza or RSV, Shah said. While he acknowledged that “we’re all tired of COVID” and said that the “worst of COVID is likely in the rearview mirror,” Shah added, “COVID will be with us for the long-term.”

Based on hundreds of millions of COVID vaccine doses that have been administered since the end of 2020 in the U.S. alone and billions worldwide, “what we’ve seen from the data is that the vaccine is safe and effective,” Shah said. “The notion that there are long-term concerns or consequences with the vaccine has thankfully not been seen in the data.”

The updated COVID vaccine “is pretty well-keyed to the viruses that are circulating around us,” Shah said. While the Bridge Access Program currently makes up a small fraction of the administered doses so far in Moultrie County, Illinois, Hogan said she anticipates a rise in demand if “we see a COVID virus uptick.”

The program is designed to expire by the end of December 2024, and Shah said it represents a potential roadmap for how to deliver life-saving vaccines to adult populations that lack adequate insurance and who might be more willing to gamble with exposure to a vaccine-preventable illness than with limited finances.

“I hope we recognize that we want people to stay healthy — we don’t want them to go to schools or workplaces sick,” Rhee said. “To me, there should be a vaccine-for-adults program.”

Rhee pointed to the decadeslong success of the federally funded Vaccines for Children program, which the CDC estimates to have saved trillions of dollars and prevented hundreds of millions of cases of pediatric illness. A program modeled after it for adults would go far to ease patient concerns about cost while preserving health at individual, household and community levels, he said.

But the nation has “a long way to go” when it comes to jabs of the updated COVID vaccine, Freeman said. Among all the respiratory illnesses circulating in the U.S. currently, COVID-19 is still the leading cause of hospitalizations and deaths, and is the fourth leading cause of death overall. “It’s disappointing after everything we just went through and the impact people had to their lives and their families. We should know better right now. We have a tool that’s proven to protect.”