Increased Vaccination Needs for Pediatric New Mainers
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Feb 20, 2024
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Running Head: INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
Increased Vaccination Needs for Pediatric New-Mainer Population
Monica A. Stimmel, BS, BSN, RN
The University of Southern Maine
NUR 606: 0100- Leadership, Health Policy, and Graduate Nursing Roles
March 5, 2023
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
Executive Summary
Maine has seen increasing numbers of refugees, including many foreign-born children, who are prone to additional health disparities as they often arrive lacking proper healthcare or records (Migration Policy Institute, 2019). If these children hope to assimilate into our educational system, they need updated care, including immunizations. The longer that this population remains removed from a standardized educational system, the increasing risk they present to communal resources. As many pediatric vaccinations are completed in series, swift policy change is necessary to decrease potential future burden on society, government, and health care-related systems, and avoiding negative impacts on the healthcare experiences and outcomes of current residents. I evaluated two policy alternatives with regards to population benefit, ethics/equity, and administrative feasibility. After analysis, I recommend passage of L.D. 221 to expand MaineCare, supporting improvements in state immunization protocols for pediatric New-Mainers as well as increasing resource availability and the equity and ethics of resource distribution.
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
Increased Vaccination Needs for Pediatric New-Mainer Population
Maine has been experiencing an influx of refugees, including many children. This new population will require additional health resources to ensure the stability of the current healthcare system and to avoid adverse impacts on the healthcare experiences and outcomes of current Mainers. In addition, in order as to not burden other current societal programs, considerations must be made when dealing with the pediatric population. This group is prone to additional health disparities, as they arrive often lacking appropriate healthcare or records of previous care, producing additional barriers related to educational access. An upstream approach to such problems aids in reducing health disparities, which based on current literature, affect racial and ethnic minorities at higher levels within the population. Upstream factors both directly and indirectly related to healthcare should be considered, including access to care (Nichols, 2021). This analysis will evaluate this vast public health problem based on pre-established criteria to propose a viable policy alternative for consideration.
Purpose
The medical model that the U.S healthcare system is founded on is based on the ideal that health is simply the lack of illness or disease (Shi and Singh, 2019). The very definition of the medical model displays a large pitfall: it lacks the needed focus on preventative care. As nurse administrators representing the American Academy of Ambulatory Care Nursing (AAACN) and the nurses within this organization, we are seeking upstream policy change to increase the number of vaccinated children within this population to increase compliance with Maine public school enrollment requirements; therefore, also increasing the number of these children eligible for enrollment in the public school system and minimizing future burden on the state’s public assistance programs.
Background
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
From 2000 to 2019, the state of Maine saw a 42.8% increase in the number of foreign-born residents, who are prone to additional health disparities as they often arrive lacking proper healthcare or records (Migration Policy Institute, 2019). If the children of this new population are to assimilate into our educational system, we will need to ensure compliance with our healthcare standards. The scope and urgency of this problem seem functionally contradictory, as the urgency is increasing and the scope remains vast. The more time that passes without set policy in place to handle this influx, the more the problem grows. The longer that his pediatric population remains removed from a standardized educational system, the increasing risk of burden they are from a fiscal and resource availability perspective. As a majority of pediatric vaccinations must be done in series, it is imperative that such preventative care begins as soon as possible in order to decrease the future burden on society, government, and health care-related system. There is dire need for increased compliance of this population with the Maine public school enrollment requirements, to allow for a more seamless transition of this population into the system in a timely manner. Evaluation Criteria
The evaluation criteria that I will use to evaluate which policy to recommend to public decision makers include population benefit, ethics/equity, and administrative feasibility. The population benefit will be beneficial to assess as it should be ensured that the policy alternative proposition is able to meet both current and future demands. Whatever that this policy may lay the framework for must logistically and structurally support the current Maine community, as well as the new Mainers arriving to our state each day, to ensure longevity and continuity. This will ensure that the changes are sustainable to continue to support our community long-term. Secondly, the policy must ensure that the resources provided are available equitably across the populations in need of such services. To promote positive and effective change, the policy alternative selected should prove feasible to provide for fair coverage and access to resources without promoting additional disparities among race, gender, or socioeconomic
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
class. Lastly, I will evaluate the administrative feasibility. This is like the first criteria mentioned, as the intention is to ensure the selected policy would promote sustainable and positive change; however, administrative feasibility would more closely analyze the ease of implementation and barrier identification. This criterion may also consider the weight of economic benefit compared to potential costs as well, as our healthcare administration is very closely entwined with financial viability. Using these clearly defined criteria, I will select a policy to recommend to decision makers advocating for public policy change.
Pre-Existing Policy Options
Pre-existing policy has failed to regulate health care resources in an equitable and ethical manner. The current reliance on the state to expand Medicaid coverage to additional individuals leaves room for a variety of factors to impact the population benefit of this program, as coverage could vary from state to state. This will be further investigated when analyzing policy alternatives. The current approach to the problem is that of jaded action, as current administration has laid valuable framework that could potentially produce great positive impact if fully executed; however, definitive action in the direction of refugee care advocation has yet to be seen. There is obvious opposition regarding the assistance for non-U.S. citizens, as we continue to have citizens of our own requiring additional assistance; however, this increase in resources would not be a net loss or simply charitable act. It would allow more access for this population to the public-school systems, which would allow more immigrant children to attend higher education, or to obtain jobs in their communities. In Maine alone, the state’s planned broadband internet expansion has been halted due to a labor shortage. It is estimated that the state is short by about 4400 workers (Murphy, 2023). According to the Migration Policy Institute, roughly 98,000 undocumented students graduate from high
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
school each year. With a population of non-U.S. citizens estimated at roughly 16,000 living in the state, this would prove to be a large untapped resource for the state (the Migration Policy Institute, 2019). With more asylum-seeking children in the state, there will be more of a compounding burden on
our public schools and local hospital systems. Ensuring fair access to educational resources is vital to ensure that these kids eventually become productive working members of society themselves. Such educational access begins with meeting the mandated health requirements.
Proposed Policy Alternatives
A variety of factors impact how we handle and process the logistics of New-Mainers moving into the state. An equal variety of strategies could
be utilized to mitigate the problems associated with the lacking primary and preventative care services available for this population, specifically the lacking infrastructure to immunize the new pediatric population in a timely manner to allow a more seamless transition into the public school system. Two proposed policy alternatives will be evaluated, using the defined evaluation criteria discussed above. To appropriately address this public health concern, action at all levels of government should be considered, with increased emphasis at the state and federal levels. The first policy alternative suggested focuses on federal government involvement, as the entirety of the issue of New-Mainers involves a scope larger than that of the state level alone. The second revolves more around
the role of the state.
Policy Alternative 1: Federal S. 4486 – the Health Equity and Accountability Act of 2022
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
Senator Cory Booker of NJ introduced this bill in June of 2022. Immediately, this bill seeks to modify Medicare, Medicaid, private insurance, nutrition assistance, and other federal programs with the
goal of reducing health disparities among at-risk populations across the country. It adds specifics related to many at-risk populations, including noncitizens, mothers, infants, children, and those with specified conditions, such as mental and behavioral health disorders and conditions that disproportionately affect minorities (cancer, HIV/Aids, kidney disease, and diabetes). It also more closely defined medically underserved populations. Although this section’s terminology does not yet particularly mention non-
citizens, it possesses great promise of increasing inclusion of similar at-risk populations already subject to additional health disparities and inequities. Other portions of the proposal specifically mention considerations for noncitizens, expanding coverage under Medicaid by more clearly defining the affected populations as noncitizens (versus aliens) and even expanding the definition (
The Health Equity and Accountability Act, 2022).
Policy Alternative 2: State L.D. 221- An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023
Representative Teresa Pierce introduced this bill in 2021. This bill effectively addresses a key gap
of the S. 4486- it expands coverage at the state-level, using MaineCare. MaineCare will be discussed in greater detail in the following section, during the evaluation of the proposed alternatives. Overall, the proposed L.D. 221 would act to expand MaineCare coverage to those who were previously not qualified for Medicaid benefits, including children under the age of 21, who were not previously eligible due to immigration status (Maine Department of Health and Human Services, 2021).
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
Evaluation of Proposed Policy Alternatives
In investigating the possible population benefits of both alternatives, the state MaineCare program must also be evaluated, as it will have to work in congruence with both proposed legislations. MaineCare provides state-specific Medicaid assistance to those in the state of Maine with limited resources, based on standard criteria including income, health status, and number of dependents established in partnership with the federal government (Maine MaineCare, n.d.); however, the key component that would make such partnership with both pieces of proposed legislation viable is surrounding MaineCare’s inclusion of non-citizens. Non-citizens entering the country legally are eligible for the same benefits as residents if they meet the set eligibility criteria (Centers for Medicare and Medicaid Services, n.d.). The population benefit for both policy alternatives revolve around increased access to the recommended and school-required immunizations to allow for enrollment into the public-
school systems. In addition, such policy would increase the availability of preventative care for this group, resulting in an overall decrease of disease spread to other at-risk individuals in the community, who may not be eligible for vaccination based on health status. From an administrative feasibility standpoint, such preventative care is much cheaper than disease spread containment and treatment. Proper preventative care, including immunizations, result in lower admission and re-admission rates, less frequent hospitalizations, and overall cost reduction (the Cleveland Clinic, 2020).
As previously mentioned, when discussing pre-existing policies, alternatives relying on current federal programs, like S. 4486, could effectively limit the potential areas for this population to establish themselves, as they could be limited to certain states for residence, inversely impacting administrative feasibility. Coverage for these individuals could vary across state lines, so future travel or work possibilities also may be limited. Reliance on separate states to provide inclusion terms in their Medicaid
packages for noncitizens would effectively limit the benefit to those states. This raises concerns over the
true equity of the solution, as additional policy work would be needed on an individual state basis to
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
support similar populations nationwide. The proposed alternative of L.D. 221 would effectively extend coverage to those individuals in the state of Maine; however, the equity of the benefit stops there.
Both proposed alternatives have the potential to increase availability of health resources and services to previously underserved populations, increasing the equity and ethics of resource distribution;
although, without policy such as L.D. 221, the benefits of policy like S. 4486 may currently be limited to Maine and states with similar legislature. Recommendations
The Health Equity and Accountability Act of 2022 provides much needed framework to begin supporting this at-risk population as a viable policy alternative. Despite this, due to the scope and size of the problem, this single piece of legislation is unlikely to make a widespread change; therefore, I recommend passage of L.D. 221 as this has the most realistic potential to impact Mainers directly. S.4486 is likely a less effective alternative, as it would require passage legislation similar to L.D. 221 at the federal level, or conversely at each individual state level, to function at the highest possible scope. L.D. 221 in conjunction with existing MaineCare policy, would lay the needed framework for the state to adequately handle the health needs of the new population. I believe there remains great potential should both bills be passed, but the proposed federal legislation leaves much to be desired in terms of definitive protections for this at-risk population, no matter the state of residence. Protections for those in our own home state of Maine is a reputable beginning, but more widespread change will be needed to ensure sustainability of the proposed alternative. Conclusion
Failure to address the public health problem of the large influx of refugee children into the state of Maine would be a disservice to our future communities. The evidence supports the possibility of great benefit from proper assimilation of this new population; however, the alternative lack of action, or
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
lack of the appropriate scale of action, would result in increased burden on our current public resources
and downstream negative effects for our current citizens. The responsible action is to address this vast public health concern swiftly, before it bends our system to the point of breaking. As a representative of
the AAACN, I urge you and your fellow legislators to act by fighting for our current and future communities through this current policy advocation for the passage of L.D. 221.
References
Centers for Medicare and Medicaid Services. (n.d.) Implementation Guide: Medicaid State Plan Eligibility
Non-Financial Eligibility Citizenship and Non-Citizen Eligibility. https://www.medicaid.gov/resources-for-states/downloads/macpro-ig-citizenship-and-non-
citizen-eligibility.pdf#:~:text=States%20may%20elect%20to%20provide%20Medicaid
%20coverage%20to,option%20to%20limit%20coverage%20of%20non-citizens%20as%20follows
.
The Cleveland Clinic. (2020). Value-Based Care. https://my.clevelandclinic.org/health/articles/15938-
value-based-care
The Health Equity and Accountability Act, S. 4486, 117 Cong. (2022). https://www.congress.gov/bill/117th-congress/senate-bill/4486?q=%7B%22search%22%3A%5B
%22pediatric+immigrant+immunization%22%5D%7D&s=2&r=3
H.P. 156 - L.D. 221: An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023. Maine Department of Health and Human Services
.
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INCREASED VACCINATION NEEDS FOR PEDIATRIC NEW-MAINER POPULATION
(2021). http://www.mainelegislature.org/legis/bills/getPDF.asp?
paper=HP0156&item=7&snum=130
Maine MaineCare. Benefits.gov. (n.d.). https://www.benefits.gov/benefit/1630
Migration Policy Institute. (2019). Maine. https://www.migrationpolicy.org/data/state-profiles/state/demographics/ME
Murphy, E. (2023, February 15). Labor shortage could slow Maine’s broadband expansion. The Portland Press Herald. https://www.pressherald.com/2023/02/15/labor-shortage-could-threaten-
maines-aim-to-expand-broadband-coverage/
Nichols, L. M. (2021). A primer on health economics of nursing and health policy. In D. J. Mason, E. Dickson, M. R. McLemore, & G. A. Perez (Eds.), Policy & Politics in Nursing and Health Care (8th ed., pp. 134 – 140). Elsevier.
Shi, L. & Singh, D. (2019). Beliefs, Values, and Health. In Delivering Health Care in America: A Systems Approach (Seventh edition, pp. 46–86). Jones & Bartlett Learning.