Pediatric Annals

Editorial Free

The Advisory Committee on Immunization Practices and the Affordable Care Act

Stanford T. Shulman, MD

This issue of Pediatric Annals is devoted primarily to the important topic of common pediatric epileptic syndromes, and is capably guest edited by Lalitha Sivaswamy, MD, and Deepak Kamat, MD, PhD. This is a fabulous collection of review articles, and they are loaded with useful and practical information about this common childhood problem.

I want to highlight the 50th anniversary of an organization that positively impacts our pediatric practices at a very basic level. This is the Advisory Committee on Immunization Practices (ACIP), a committee of outside experts that advise our federal government on vaccination activities. This was set up following the passage of the Vaccination Assistance Act of 1962, which established a national vaccine program for polio, diphtheria, tetanus, and pertussis; the ACIP has provided invaluable guidance to the Centers for Disease Control (CDC) since its initial meeting in May 1964.

The CDC Director initially chaired the ACIP; however, there were significant reforms in the ACIP membership and operation guidelines, resulting from the Federal Advisory Committee Act of 1972. These changes included exclusion of government employees as voting members, greater public access to meetings and materials, and ending the role of the CDC Director as the ACIP chair. In addition to its scientific advisory role, the ACIP, since 1994, has also had policymaking responsibilities related to the establishment and operations of the Vaccine for Children Program, which provides ACIP-recommended vaccines free-of-charge to uninsured and underinsured children. This role has been expanded by the Affordable Care Act (ACA), because the vaccines recommended by the ACIP must now be included among the preventative services covered by new insurance policies.

Vaccination efforts in the US have been facilitated tremendously by the ACIP’s activities for almost 51 years, during which the roster of vaccine-preventable illness has expanded greatly, despite the vaccine hesitancy trends in some populations.

It may be time for an interim assessment of the ACA, since the new Congress has been formed. I recently saw this amazing quote from the incomparable Mark Twain (1835–1910) from over 100 years ago: “Suppose you were an idiot. And suppose you were a member of Congress. But I repeat myself.”

In late December, a report was issued by the Department of Health and Human Services, regarding the 37 states where residents can use the federal health care government website to buy coverage. Between November 15 and December 19 last year, nearly 6.4 million individuals selected health plans or were reenrolled through the federal website—about 1.9 million totally new to the system. Overall, about 10 million uninsured people have acquired coverage within this past year since the market places opened. This represents the largest expansion of health insurance coverage in a half century, contributing to a sharp decline in the proportion of working-age Americans who lack insurance.1

In a December 2014 lead perspective in the New England Journal of Medicine, Professor Jonathan Oberlander2 asks “Can Congress and the Supreme Court Undo Health Care Reform?” Oberlander reviews the potential impact on the ACA due to the makeup of the new Congress. He also reviews the potential influence of the Supreme Court’s decision to hear a case (King v Burwell) that challenges the legality of providing insurance premium subsidies in the federal exchanges, and he analyzes the impact of the possible decisions by the Court on the ACA.2 The events of the next year will be very important to the future and survival of health care reform.

Just how important this is: according to a recent review, about 5 million middle-income people in more than 30 states now receive subsidies to purchase health insurance through the federal exchange. Without those subsidies, most could not afford insurance, and if those people drop out of the insurance market, everyone else’s costs would likely rise.3 Separately, a new study by the RAND Corporation, a global nonprofit think tank, indicates that eliminating subsidies for those in the 34 states now using the federal exchange would reduce the number of insured by 9.6 million.4

This Month’s Stamps

In view of the terrible Paris attack on the offices of Charlie Hebdo, the famous satirical weekly, in which 10 cartoonists and journalists were slaughtered, and the kosher supermarket attack, I have chosen the French souvenir sheet to accompany this column. This 2010 sheet shows, in its top-half, four old-style posters promoting the French Red Cross and urging the public to support and join their efforts. The stamps in the lower-half highlight life-saving activities, including calling for protection and to be alert, caring for an unconscious person, performing a Heimlich maneuver on a choking patient, and providing cardiac massage and cardiopulmonary resuscitation. The Croix-Rouge Francaise was organized in 1940 when three organizations merged. In 1919, five founding-member societies from France, Britain, Italy, Japan, and the US formed the League of Red Cross Societies, one of the precursor Red Cross organizations. Jean-Henri Dunant and four other Swiss colleagues founded the initial organization in 1864 in Geneva.

French souvenir sheet promoting the French Red Cross.

French souvenir sheet promoting the French Red Cross.


  1. Levey N. Health coverage sign-ups balloon. The Chicago Tribune. December24, 2014.
  2. Oberlander J. Unraveling Obamacare--can Congress and the Supreme Court undo health care reform? N Engl J Med. 2014;371(26):2445–2447. doi:10.1056/NEJMp1413992 [CrossRef]
  3. Goodnough A. Health-law suit hints at G.O.P. divide. The New York Times. Accessed January 14, 2015.
  4. Saltzman E, Eibner C. The effect of eliminating the Affordable Care Act’s tax credits in federally facilitated marketplaces. RR-980-RC. Accessed January 20, 2015.

Pediatric Annals Editor-in-Chief Stanford T. Shulman, MD, is the Virginia H. Rogers Professor of Pediatric Infectious Diseases at Northwestern University Feinberg School of Medicine and Former Long-Time Chief of the Division of Infectious Disease at the Ann & Robert H. Lurie Children’s Hospital of Chicago.

An avid stamp collector, Dr. Shulman chooses relevant stamps from his personal collection to accompany his column each month.

Address correspondence to Stanford T. Shulman, MD, via email:


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