Correction: This story has been corrected to reflect Grace Howat’s quote during public testimony.
Idaho legislators advanced a bill on Monday that would require parents to opt in to the state’s vaccine registry, rather than Idaho’s existing policy that lets them to opt their children out.
Legislators on Idaho’s House Health and Welfare Committee on Monday advanced a bill that would require medical providers to only share the vaccination status of Idaho kids in a state-run database if their parents or caregivers say so.
Currently, Idaho’s immunization database, called the Immunization Reminder Information System, lets patients not be part of the database by opting out. If passed, the bill would take effect July 1, 2024.
Some health care professionals said the switch could leave Idaho medical offices with millions more in administrative costs.
Idaho’s children immunization rates, which have been among the lowest in the nation for years, fell in recent years as more people opted out of vaccines required for school, Idaho Education News reported last fall. Before the pandemic, 86.5% of Idaho kindergartners, first- and seventh-grade students were vaccinated. By 2021-22, only 80.2% were, Idaho EdNews reported.
House Majority Leader Megan Blanksma, R-Hammett, who is sponsoring House Bill 397, said she worried that Idahoans vaccination data — including for adults — is in Idaho’s vaccine database without them knowing. She referenced own experience finding out that her children’s and mother’s vaccine records were in the state database without their permission, after she opted out for her children. She also said Idaho’s vaccine database originally was “opt in” based.
As she closed debate on her bill, Blanksma said many Idahoans who received vaccines “don’t know that the government was collecting your data on that vaccine” because they weren’t given an informed consent form.
“That’s what should scare us more than anything else … that there’s data collection that people don’t know about, are completely unaware of. And that’s what this bill fixes,” Blanksma said. “It makes sure everyone knows where their medical data is going.”
Blanksma also said in the hearing that Idaho’s opt-out rate was low because it is difficult to opt out, and the bill would ensure that medical “providers don’t opt you in.”
“It’s become more complicated, and less transparent,” she said. “… Anytime the government is collecting your data, it should be transparent.”
How would the opt-in changes affect medical providers?
The change should not require more state and federal funds, the bill’s fiscal note estimates. Blanksma also told the committee that she doesn’t expect increased costs for providers. She said under Idaho’s current opt-in model, “they are already providing the data to the government.”
But Rebecca Coyle, who said she was an expert on immunization registries, said if you assume that this would cost $10,000 to update each system, it’d cost over $10 million across the more than 1,000 clinics connected to Idaho’s vaccine registry. The medical system today is built for an “opt-out system,” she said, and adding consent files to those systems would be costly.
“It’s going to push a cost over $10 million in costs back to citizens of this state,” Coyle said, “for fewer than 1,000 people who have opted out since 2010.”
Many rural clinics would likely “fail to comply” with the bill because of the high costs of changing the reporting system, said Dr. Cristina Abuchaibe, a doctor in eastern Idaho who represented the Idaho chapter of the American Academy of Pediatrics.
“In order for every single potential patient to be given the choice, it will require extra staff and it will require fancier electronic medical record systems. To be perfectly honest with you, the rural areas don’t have the capacity to support,” Abuchaibe testified. “We’re barely surviving now with a lot of the physicians also doing a lot of the staff work and working as a team to be able to keep up.”
Idaho Family Policy Center Policy Associate Grace Howat, the only member of the public to testify in support of the bill Monday, said Idaho’s current opt-out practice “intrudes on the privacy of its citizens and undermines parental rights.”
“Parents are responsible for raising their children, not the state,” Howat testified.
Heather Gagliano, an Idaho mom and registered nurse, testified against the bill. She said she’s been fully informed of her rights to participate in Idaho’s vaccine registry for her two children over the years.
And as a public health professional who’s given thousands of vaccines, she said she’s seen the benefits of Idaho’s vaccine system’s ease of use for medical providers. But when kids immunization records are incomplete, or hand-written and often illegible, she has to delay care, Gagliano said.
Rep. Jordan Redman, R-Coeur d’Alene, made a motion that the committee send the bill to the House floor and recommend that it pass. Only the committee’s three Democrats opposed the vote, after a failed motion by House Minority Leader Ilana Rubel, D-Boise, to hold the bill in committee.
House Bill 397 now heads to the House floor, where lawmakers could debate it before sending it through to the Idaho Senate.
What is the Immunization Reminder Information System, or IRIS?
Idaho’s IRIS system is similar to those used by other states. It helps health care providers remind people when they, or their children, are due for vaccines. Child care providers can access it to verify a child’s vaccine status. It also maintains a record so that, for example, a patient with a short memory doesn’t get a tetanus booster shot every year.
The records are stored securely and made accessible only to health care providers, child care providers and schools. Individual patients also can request their own records, or opt to have their records excluded from IRIS.
Idaho Republican leadership sent a letter to former Idaho Attorney General Lawrence Wasden in 2021 accusing the Idaho Department of Health and Welfare of unlawfully using the state’s vaccine-record keeping system, calling for the agency to destroy its records on adult immunizations. An attorney for the Idaho Office of the Attorney General replied later that year that the department wasn’t unlawfully using the system and that lawmakers were wrong.
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