For years, every Idaho child who needed immunizations could get them for free or nearly free, thanks to the federal and state governments, which picked up the tab.

But the loss this year of $2.9 million in state funds means physician practices will have to buy vaccines themselves, some parents will now have to pay for them, and more children could end up without any shots, health officials say. That could lower the state's already-low immunization rate and promote disease.

"We can't afford to see a drop," said Tom Shanahan, spokesman for the Idaho Department of Health and Welfare. "We could see an outbreak that could cause some serious illnesses or even deaths."

The vaccines safeguard against diseases including diphtheria, tetanus, whooping cough, polio, influenza, measles, mumps, rubella, chickenpox, hepatitis and meningitis.

A baby died earlier this year in eastern Idaho of whooping cough, or pertussis, a vaccine-preventable disease.

Some physician practices are expected to stop providing vaccinations for children, officials say. A Statesman check Friday of four major Valley medical practice groups found three that would provide vaccinations and one that hopes to.

"All of us are very passionate about this issue," said Susie Pouliot, chief executive officer of the Idaho Medical Association, who called the situation "potentially devastating" for Idaho's immunization program. "Immunizations are one of those things where you get such a big bang for your buck."

Meanwhile, health officials sought creative ways to make shots convenient and affordable for children with insurance. The state and its largest insurer, Blue Cross of Idaho, tried to obtain affordable bids from major manufacturers for vaccines at a discount. The discount would have paid for vaccines for all children with Blue Cross insurance, which is estimated to be up to 40 percent of insured children in Idaho.

But only one bid came, and it was too high.

So Blue Cross customers, like those of other insurers, will have to pay for children's vaccines if they don't qualify for government help.

Policies vary widely. Some pay for vaccines without requiring families to meet deductibles, or out-of-pocket fees, before vaccines are covered. Others have high deductibles that may leave parents holding the bag for hundreds of dollars worth of vaccinations.

About 60 percent of Idaho children likely are eligible to receive vaccinations free or at a deep discount through the public Vaccines for Children program. To qualify, children must be one of these:

® On Medicaid, the public health insurance plan mainly for low-income residents.

® Uninsured.

® Insured, but with coverage that does not pay for all vaccinations or limits the amount of coverage for vaccinations.

The Central District Health Department said it will turn no children away. Families on Medicaid still won't pay anything, Director Russell Duke said. Reduced rate shots for children who qualify will cost $14.34 for each shot.

The department will bill the insurers of families with coverage. At private physicians' offices, families with health insurance that covers all vaccines will now have to pay, even if they have deductibles they have to meet first.

Some people have policies with deductibles of $2,000 or more, which means they have to pay that amount before their insurance kicks in. Those families potentially may owe $100 or more for vaccinations at well-child visits.

"I think for people with high-deductible plans, it is going to be sticker shock," said Dr. Ben Godfrey of Treasure Valley Pediatrics, which still plans to offer vaccines.

Both Saint Alphonsus Regional Medical Center and St. Luke's hospitals say they will stock vaccines for all kids. Those vaccinations will be available at all physician practices affiliated with or owned by the hospitals.

Primary Health also said its physician practices will provide vaccinations.

The Idaho Medical Association has struck a deal with a vendor that will allow doctors to enroll in a program to get discounts on vaccines, Pouliot said.

But physician practices will have to pay their own upfront costs of buying vaccines. In past years, the state and federal governments paid for and supplied all recommended vaccinations.

In addition, doctors' offices will be required to store vaccines for poor patients who qualify for state assistance separately from the same vaccine for insured patients. That's an administrative burden.

Exactly how the loss of funding for vaccinations will play out in the Treasure Valley is uncertain. Representatives from public health offices, hospitals, insurers and physician offices have been meeting to figure out how to get vaccines to all who need them.

Colleen LaMay: 377-6448