Source: Children’s Health Defense

The Arizona Senate this week approved legislation that would bar insurance companies — including Medicaid — from reimbursing physicians at different rates based on whether their patients “refuse one or more vaccines,” according to the Arizona Mirror.

Lawmakers passed the bill Tuesday by a 16-13 party-line vote. The measure now moves to the Arizona House of Representatives. If approved there, it would head to Democratic Gov. Katie Hobbs for consideration.

Bill sponsor Sen. Janae Shamp, a Republican nurse, said the proposal is a response to parents who say they struggle to find pediatric care for their children if they don’t follow the full childhood vaccination schedule from the Centers for Disease Control and Prevention (CDC).

“This specifically comes from a lot of parents asking for help for their children to be able to go to a pediatrician’s office when they don’t meet the entire vaccine schedule minimums to go to a practice,” Shamp told colleagues on the Senate floor. “This is about equity for all patients.”

Shamp previously said she lost her nursing job after refusing the COVID-19 vaccine.

‘Bill protects families’ rights to make informed decisions’ 

Ursula Conway, president emeritus of Children’s Health Defense’s (CHD) Arizona Chapter, said the legislation reflects broader debates about medical choice and physician incentives.

Shamp’s bill reflects “Arizona’s commitment to each individual’s right to make their own healthcare decisions,” Conway said.

She said some physicians receive financial bonuses tied to vaccination rates within their practices. She argued that those incentives can influence how doctors treat families who decline shots.

“Consequently, some practitioners choose to restrict their practice to those families who agree to the recommended vaccine schedule, thus securing their bonus income,” she said.

Families who don’t follow the schedule face difficulty finding care, according to Conway.

“Many discerning families who do not adhere to the schedule are now faced with discrimination as they seek care for their children,” Conway said. “This bill protects families’ rights to make informed decisions in conjunction with their healthcare providers.”

Opponents said the measure could disrupt how insurers design payment incentives.

Before voting against the bill, Democratic Sen. Mitzi Epstein argued that insurers should retain the ability to reward what she described as evidence-based health decisions, the Arizona Mirror reported.

“The current system allows market forces to work,” Epstein said. “Insurance companies need to have the right to incentivize medically accurate choices that their patients make.”

Conway said she expects the measure to pass the House. However, Hobbs “has earned the nickname ‘Veto Queen’ and sets a record-breaking pace in vetoing legislation coming from the Republican-controlled legislature,” she said.

Bill prevents emphasis on ‘incentives over patient outcomes’

Some pediatric practices participate in “value-based care” programs, where insurers give doctors bonuses for meeting certain preventive care targets. Those targets can include how many of their patients receive recommended vaccines.

A 2018 report published in the American Academy of Pediatrics (AAP) journal Pediatrics found that about half of pediatricians receive flat fees through such arrangements. Shamp’s bill would prohibit vaccination rates from being used in those payment calculations.

Conway called the bill “an important step to eliminate discrimination in healthcare.” She said financial bonuses for vaccination metrics “may inadvertently emphasize incentives over patient outcomes in the providers’ decision-making process.”

Dr. Paul Thomas, a Dartmouth-trained pediatrician, previously told CHD that pediatric practices can face financial pressure when fewer patients follow the vaccine schedule recommended by the CDC.

“You cannot stay in business if you’re not giving pretty close to the CDC schedule,” said Thomas, author of “The Vaccine-Friendly Plan: Dr. Paul’s Safe and Effective Approach to Immunity and Health — from Pregnancy Through Your Child’s Teen Years.”

Thomas, who ran a general pediatrics practice with about 15,000 patients and 33 staff members, said declining vaccination rates in his practice had a significant financial impact. “We were losing … over a million dollars in vaccines that were refused,” he said.

Insurers have also created bonus programs for physicians.

A 2016 provider incentive program from Blue Cross Blue Shield offered pediatricians bonuses when children completed recommended immunizations before age 2, though such programs vary by insurer and state.

Refusing unvaccinated patients is ‘acceptable option,’ AAP says

Research published in 2024 found that nearly half of pediatricians either decline to accept families who refuse vaccines or dismiss those families.

In 2016, the AAP said dismissing patients for refusing vaccines was “an acceptable option.”

AAP guidelines recommend 11 well-child visits during a child’s first 30 months, followed by annual visits through adolescence. Pediatricians often administer vaccines during many of those visits under the AAP’s recommended immunization schedule.

The AAP released its own vaccine schedule in January, shortly after the CDC decreased the number of diseases the agency routinely recommends being vaccinated against.

In July 2025, the AAP and other medical groups sued the U.S. Department of Health and Human Services (HHS) and Health Secretary Robert F. Kennedy Jr. in federal court in Massachusetts, seeking to block the vaccine schedule changes and disband the Kennedy-appointed vaccine advisory panel.

Some of the AAP’s biggest donors are pharmaceutical companies and vaccine manufacturers.

Bill reflects evolving attitude toward vaccines

During a Feb. 16 hearing before the Senate Finance Committee, Shamp said her bill reflects the CDC’s changing attitudes toward vaccination policy.

The legislation is one of several vaccine-related proposals introduced in Arizona in recent years.

Shamp also sponsored a medical freedom bill that passed the Arizona House of Representatives earlier this year and awaits a vote in the Arizona Senate. That measure would prohibit state government, businesses and schools from requiring a medical intervention — including vaccines — as a condition of employment, access to public spaces or school attendance.

In 2023, Shamp sponsored legislation expanding religious vaccine exemptions and fining businesses that failed to grant them. Hobbs vetoed the bill.

Arizona has also been involved in national disputes over vaccine policy. In 2026, it joined a group of 15 states suing HHS over changes to federal vaccine recommendations.

The vaccine issue has also surfaced in public health investigations. In 2025, a suspected measles case in the state was later determined to be a reaction to the measles-mumps-rubella (MMR) vaccine rather than a measles infection.

Related articles in The Defender

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• Ex-CDC Director Pushes Extra MMR Shot for Babies, as Arizona Reports Suspected Measles Case Was ‘Rare’ Vaccine Reaction
• 8 States Weigh Bills to Establish or Expand Exemptions to School Vaccine Mandates
• ‘Publicity Stunt Dressed Up as a Lawsuit’: 15 States Sue HHS Over New Vaccine Guidance