Delta, health insurers charge the unvaccinated for their choice.

Refusing to be vaccinated against COVID-19 was already a reckless health decision. Lately it has also become expensive.

Take the price of insurance. On Wednesday, Delta Airlines announced that it would charge unvaccinated employees an additional $ 200 per month for their health coverage and require them to be tested for the coronavirus every week. At least part of the airline’s motivation was financial. Like many large companies, the airline is self-insured, which means it pays for the medical claims of its own workers, and in an open memo to staff, CEO Ed Bastian noted that the average hospital stay for COVID had cost him $ 50,000. While 75 percent of its workforce is vaccinated, Delta wants to increase that figure.

It would not be surprising if other large companies followed suit. A number of employers, from hospital networks to Disney, have decided to simply require their workers to get vaccinated or get tested. But for a variety of reasons, others fear the mandates seem too authoritarian – Delta, for example, might be concerned about the backlash from Republican politicians in his home state of Georgia – and may prefer to push their employees with it. insurance surcharges. A business consultant told The New York Times that about 50 companies have spoken to him about imposing these kinds of sanctions.

There are likely limits to the amount that companies can increase premiums for the unvaccinated. Under the Health Insurance Portability and Accountability Act, better known as HIPAA, employers are generally not allowed to charge workers additional insurance fees based on their medical condition (the rule is somewhat similar to the Affordable Care Act regulations for the individual market). But federal law makes an exception for employer wellness programs, which can offer workers financial rewards or penalties for taking actions such as quitting smoking. Vaccine supplements should probably be structured according to the same rules, which means that the punishments for not receiving a vaccine cannot be so severe that they can be considered “coercive” – ​​a slightly fuzzy standard – and are limited to no more than 30 percent of the cost of individual coverage under the company’s plan. Delta seems to keep all of this in mind, although all their spokesperson told me when I asked about it was that the company “is well within the plan and legal parameters to perform. this change”.

Simply prescribing vaccines to employees may be the simplest and most effective public health strategy compared to using the wellness program model. After all, there’s no question that companies can outright demand that workers get vaccinated before returning to the workplace (which, ironically, is a much more “coercive” option than any premium increase). And some die-hard anti-vaccines might choose to just go without the vaccine or the blanket, which could further isolate them from mainstream medical advice.

“I’m not sure price someone out of their insurance by charging them more is a good strategy to get them vaccinated,” Sabrina Corlette, director of the Center on Health Insurance Reforms at the University of Montreal, told me. Georgetown. “Why cut people off from their family doctor or pediatrician to convince them to get vaccinated? Looks like you are biting your nose to annoy your face.

But companies don’t necessarily look for the optimal choice from a public health perspective – they look for an option that makes sense to them financially, politically, and from a workforce management perspective. , which could mean using higher premiums as a big boost.

Big business policies, meanwhile, aren’t the only way it’s getting more and more expensive not to get bitten.

Let’s say you get sick. At the start of the pandemic, private insurers largely chose to waive out-of-pocket expenses for coronavirus patients who needed hospital care. But most have stopped offering these breaks; a recent analysis by the Kaiser Family Foundation found that nearly three-quarters of insurance companies have reinstated cost-sharing, and 10 percent plan to do so by October. As a result, Americans who land in emergency rooms with COVID could well face a hefty bill. (Unlike coronavirus testing, federal law does not require free care for people who actually get sick.)

Why do insurers no longer waive reimbursable expenses? There is a confluence of factors. Free COVID care coverage was essentially an inexpensive way for carriers to generate goodwill early in the pandemic, let alone avoid a federal mandate for them to do so, Cynthia Cox, an expert in health care at the Kaiser Family Foundation. . The Affordable Care Act requires insurance companies to spend 80 percent of the premiums they collect on medical claims; otherwise, they have to refund some of the money to registrants. When Americans cut hospital visits at the start of the pandemic for something other than COVID, insurers essentially found themselves making too much money and had to spend it on something in order to adhere to Obamacare rules. . Using the money by waiving out-of-pocket expenses was essentially “a free way to build good public relations,” Cox said.

“They weren’t losing anything,” Cox explained. “But this year, most healthcare utilization has rebounded, and there is a vaccine, so hospital costs can largely be avoided. So there isn’t as much sympathy, I think, for people hospitalized with COVID. “

How much can COVID patients expect to pay for a trip to the hospital? Cox told me that his think tank has yet to find good real-time data, but has looked at the costs incurred by patients with pneumonia over the past few years, which have been on average at around $ 1,300 to $ 1,464 depending on complications, similar to deductibles on many health plans. People with a higher deductible or maximum amount might pay more, especially if they end up in the intensive care unit or need a ventilator.

One way to look at it all is that some of the worst aspects of America’s healthcare system are being used for reasonably good purposes right now. After all, wellness programs are a major loophole in insurance law that allows companies to discriminate against some of their employees, which is why patient advocates have fought fiercely against their inclusion in the law. affordable care. Likewise, it’s generally a bad thing that Americans can face thousands of dollars in fees when they find themselves in the hospital with an illness.

But right now we are in an exceptional situation, where much of the country has made the personally and socially irresponsible decision not to get vaccinated in the midst of a plague. If the threat of a life-threatening illness doesn’t convince them, well, hopefully the threat to their bank account will.

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