People who smoke pay more for health insurance. People who drive sports cars pay more for car insurance. People who engage in what can be termed high-risk behavior, such as scuba diving or rock climbing, sometimes can’t get insurance at all. If all that’s true, argues the authoritative Kaiser Health News, why shouldn’t people who refuse to get a COVID-19 vaccine pay more for their hospitalization coverage?
That’s the argument made in this recent Kaiser Health News analysis (more like an editorial to us) written by Kaiser editor Elisabeth Rosenthal. The argument is simple: now that there are various vaccines available, all of which have been shown to be remarkably effective, those who put themselves at higher risk of costly hospitalization by refusing to be vaccinated should be required to pay higher insurance premiums than those who have had their inoculations. In some cases, in fact, this shift is already taking place.
Serious COVID Outbreaks are on the Rise – Again
“America’s COVID-19 vaccination rate is around 60 percent for ages 12 and up,” Rosenthal writes. “That’s not enough to reach so-called herd immunity.” That’s the situation in which (as defined by the Mayo Clinic) a large portion of a community (“the herd”) becomes essentially immune to a disease, making the spread of disease from person to person unlikely. As a result, the whole community becomes protected.
But in the case of COVID-19, herd immunity is proving elusive, and some health experts blame low vaccination rates in some states. In Missouri, for example, “a number of counties have vaccination rates under 25 percent,” Kaiser reports, and as a result “hospitals are overwhelmed by serious outbreaks of the more contagious Delta variant.” A barrage of advertising, special promotions, even state lotteries haven’t persuaded the vaccine-deniers, since well over 40 percent of the U.S. population has yet to receive even one COVID shot.
“So,” Kaiser suggests, “how about an economic argument? Get a COVID shot to protect your wallet.”
Insurers No Longer Waiving COVID Fees and Co-Pays
The Kaiser article gives a few examples of the huge bills that a COVID hospitalization can trigger. On a website set up by NPR and Kaiser Health News called “Bill of the Month,” the two news agencies track outrageous medical charges submitted by ordinary patients. One COVID patient in Georgia was billed $17,000 for a brief hospital stay, while the bill for an insured Florida man totaled $104,000 for a 14-day hospitalization.
In 2020,” the Kaiser article states, “before COVID vaccines, most major private insurers waived patient payments — from coinsurance to deductibles — for COVID treatment. But many if not most have allowed that policy to lapse. Aetna, for example, ended that policy February 28; UnitedHealthcare began rolling back its waivers late last year and ended them by the end of March.” Since more than 97 percent of COVID hospitalizations occur among the unvaccinated, and because the vaccines have been shown to prevent severe cases, the Kaiser analysis argues that this decision to stop the “COVID subsidy” makes sense.
“A Preventable Hospitalization”
“There’s logic behind insurers’ waiver rollback,” writes Rosenthal: “Why should patients be kept financially unharmed from what is now a preventable hospitalization, thanks to a vaccine that the government paid for and made available free of charge?” If the U.S. had harsher laws, she says, our society might impose even tougher penalties on people who refuse vaccinations and contract the virus. But apart from government action, it’s quite possible that insurance companies might start charging unvaccinated policy holders even more for coverage.
“There is precedent,” Kaiser reports. “Already, some policies won’t cover treatment necessitated by what insurance companies deem risky behavior, such as scuba diving and rock climbing. The Affordable Care Act allows insurers to charge smokers up to 50 percent more than what nonsmokers pay for some health plans.” The logic behind these pricing decisions is simple, and the application to COVID is clear. “If a person decides not to get vaccinated and contracts a bad case of COVID,” the article continues, “the tens or hundreds of thousands spent on their care could mean higher premiums for others as well in their insurance plans next year.” The unvaccinated are at greater risk and therefore should face higher premiums.
Some Companies are Dropping the Carrot and Using the Stick
So far, Kaiser states, insurance companies have favored “carrots, not sticks,” to get folks vaccinated, offering them a variety of incentives including gift cards and premium breaks. But Kaiser’s own research shows such incentives are of limited value. “Many holdouts say they will be vaccinated only if required to do so by their employers,” the article reports, a stance gradually being adopted by some companies as well as some state and local governments across the U.S. Tech giants Microsoft and Google have recently announced vaccine mandates for office workers, as have retailers like Walmart and gig employers like Über.
Those employers who require vaccinations seem to be holding all the cards. For example, this recent MarketWatch article reports that employees who quit because of their refusal to be vaccinated will probably be denied unemployment insurance. The article quoted on expert in employment law who said that refusing to get an employer-required COVID-19 vaccine “is akin to an employee’s refusal to submit to permissible drug tests or participate in safety trainings.” Such an employee, when terminated, would not qualify for unemployment benefits.
As the Kaiser editorial argues, when it comes to expanding the rate of COVID vaccination, the most persuasive inducement might just involve the wallet. “What if the financial cost of not getting vaccinated were just too high?” says Kaiser. “If patients thought about the price they might need to pay for their own care, maybe they would reconsider remaining unprotected.” Here at AgingOptions, we’ll keep an eye on this important and controversial topic for future developments.
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(originally reported at www.khn.org)
