Refuse to get a vaccine? You might be hit with expensive medical bills, employer mandates

People who choose not to get vaccinated against the coronavirus face greater odds of getting seriously ill and hospitalized – a decision that could risk not just their health but also their finances as employers require vaccination and insurance companies look at ways to pass on the costs of treatment.

More than 90% of patients hospitalized with COVID-19 are unvaccinated. And because 41% of eligible Americans have not yet been fully immunized against the virus, a new tactic is being pushed: making the unvaccinated pay a larger share of their medical bills.

Advocates of the pocketbook approach say tens of millions of Americans who refuse vaccination make it riskier for everyone else, including kids who are not old enough to get vaccinated and have filled hospitals in some states. Taxpayers are on the hook for $178 billion in federal funds allocated to hospitals and health care providers. Insurance premiums could rise across the board.

"There's a very clear line we can draw between (refusing) vaccination and getting COVID severe enough to put you in the hospital," said Jonathan Meer, an economics professor at Texas A&M University.

"The unvaccinated are essentially asking for a handout, a subsidy for their stance, and that’s cheap talk. Standing up for your beliefs means being willing to take the consequences of them," he said.

Some health insurers already are sharing the financial pain with those sick enough to be hospitalized.

A Kaiser Family Foundation survey last November found that 88% of people had health insurance plans that shielded COVID-19 patients from copayments, coinsurance or annual deductibles that might require families to spend $2,800 or more before coverage kicks in.

Now that vaccines are free and available to all Americans 12 and older, insurers have scaled back those waivers.

Insurers eliminated pandemic perk

Major insurers such as Aetna, Anthem Blue Cross and UnitedHealth Group discontinued fee waivers as vaccines became widely available, as first reported by Kaiser Health News. Humana still covers out-of-pocket costs for older adults on its Medicare plan, but the insurer does not shield out-of-pocket costs for those covered by employer-sponsored plans.

Experts say patients hospitalized with COVID-19 could face significant bills as a result –and those patients are mainly the unvaccinated. Immunized people rarely are hospitalized with breakthrough infections, according to a Kaiser Family Foundation analysis of state and federal data.

"Now you probably will have to pay a lot of money if you get hospitalized," said Cynthia Cox, a vice president and director for the Kaiser Family Foundation's program on the Affordable Care Act. "That’s a very direct cost to people because of their lack of vaccination."

Still, some doubt the prospect of high medical bills will persuade many vaccine resisters to get immunized.

"The person who is holding out against the vaccine doesn’t have the same risk-benefit calculation as someone who gets the vaccine," said Erin Fuse Brown, director of the Center for Law, Health & Society at Georgia State College of Law. "They think the chances they are seriously going to be affected by COVID are pretty small to begin with."

Insurance surcharges for the unvaccinated?

Under the Affordable Care Act, health insurers that pay the bulk of hospital bills are not allowed to charge higher premiums for people who are sick or have a chronic health condition.

But insurers are allowed to charge more for smokers and tobacco users. Employers routinely offer premium discounts or incentives for nonsmokers or for those who meet wellness goals such as having a physical exam.

"People have looked at those wellness plans as being a way insurers may be able to either reward people for getting vaccinated or penalize people for not getting vaccinated," Cox said.

So far, employers have been slow to offer incentives to encourage workers to get vaccinated. Of more than 300 employers surveyed by Mercer in July and August, only 10% said they offered a financial incentive.

It may take time for companies to use those wellness plans to push employees to get vaccinated, Cox said.

Companies turn to 'no jab, no job' policies

The unvaccinated are facing increased pressure from employers to get immunized or submit to frequent testing.

Last week, California Gov. Gavin Newsom said all California teachers and school employees must be vaccinated or undergo regular testing. California, New York City and Washington, D.C., have announced that public employees must get vaccinated or they must wear masks and submit to weekly testing.

Several private employers, including Tyson Foods and United Airlines, have announced vaccine mandates. The National Football League has pressured players to get vaccinated, saying teams will be forced to forfeit games and paychecks if there is an outbreak among unvaccinated players.

Nearly 14% of U.S. employers now require staff to be vaccinated to work at a company site, Mercer said. That's a dramatic shift from May, when fewer than 1% were requiring vaccinations, and only 8% said they would consider it.

Even more employers are expected to require vaccinations once the Food and Drug Administration moves beyond emergency use authorization to full approval and licensing of the vaccines, said Dr. Art Caplan, head of the division of medical ethics at NYU Grossman School of Medicine.

The "no jab, no job" policy probably will persuade more employees to get immunized rather than lose income or face the prospect of expensive medical bills, Caplan said.

"A lot of people who are hesitant, or resisters, say, 'You can’t make me vaccinate,'" Caplan said. "The problem is, they live in a very capitalistic society which says, 'I don’t have to hire you if you don’t do what I want for safety.'"

Those who choose tests over vaccines could pay, too

Beyond the prospect of medical bills and job loss, the unvaccinated might face more scrutiny when applying for life or disability insurance. People who apply for such coverage often need to have physical exams or answer detailed questions about their health, including vaccination status, Caplan said.

"That’s where you can expect to see penalties for non-vaccinators," Caplan said.

Fuse Brown said those who choose to meet employer mandates by getting tested periodically may see big bills, too.

Health insurance companies typically pay for coronavirus tests to diagnose or treat somebody if they have symptoms or had contact with an infected person. But the federal Families First Coronavirus Response Act does not require insurers to pay for tests to monitor workplace safety or for public health surveillance, said Kristine Grow, a spokeswoman for America's Health Insurance Plans, which represents commercial health insurers.

Fuse Brown said the cost of weekly tests "could add up fast" if an employer passes the bill to workers who choose not to vaccinate.

"Financially," Fuse Brown said, "that’s a bigger immediate cost that I think could change minds."

Ken Alltucker is on Twitter as @kalltucker or can be emailed at alltuck@usatoday.com.

This article originally appeared on USA TODAY: Vaccine refusers could face expensive medical, testing bills