A Private Insurance Response to Vaccine Refusal (Updated)

Elisabeth Rosenthal and Glenn Kramon write, in Don’t Want a Vaccine? Be Prepared to Pay More for Insurance, about insurance companies rejecting waivers for anti-vax insureds who expect coverage for expensive COVID-19 treatment. Insurance companies should go farther, as Rosenthal and Kramon advocate:

Get a Covid-19 shot to protect your wallet.

Getting hospitalized with Covid-19 in the United States typically generates huge bills. Those submitted by Covid patients to the NPR-Kaiser Health News “Bill of the Month” project include a $17,000 bill for a brief hospital stay in Marietta, GA (reduced to about $4,000 for an uninsured patient under a “charity care” policy); a $104,000 bill for a fourteen-day hospitalization in Miami for an uninsured man; possibly hundreds of thousands for a two-week hospital stay — some of it on a ventilator — for a foreign tourist in Hawaii whose travel health insurance contained a “pandemic exclusion.”


In 2020, before there were Covid-19 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 on Feb. 28; UnitedHealthcare began rolling back its waivers late last year and ended them by the end of March.


But insurers could try to do more, like penalizing the unvaccinated. And there is precedent. Already, some policies won’t cover treatment that results from 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 types of health plans. Four-fifths of states in the U.S. follow that protocol, though most employer-based plans do not do so. In 49 states, people who are caught driving without auto insurance face fines, confiscation of their car, loss of their license and even jail. And reckless drivers pay more for insurance.

The logic behind the policies is that the offenders’ behavior can hurt others and costs society a lot of money. If a person decides not to get vaccinated and contracts a bad case of Covid, they are not only exposing others in their workplace or neighborhoods; the tens or hundreds of thousands spent on their care could mean higher premiums for others as well in their insurance plans next year. What’s more, outbreaks in low-vaccination regions could help breed more vaccine-resistant variants that affect everyone.

Neither insurance companies nor society should coddle the unvaccinated.

Posted originally 7.26, updated 8.3.

Over at the subscription-based Bulwark, Jonathan V. Last writes about a hospital patient in Louisiana who, despite nearly dying from COVID-19, insists he would do it all over again without vaccination:

The reporter asks this very fine, high-IQ citizen if, knowing what he knows now, he could go back in time to take the vaccine and avoid getting sick, being hospitalized, and almost dying—would he get the vaccine?

Dude does not even hesitate for a second.

Hearing that, I wondered: Who is paying for the costs of his hospitalization? I hope he has health insurance. And if he does, he’ll pay some out-of-pocket minimum to meet his deductible. Then the insurer will reach a negotiated settlement with the hospital. And then, next year, the insurance company will pass on the costs of that large payment to the rest of its customers.

The people in the insurance pool who got the vaccine will pick up the tab for the treatment of the people who got sick after refusing to get the vaccine.

That’s conservative, rugged individualism, circa 2021.

And it’s a pretty sweet deal, too. You can make whatever damn fool choices you want, and someone else — the hospital, your insurance company, your neighbors paying into the insurance pool—will pick up the tab.

Why would these people ever change?

Here’s the news account that inspired Last’s commentary (obstinate patient’s remarks begin @ 1:55):

What should be done about ordinary people who refuse vaccination, then require expensive coronavirus-related medical care and hospitalization? They’ve chosen against vaccination, thereby draining resources away from others (including non-COVID patients who find themselves competing for intensive-care rooms).

Private insurers, without government prohibition, should be able to write policies to exclude coverage for unvaccinated insureds who contract COVID-19. Insurance policies should, if they do not already, have exclusions of coverage, and the law should recognize the validity of these exclusions in every state. Adult patients privately excluded on this basis should also be ineligible for public subsidies for their care, as should routine recipients of public subsidies.)

Under this arrangement, ordinary people could refuse vaccination, but they would pay the economic costs of their refusal.

As a matter of public health, after a few hundred people nationally found themselves in this position, and as news reports made their self-created economic hardships widely known, vaccine hesitancy might significantly decline.

A sensible person would choose vaccination at the earliest opportunity; even many foolish people, however, will adjust their behavior after learning that insurers will not cover their their foolishness.

Those who choose otherwise should pay the costs of that choice.

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2 years ago

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