Unvaccinated COVID patients can’t be denied hospitalization insurance coverage like a Dem lawmaker wants, but employers, including Illinois, have other options


The majority of private health insurers in the United States have stopped voluntarily waiving deductibles and co-payments related to COVID-19 hospitalizations, as vaccines have been widely available for more than half the year, and some Private employers charge unvaccinated workers more for Medicare.

But State Representative Jonathan Carroll (D-Northbrook) wants health insurers to go further, tabling legislation on Monday that would require unvaccinated Illinois who contract COVID to pay out of pocket for any hospital stays that occur. result from 2023.

“We’re not saying people who aren’t vaccinated can’t get health care… but we’re now at a point where the vaccine has been shown to be effective,” Carroll said. “We’re seeing more and more variants appearing, we’re seeing numbers going up, and generally it’s the unvaccinated people that are causing this problem. “

However, this is illegal under the Affordable Care Act and other federal laws, as one reaffirms bulletin from the Federal Centers for Medicare and Medicaid Services in October.

“Plans and issuers cannot discriminate in eligibility for benefits or coverage based on whether or not an individual gets a COVID-19 vaccine,” CMS said.

Carroll admitted he had heard comments on his idea before and called his proposal a “starting point” for exploring other ways to get hesitant people to get vaccinated.

“It’s really about, ‘What are the responsible things to do? ”Said Carroll.

While employers are allowed to charge more for their premiums to unvaccinated employees through “wellness programs” that encourage healthy behaviors, CMS said this option is limited to changing costs “not denying it. eligibility for benefits or coverage based on a health factor ”.

Employers take advantage of the wellness program option to encourage vaccination among their workforce. Companies, including Delta Airlines, have announced plans to start charging unvaccinated employees more for health insurance premiums. Delta announced the change in August and has begun implement it last month.

Private companies aren’t the only ones trying out the strategy; Nevada could become first state to add surtax on premiums for unvaccinated state employees after council oversees state employee benefits voted last week bill unvaccinated workers $ 55 per month. The money is intended to offset the cost of COVID testing for those who have not received their vaccines.

Wisconsin-based Mercyhealth, which operates three hospitals in northern Illinois, took a slightly different tact. Instead of higher insurance premiums, Mercyhealth introduced a “risk pooling fee” of $ 60 per month for unvaccinated employees, which began being deducted from their pay in October.

Following the announcement of the new policy in September, Mercyhealth says NPR last month its employees’ vaccination rate rose from around 70% to 91%, and very few workers quit in protest.

Delta, omicron and costly hospitalizations

All U.S. adults have been eligible for COVID-19 vaccines for more than six months, but a stubborn portion of the U.S. population 18 and older has yet to be vaccinated. Among all American adults, 71.5% have received at least one dose of the COVID vaccine, and in Illinois that number is slightly higher: 73.1%.

But as new data began to accumulate this fall on the decline in immunity about six months after a first cycle of Pfizer or Moderna vaccines, public health officials rushed last month to adjust the messages. on who needs a reminder.

Just as the summer outbreak of the pandemic ended in Illinois, colder temperatures began to push people indoors, where the virus spreads more easily. This coincided with the vaccination of millions of adults after six months of vaccination after the spring, although the absorption of the booster dose was relatively rapid; more than 2 million Illinois have now got a third injection.

But while public health officials still await a definitive understanding of how the newly discovered Omicron variant of COVID behaves, early data suggests it spreads even more easily than Delta.

After a brief lull in mid-October, the number of new COVID patients admitted to hospitals in Illinois daily has more than doubled over the past month. In addition to representing a dangerous trend as Christmas and New Years approach, the increase in hospitalizations linked to COVID is costly.

From June to August of this year, approximately U.S. hospitals saw approximately 287,000 preventable COVID hospitalizations of unvaccinated U.S. adults, according to a September report. report from the Peterson Center on Healthcare and the Kaiser Family Foundation. Those preventable hospitalizations cost around $ 5.7 billion – and that was before the most recent wave of the pandemic fueled by the Delta variant of the virus peaked in September.

These costs are borne by the two insurers, the vast majority of whom have not yet passed on the increased financial burden to consumers, although this is expected in the long term.

The average cost of a COVID patient’s hospital stay is around $ 20,000, according to the Peterson Center and Kaiser report, and could exceed $ 50,000 for long stays and complicated cases. But fully insured patients would only pay about $ 1,300 out of pocket.


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