Refusing to be vaccinated against COVID-19 was already a unwise decision of health. It has also become more expensive lately.

Take the price of insurance. On Wednesday, Delta Airlines announced that it would receive a $ 200-a-month bonus from unvaccinated workers for their health insurance and would require them to undergo weekly tests for coronavirus. At least part of the airline’s motivation was financial. Like many large corporations, the airline is self-insured, which means it pays for the medical needs of its employees, and in an open memo to staff, CEO Ed Bastian said the average COVID hospitalization cost $ 50,000. While 75 percent of its workforce is vaccinated, Delta wants to increase that number.

Surprising would not be possible if other large companies followed suit. A number of employers, from hospital networks to Disney, have decided to simply demand that their employees be vaccinated or tested. But for a variety of reasons, others worry that the mandates seem too innumerable, for example, Delta, for example, may be concerned about the blow of Republican politicians in its home state, may prefer to pay insurance premiums to their employees. One corporate consultant told the New York Times that about 50 companies had spoken to him about imposing such penalties.

There are probably limits to how many companies can increase premiums for the unvaccinated. The Health Insurance Accessibility and Accountability Act, better known as the HIPAA, does not allow employers to make premiums on employee health insurance at all (the rule is somewhat similar to the Affordable Care Act for a single market). But federal law is an exception to employers’ health plans, which may offer employees financial rewards or penalties for taking steps such as quitting smoking. Vaccine surcharges should probably be based on the same rules, which means that without shooting, the penalties may not be so severe that they can be considered “compulsory” (somewhat incomprehensible criterion) – limited to no more than 30 : Percentage of the cost of individual coverage under the company program. Delta seems to mean all this, although their spokesperson would have told me when I asked that the company “fits in well with the legal parameters of the change plan.”

Simply imposing vaccines on public health workers may be a simpler, better strategy than using a health plan model. After all, there is no question that companies can directly demand that employees be vaccinated before returning to work (which, ironically, is a much more “forced” option than any increase in premiums). And for some as a baby gets older, he or she will outgrow this.

“I’m not sure that charging someone for their insurance by charging them more is a good vaccination strategy,” said Sabrina Corlett, director of the Sab Insurance University Health Insurance Reform Center. “Why cut people off from their family doctors or pediatricians to get them vaccinated?” “It looks like you’re biting your nose, even though your face.”

But companies are not necessarily looking for an optimal choice from the point of view of public health. They are looking for an option that makes sense to them in terms of financial, political and labor management, which can mean using high bonuses as a strong push.

Meanwhile, the policy of large corporations is not the only way to make restraint expensive.

Suppose you are sick. At the beginning of the epidemic, private insurers largely decided to waive out-of-pocket expenses for coronavirus patients in need of hospital care. But many have stopped offering those breaks. A recent analysis by the Kaiser Family Foundation found that nearly three-quarters of insurance companies have reimbursed spending, with 10 percent planning to do so by October. As a result, Americans infected with the coronavirus in the ER may face a serious bill. (Unlike coronavirus tests, federal law does not require free care for people who actually get sick.)

Why do not insurers refuse out-of-pocket expenses? There is a mixture of factors. Free COVID care coverage was a significantly cheaper way to build goodwill at the beginning of the epidemic, not to mention the federal mandate that required them to do so, Cynthia Cox, a health expert at the Kaiser Family Foundation, told me. . The Affordable Care Act requires insurance companies to spend 80 percent of their premiums on medical claims. otherwise they have to return some of the money to the registrants. When Americans stopped hospital visits at the beginning of the epidemic, other than COVID, which, for some other reason, insurers actually found themselves making too much money, they had to spend it on something to comply with Obamacare rules. “Paying out of pocket money was, in fact, a ‘free way to build good PR,'” Cox said.

“They were not losing anything,” Cox added. “But this year the use of healthcare has largely been restored, there is a vaccine, so hospital costs can generally be avoided. So I think there is not much compassion for people who have been hospitalized with COVID. ”

How much do coronavirus patients pay for a hospital stay? Cox told me that his research center had not yet found good real-time data, but they had studied pneumonia patient charges in recent years, which averaged between $ 1,300 and $ 1,464, depending on the complications of such deductions. on many health programs. People who have a larger reduction or out-of-pocket maximum may pay more, especially if they are in the intensive care unit or need artificial respiration.

One way to look at all of this is that some of the worst aspects of the US healthcare system are currently being used for reasonable good purposes. After all, health plans are a major loophole in insurance law that allows companies to discriminate against some of their employees, which is why patient advocates have struggled to write about them in the Affordable Care Act. Likewise, it is generally bad that Americans can be charged thousands of dollars when they are hospitalized with the disease.

But right now we are in an exceptional situation when a large part of the country has made a personally: irresponsible decision not to be vaccinated against the plague. If the threat of a potentially deadly disease does not convince them, well, I hope the threat of their bank account will be convinced.