Could health insurers charge unvaccinated higher premiums? Experts say it's complicated

WASHINGTON (SBG) — The Biden administration and public health officials are pursuing ways to compel unvaccinated Americans to get the vaccine, including encouraging companies to mandate their employees get vaccinated. But one tempting option might be off the table.

Some commentators have suggested increasing health care insurance premiums for people who have not been vaccinated might help increase vaccination rates. One New York Times editorial cited a provision in the Affordable Care Act to support that position.

"The Affordable Care Act (ACA) allows insurers to charge smokers up to 50 percent more than what nonsmokers pay for some types of health plans," Elizabeth Rosenthal, the editor in chief of Kaiser Health News, wrote in that New York Times editorial Monday.

Rosenthal's suggestion comes amid an uptick in COVID infections, especially among people who are not vaccinated. The delta variant is responsible for about 83% of new cases and 97 percent of people hospitalized with COVID-19 are unvaccinated, according to the U.S. Centers for Disease Control and Prevention.

So far, about 70% of American adults have gotten at least one dose of the vaccine, hitting the Biden administration's promise a month after the president's self-imposed deadline of July 4th.

Increasing those numbers by targeting the unvaccinated with higher premiums is going to be tough, according to health and legal experts.

"Sanctions would be harder to do, mostly because of the law," Michael Doonan, executive director of the Massachusetts Health Policy Forum, told Sinclair Broadcast Group.

Doonan cited elements of the ACA, which prohibit adjusting individual insurance costs for anything but things such as age, geography, tobacco use and family size.

"It would take a change in the law, and that would be really hard to do in this polarized political environment we live in," Doonan added. Jonathan Crotty, a partner at law firm Parker Poe, echoed that sentiment.

Targeting unvaccinated people with higher premiums would require congressional action, according to Crotty, whose law firm focuses on corporate, finance, regulatory, real estate and litigation matters.

"Higher premium charges potentially could be a prohibited penalty against non-vaccinated participants," Crotty wrote in a legal note back in May, noting there are other problems preventing companies from focusing on the unvaccinated.

In particular, he asks how insurance companies can determine the premium difference between vaccinated and unvaccinated Americans.

"Unlike tobacco use," he argues, "there may not be available actuarial data that determines the actual difference in cost to the plan between vaccinated and unvaccinated participants."

While insurance companies are prohibited from specifically targeting unvaccinated people, that might not necessarily be the case for employers, who can modify premiums to offer incentives worth as much as 30% of the cost of coverage.

Meanwhile, President Joe Biden took steps last week toward making the vaccine mandatory for members of the military. Some of the biggest corporations in the company are following Biden's lead.

Google, Facebook, and Twitter are mandating that some or all employees get vaccinated or provide proof of vaccination. Google was the first major tech company to require employees to get jabbed, NBC News reported on July 28th.

All of this drama will likely kickstart a call for a radical change in U.S. health care policy going forward, according to Doonan. Americans can no longer engage in risky health behaviors if those behaviors have a negative impact on their fellow neighbors, he argues.

"When you're thinking about public health, if you don't have health insurance now, you don't get vaccinated, you are impacting me," Doonan said, noting that people pushing for Medicare-for-all and possibly even universal health care could see more support in the future.

"If the rest of us don't get vaccinated, we are hurting each other, so there is more incentive to say: 'let's all get covered," Doonan added.