Vaccinations: Free, but Increasingly Mandated

A third of unvaccinated Americans were unsure if their insurance covered the vaccine.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act passed last spring prohibits providers from charging patients for COVID vaccinations, and the Centers for Disease Control and Prevention (CDC) doubled down by requiring providers to sign an agreement that they won’t do so. Commercial insurance and government plans are required to pay for any fees to providers for administering the shots, and the government has set up a fund through the U.S. Health Resources and Services Administration (HRSA), through which providers can get reimbursed for uninsured patients. In short, under a number of laws and programs, individuals should not be paying anything to get vaccinated.

However, a recent Kaiser Family Foundation survey found that a third of unvaccinated Americans were unsure if their insurance covered the vaccine, leading U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra to write a letter to both providers and payors, reminding them that patients should not be charged.

According to the New York Times, it’s not clear that any substantial number of patients have actually been charged and then subsequently paid for a vaccination. But Becerra and others are worried about the perception of possible costs, which may be one factor that keeps individuals from getting the vaccine. According to researchers quoted in the Times, this perception reflects a general distrust in the health system, based on experiences with unexpected medical bills.

On a related note, for one group of Americans, the vaccine is quickly becoming a requirement for employment. Hospital systems across the country – including New York-Presbyterian and New Jersey’s RWJBarnabas – are requiring their employees to become vaccinated before September or find another job.

Houston Methodist was one of the first hospitals to require employees to be vaccinated. A group of that hospital’s employees filed suit last month against the requirement, citing the fact that while the Food and Drug Administration (FDA) has approved vaccines for emergency use, they had not been fully approved. Over this past weekend, a federal judge dismissed the lawsuit, saying that the hospital’s decision to mandate vaccinations for its employees was consistent with public policy.

As health systems move toward requiring employees to be vaccinated, hospitals must also implement the long-awaited COVID safety standards released on Friday by OSHA, the Occupational Safety and Health Administration.

The standards, which only apply to hospitals, nursing homes, and other healthcare workplaces, now mandate many of the safety precautions that have been in place for over a year, including the use of personal protective Equipment (PPE), social distancing and masking, ventilation requirements, and daily employee health screenings. The difference now, however, is that hospital are required to implement these protections.

The new OSHA hospital rules do say that fully vaccinated workers are exempt from masking and social distancing when they are in “well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present.”

While the new OSHA rules do not apply to workplaces outside healthcare settings, OSHA did update its guidance for other workplaces, and that guidance reflects the CDC’s most recent recommendations for vaccinated individuals.

In such workplaces, OSHA suggests, employers no longer need to take steps to protect vaccinated employees. Vaccinated employees no longer need to wear masks or practice social distancing, but unvaccinated and high-risk employees must continue to do so.

This poses something of a problem, because neither OSHA nor the CDC have given guidance about workplaces in which the employer does not know which employees have been vaccinated – and to date, only a small percentage of employers track any such metrics. So, how should employers in those situations apply protective policies in a mixed vaccinated workforce?

It will be interesting to see whether this new OSHA guidance will push more employers to ask their employees whether they’ve been vaccinated – or, like Houston Methodist and other hospitals, make vaccinations a requirement of employment.

Programming Note: Listen to Matthew Albright’s live reporting on legislative issues, every Monday on Monitor Mondays at 10 Eastern and sponsored by Zelis.


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