Unvaccinated? Connecticut might let your health insurer charge more

Admit it, if you've had the COVID-19 shot you sometimes wonder, perhaps angrily, "How much will it cost me in health insurance premiums just because all these knuckleheads refuse to be vaccinated?"

And that's after you fume that we'd be just about back to normal by now if we had, say, 90 percent uptake.

Now some folks in the Connecticut General Assembly might do something about it.

"I'd have no problem with insurance companies saying you have to pay a higher premium per month if you're not willing to get vaccinated," House Speaker Matt Ritter, D-Hartford, told me in a broad conversation we had about coronavirus.

Letting health insurers charge more for unvaccinated people? That's a big deal especially since, under Obamacare, the nation has moved away from using health habits and experience - such as pre-existing conditions - as a factor in how much insurers can charge.

But the door is opening. Consider, on Nov. 12, the state Department of Insurance sent new guidance to life insurers that they can ask customers whether they've had the COVID vaccine.

Ritter would not only have no problem with allowing health insurers to charge more - he'd support a bill that did just that, if it were structured right. It's part of what he called tailored legislation to address the unvaccinated. "If you're not vaccinated and you have to go to the hospital, maybe you should have to pay for it," Ritter said.

He and Sen. Matt Lesser, co-chairman of the insurance committee, both said the idea has been kicking around, informally so far. It's a natural byproduct of the frustration the majority feels about the 20 percent of adults who decline in Connecticut - at or near the lowest unvaccinated rate in the nation.

"I think it would make sense. We have to figure out if there's a way to do it," Lesser told me. "It might be restricted by the Affordable Care Act. But I am for getting people vaccinated by any means necessary."

It's a good idea, in some ways better than job-based vaccine mandates, because it still gives refuseniks an option short of losing their jobs - and would force them to pay a small part of the very real cost they're imposing on all of us as they exercise their freedom.

You know, it would be the market at work. Conservatives should love it but it will cut across party lines.

'A precedent that's scary'

A state rule would apply to about 600,000 Connecticut residents, whose health plans are regulated by the state and not by federal agencies. Chiefly, it would be people in the "large group" market of employers with 50 or more people, who are "fully insured," meaning the carriers take the risk. It could also apply to individual and some small group plans.

Most large employers are self-insured and pay carriers to run their plans, a system that's not under state regulation.

We could be the first in the nation to do it, or it could never happen because of a bevy of troubling issues about whether it's legal and whether it's fair.

"I think we're setting a precedent that's scary if we go down that road," said State Rep. Kerry Wood, D-Rocky Hill, the other co-chair of the insurance committee. "It's a slippery slope."

Many factors go into people's decisions on whether to be vaccinated, said Rep. Vin Candelora, R-North Branford, the House GOP leader. "If we're gong to go charging more for health decisions that people make, that is counter to the Democrats' prior policies and it is a dangerous direction."

Candelora said it's not a political issue, but he added, "if Democrats what to go this principle-based route...then that is a door that is going to be opened up broadly beyond just vaccination decisions."

Certainly we can all name things we do, or don't do, that lead to health hazards, sometimes for other people. Why this vaccine? What about dangerous behaviors people engage in, like base-jumping?

The COVID vaccine stands out from other possible factors because the coronavirus disease travels easily between people with no warning and because, the numbers appear to show, the vaccine works safely and reasonably well. "At some point you need to reward the people who are following all the science," Ritter said.

Federal approval not clear

The first hurdle, as Lesser suggested, would seem to be whether the Feds would let states sanction higher premiums for people who are eligible but refuse. That's not allowed under the Obamacare rules but the Feds can grant exceptions, explained Paul Lombardo, director of life and health at the state Department of Insurance.

He hasn't heard of another state allowing higher rates for no-vaxxers, nor had Lesser, Wood or Ritter, but Lombardo said, "That question is beginning to be raised" around the country. Delta Air Lines announced in August it will charge employees $200 if they don't have the vaccine - a version of the insurance rating change, since Delta is self-insured.

For a decision, the state would have to pose the question to the Feds. "And my guess would be that they wouldn't respond unless we had a law on the books," Lombardo said.

Geez, that's just like the price of medical services - you can't find out how much you'll owe until after you've had the surgery. But that's another column.

Obamacare, the Affordable Care Act, favors a "community rating" system that bunches people together in large pools for the purpose of setting rates. Permitted rating factors have been limited pretty much to age (a 3-to-1 ratio at most, flatter than in the past); geographic location (Connecticut has eight districts, one for each county, after receiving an exemption to the state limit of seven); and whether an insured person smokes (maximum charge is 1.5 times the premiums of nonsmokers).

Notably, even though smoking is allowed as a price rating factor, no insurer uses it in Connecticut. Why not? It's a mess, that's why. Aetna and Anthem don't have a way of monitoring your smoking habits. How would they define it? One cigarette? The COVID vaccine is easy to measure, easy to prove, easy to define.

Industry treading lightly

Other problems in making vaccinations an allowable price factor: What do we do about booster shots? How about children who are eligible but not vaccinated?

The health insurance industry is treading lightly on this one.

"Vaccinations are the highest form of preventive care and carriers strongly encourage their use through various financial incentives," said Susan Halpin, executive director of the Connecticut Association of Health Plans and a lobbyist with Robinson & Cole, in a written statement. "Community rating is a core premise of the ACA and including vaccination status as a factor going forward is something that will largely have to be decided at the federal level."

Max Reiss, a spokesman for Gov. Ned Lamont, said the governor would need to see a bill before commenting on it. Wood, the co-chair of the General Assembly's insurance committee said it shouldn't be a Connecticut priority. "I'm more interested in lowering costs for people," she said.

Fair enough, but allowing a COVID vaccine penalty could lower costs for anyone who takes a step that's likely to keep them out of a hospital. We should at least debate the issue.

dhaar@hearstmediact.com