Spurred by persistently high Covid case numbers and only modest vaccination rates, the Biden administration announced Thursday a new effort to combat the pandemic. It intends to mandate that workers at large companies get vaccinated, or submit to regular testing.
The rule applies to tens of millions of Americans, about two-thirds of the country’s work force. And it raises a thorny question: Who pays for those coronavirus tests?
Doctors typically charge about $50 to $100 for the tests, so the costs of weekly testing could add up quickly. Federal law requires insurers to fully cover the tests when ordered by a health care provider, but routine workplace tests are exempt from that provision.
“It’s really up to the employer,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “They can require employees to pick up the tab.”
Employers have so far considered a range of approaches, from fully covering the costs to having unvaccinated workers pay full freight.
When the U.S. government proposed regular testing for unvaccinated workers earlier this summer, it also announced that federal agencies would cover the costs of those screenings.
That plan will most likely be scrapped, however, as the Biden administration announced Thursday it would no longer allow the country’s millions of federal workers to test out of the vaccination requirement. Instead, unvaccinated workers now have 75 days to get vaccinated before a disciplinary process could begin.
Among the employers that took a different approach was Rhodes College in Tennessee: It required unvaccinated students without a medical or religious exemption to pay a $1,500 fee per semester to cover the costs associated with a weekly coronavirus testing program.
Rhodes, a small liberal arts college, estimated that three-quarters of its employees were vaccinated.
Some employers have had workers chip in for the costs of coronavirus testing. MGM Resorts, which owns many hotels and casinos in Las Vegas, was charging a $15 co-pay for the testing at an on-site clinic for unvaccinated workers. Workers had the option to be tested at an outside provider.
Many states and cities still have free coronavirus testing sites that they started earlier in the pandemic. Long Beach, Calif., was requiring testing for unvaccinated city workers. In a statement to The Times in late July, the city said that workers would “have the option to do their mandated testing for free at the Long Beach Health Department.”
But many Americans also get tests at doctor’s offices and pharmacies, which will typically bill patients and their insurance for the service.
These disparate approaches could provide a menu of options for many workplaces that fall under the new federal rule, which applies to companies with more than 100 employees. The Biden administration has directed the Department of Labor to draft a rule detailing the new mandate.
Federal law requires insurers to fully cover coronavirus tests ordered by health care providers, meaning the doctor cannot apply a deductible or co-payment to the service. Rules written by the Trump administration, and continued into the Biden administration, excluded routine workplace testing from that requirement.
Understand Vaccine and Mask Mandates in the U.S.
- Vaccine rules. On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.
- Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
- College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
- Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.
- Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
- New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city’s vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
- At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.
In practice, insurers do often end up covering employer-mandated tests — it’s hard to tell from a doctor’s bill whether a workplace ordered the care — but they could start reviewing cases of patients who suddenly have claims every week for the same service.
“If they are starting to see a significant number of people who have these tests submitted every week, or twice a week, under federal law they would be within their authority to say this looks like routine workplace testing and not cover it,” said Professor Corlette of Georgetown.
This means unvaccinated workers who have to obtain their own coronavirus testing could have to pay their own fees. Some patients have faced surprise medical bills for coronavirus tests, which can range from a few dollars to over $1,000.
Some of those bills were the result of an employer-mandated test. In the last year, The Times has asked readers to send in their medical bills for coronavirus testing and treatment, and reviewed multiple cases of surprise charges for a workplace-required test.
That includes Marta Bartan, who needed a coronavirus test to return to a job last summer working as a hair colorist in Brooklyn. As The Times reported, she received a $1,394 bill from a hospital running a drive-through site.
“I was so confused,” she said at the time. “You go in to get a Covid test expecting it to be free. What could they have possibly charged me $1,400 for?”
Unvaccinated workers who fall under the new federal rule may benefit from another Biden initiative announced Thursday: a plan to make rapid virus tests more widely available.
That includes making at-home tests available at cost (meaning no profit) from major retailers including Amazon and Walmart, as well as providing free rapid tests at community centers. The White House has announced that these cheaper tests will be available at online retailers “for up to 35 percent less starting by the end of this week.”