: ‘An unprecedented departure’: Unvaccinated workers face new challenge paying for their COVID-19 testing


Starting early next year, unvaccinated employees will have to make time to undergo COVID-19 testing, according to newly unveiled federal rules for private-sector businesses with at least 100 staffers.

These workers also better start budgeting for that event, because the new rules create a real, and pricey, possibility for workers to pay for their own COVID-19 tests every week.

In the Biden administration’s efforts to increase the COVID-19 vaccination rate at a time when 20% of adults still have not received one shot, the Department of Labor’s Occupational Safety and Health Administration released specifics Thursday about a vaccine mandate rule that could apply to 84 million workers.

Beginning Jan. 4, workers either need to be vaccinated or face regular testing, the rules say. Employers have to provide paid time off for unvaccinated workers to get their jabs, the rules add.

But in a twist to make unvaccinated workers pay for their decision, the rules say employers are not obligated to provide regular testing for those employees — and they’re not required to pay for it either.

So if state laws or collective bargaining agreements don’t make companies bear the costs — and if insurance companies don’t pick up the tab — experts say workers will end up holding the tab.

Those costs can get steep. For example, one home testing kit with two tests from Quidel costs $23.99 on Amazon

and a pack of 45 kits goes for $1,079.55. A 10-pack saliva test from DxTerity costs $950.

OSHA wants to ‘nudge people to get vaccinated’

The provision on who pays for tests “is in keeping with the intent behind the rule, which is to nudge people to get vaccinated,” said Cynthia Cox, vice president at the Kaiser Family Foundation or KFF, a nonprofit based in San Francisco, Calif.

That approach is on display elsewhere, as more employers implement vaccination requirements or think about making unvaccinated workers pay surcharges on their health-care premiums. Meanwhile, an increasing number of health-insurance companies are making people pick up their side of the costs for COVID-19 treatment and hospitalization.

“‘Pushing these costs onto workers is wrong-headed and an unprecedented departure from all previous OSHA standards.'”

— Jessica Martinez, co-executive director of the National Council for Occupational Safety and Health

When it comes to COVID-19 testing that isn’t meant for a medical diagnosis, insurers can “pay for all of it, some of it, or none of it,” Cox noted.

Earlier this year, Cox and other Kaiser Family Foundation researchers looked through the publicly-available prices that more than 90 hospitals charged for COVID-19 tests. Those costs ranged from $20 to $1,419 per test, but they do not account for out-of-pocket costs if insurance coverage kicks in.

The new rule’s authors say they are aware of the potential financial toll. “Because employees who choose to remain unvaccinated will generally be required to pay for their own COVID-19 testing, this standard creates a financial incentive for those employees to become fully vaccinated and avoid that cost,” said the 490-page rule posted Thursday to the Federal Register.

There’s no testing option in the OSHA rule for the workers in health-care providers receiving Medicaid and Medicare money. “We have a higher bar for health-care workers given their critical role in ensuring the health and safety of their patients,” senior administration officials said in a briefing with reporters.

When do consumers pick up the tab for testing?

Medically necessary COVID-19 testing is completely covered by insurance. That applies to tests for people who’s been potential exposed or showing symptoms, said Patricia Kelmar, health-care campaigns director for U.S. PIRG, a consumer advocacy organization.

But there are times when someone needs a test, like a test to travel or a test to show up at work, she said. That’s where it becomes a plan-by-plan question whether tests are covered for those scenarios.

People should check with their health-insurance company about the extent of coverage for COVID-19 tests, but Kelmar’s view is many insurers are not picking up the costs. “In this case, the consequence is they are likely to be paying a fair amount out of pocket each week because of their choice not to get a vaccine,” she said.

Is this fair outcome? Not according to Jessica Martinez, co-executive director of the National Council for Occupational Safety and Health, a countrywide network of worker-advocacy groups.

The regulation can boost vaccination rates, she said, but still, “It’s very unfortunate that this new rule does not require employers to pay for face masks, or for the cost of testing for workers who choose not to get vaccinated,” she said in a statement adding to the mixed bag of reviews on OSHA’s new rule.

“Pushing these costs onto workers is wrong-headed and an unprecedented departure from all previous OSHA standards,” Martinez said.

Businesses still have to remember the “patchwork” of state laws that actually may still make them pay for the tests, said Devjani Mishra, a shareholder at Littler Mendelson, a national law firm representing employers.

There are 30 states where employers have to pay for a worker’s employment-related medical tests, like a drug test, she noted. With some overlap, 12 states make employers reimburse staff for certain work costs, including tests and other costs.

“It didn’t change the equation. It still remains complicated for employers to administer,” Mishra said. That’s especially so if a business has operations across the country. “COVID doesn’t know what state you are in,” she said. “OSHA is trying to set a national bar here. We’ll see how that goes.”

The new rules are going to put health-care costs in hard focus for unvaccinated workers, Kelmar said. Even if a plan covers COVID-19 testing that isn’t medically necessary, workers will have to think about in-network and out-of-network fees.

“This is a situation where there’s absolutely no reason a patient shouldn’t get prices up front, all inclusive,” Kelmar said. “Obviously, the least expensive option for every consumer, and the one that makes the most health sense is getting vaccinated.”

(Elisabeth Buchwald contributed to this report.)

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