Unvaccinated Hawaii employees could face steep costs for COVID-19 testing, treatment

For many of Hawaii’s unvaccinated residents, pandemic life is set to become a little more annoying and potentially more expensive as a rising number of employers and schools require vaccine holdouts to undergo regular COVID-19 tests, and at least one of Hawaii’s major health insurers stops covering members’ share of the costs if they land in the hospital sick with the coronavirus.

While employer policies vary, many unvaccinated workers will need to schedule weekly appointments or track down walk-in testing sites, navigating their way through a fragmented system of pharmacies, clinics, pop-up sites and doctor’s offices with different types of tests and widely varying costs.

While some offer free tests, others charge upward of $300, a hefty sum for residents who will need four tests a month.

“It’s hard to tolerate weekly testing,” Mark Mugiishi, president and CEO of the Hawaii Medical Service Association, told members of the state House of Representatives during a COVID-19 briefing last week.

In a discussion about ways to encourage vaccinations, Mugiishi pointed out there’s also the “scarlet letter version of incentives,” where employees get stickers on their badges if they are vaccinated that denote certain workplace privileges, such as being able to come to the office or travel for work.

Many employers and schools were reluctant in past months to impose vaccine mandates as COVID-19 cases remained low throughout the islands and the state’s vaccination rate ticked upward. But the arrival of the highly contagious delta variant and the ensuing surge in cases upended the policy landscape in a matter of days, spurring employers and government officials to take a harder line on vaccinations.

Since the beginning of August, five major hospital systems, the state and county governments and three Hawaii banks, including Bank of Hawaii, First Hawaiian Bank and Territorial Savings Bank, have announced they are requiring employees to undergo weekly testing if they aren’t vaccinated, policies that affect tens of thousands of residents throughout the islands.

The University of Hawaii, which has 10 campuses across the state and a number of education centers, is also requiring unvaccinated students to be tested regularly.

More employers are expected to follow suit, said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, the major trade group for hospitals and nursing homes, which announced Monday that its members supported vaccine mandates, helping spur the trend.

“We knew that there were a lot of organizations that were looking at this, but there was some concern about being the first out of the gate,” he said. “There are some very vocal opponents to vaccination and we believed we had a responsibility to take that stand and lead by example.”

EMPLOYERS and schools are taking different approaches to the vaccination requirements. While some will offer exemptions for medical or religious reasons, others such as UH aren’t requiring students to apply for a waiver.

Not wanting the vaccine requirements to seem punitive, some have stressed the policies are simply offering a choice to ensure workplace safety: get vaccinated or get tested.

But an increase in demand for testing could pose a dilemma for those needing weekly screening.

“There are still a number of free testing sites around, but I don’t know that there is enough for everyone who does need to get tested,” Raethel said. “We don’t know yet how many people will meet the exemptions for vaccination.”

Federal law requires health insurers to cover the full costs of coronavirus tests ordered by health care providers. However, routine workplace testing is exempt from that requirement.

Some employers have already said they will cover the costs of testing. But Gov. David Ige said Thursday that state and county employees who can’t find a free testing site will have to pay for the costs themselves.

Meanwhile, UH is hoping that federal funds will cover the costs of student tests, according to Dan Meisenzahl, a university spokesman.

State health officials say they are working to make free testing widely available throughout the state in light of the surging cases and new mandates.

“We want to make it as easy and accessible as possible,” said Brooks Baehr, a spokesman for the Department of Health.

Health officials are pointing residents to its website, which includes a portal for finding testing sites. But it can be difficult to navigate and discern which ones might offer free tests for workplace screening.

“It does take some doing; I will concede that,” Baehr said.

The uncertainty surrounding free and easily accessible testing has elicited criticism from public sector unions whose leaders say they are particularly worried about workers in rural areas where access is more limited than in Honolulu.

Osa Tui, president of the Hawaii State Teachers Association, said he is also worried about the inconvenience.

“Our teachers have second and third jobs sometimes. When are they supposed to get tested?” said Tui during a press conference last week.

Health insurers could absorb testing costs, but some question why workers should have their tests paid for when vaccines have been free and readily available for months.

“The question is, if someone chooses not to get vaccinated, why should someone else pay for the testing?” Raethel said. “If you have a medical or religious exemption, I understand that. But if someone just flat out makes a decision — ‘Well, I don’t want to get vaccinated’ — they have a right to make that decision, but that doesn’t mean that someone else has the responsibility to pay for their tests.”

In addition to potential testing costs, Hawaii’s unvaccinated are taking a greater risk when it comes to the costs of treatment if they get sick from COVID-19.

The delta variant has been shown to infect vaccinated people at higher rates than the original strain, but it’s the unvaccinated who are mostly ending up in the hospitals and intensive care units. About 95% of COVID-19 patients in the hospital are unvaccinated, according to state health officials.

Throughout much of the pandemic, most health insurers were waiving cost sharing for COVID-19 treatment, meaning patients weren’t being hit with deductibles, co-insurance and co-payments if they got sick. Health insurers wanted to incentivize detection and treatment of the virus.

But health insurers are increasingly rescinding those cost-sharing waivers given the availability of vaccines.

HMSA, the state’s largest health insurer, says it expects to keep the waivers in place through the end of the year, but Kaiser Permanente revoked the waiver for commercial and QUEST members starting Aug. 1. Members are now charged their normal plan’s out-of-pocket costs for all COVID-19 treatments, according to a Kaiser spokeswoman.