By Joshua Schneyer

(Reuters). Almost a year since COVID vaccines began to be freely available in the U.S. A picture is beginning to emerge of the economic consequences of vaccine hesitancy. The data points to financial risks that are both for companies and individuals as well publically funded programs.

Experts say that vaccine hesitancy already contributes to tens or hundreds of millions of unnecessary deaths in America and preventable U.S. hospitalizations.

If you choose not to get vaccinated, there are risks such as unemployment and being unable to claim benefits. There may also be higher premiums or increased out-of pocket medical expenses.

Employers can be affected by vaccine hesitancy, which could lead to a shortage of workers. It could lead to a decrease in the funding of programs like Medicare that provide healthcare for senior citizens.

Unvaccinated employees may see some employers offering a higher risk premium than smokers. Unvaccinated employees will be charged $200 more per month by one airline, according to reports.

“When the vaccines emerged it seemed like everyone wanted one and the big question was how long it would take to meet the demand,” said Kosali Simon, a professor of health economics at Indiana University. “It didn’t occur to me that, a year later, we’d be studying the cost of people not wanting the vaccines.”

Alicia Royce is a special education teacher from Coachella, California. She opted not to get the COVID vaccination or have her children, who are vaccine-eligible, receive it. Royce’s parents got the shots, but she has been concerned by issues including reports of adverse reactions.

The decision puts Royce in a delicate spot. Like other schools in California, her school has a mandated vaccine for all staff members. Royce, who is a Christian exemption, has her COVID test twice a weeks before she enters the classroom. After the school year, Royce’s family has begun to move to Alabama where there are no mandates.

“I’ll get paid less,” said Royce, who expects to take a $40,000-a-year pay cut. “But I’m moving for my own personal freedom to choose.”

PREVENTABLE CARE, BILLIONS OF COSTS

Nearly 17 months have passed since the beginning of the third year of the COVID pandemic. The majority of Americans have been vaccinated and there is some recovery. However, authorities are anticipating an increase in infection from the BA.2 subvariant.

Yet as millions return to offices, public transportation and other social settings, Centers for Disease Control and Prevention figures show nearly 25% of U.S. adults haven’t been fully vaccinated, and the latest data suggests many holdouts won’t be easily swayed: The number of people seeking a first COVID vaccine in the U.S. has fallen to 14-month lows.

The effectiveness of vaccines against this virus has been demonstrated. CDC figures from 2021’s Delta wave found that unvaccinated Americans had four times greater risk of being infected, and nearly 13 times higher risk of death from COVID. The gap was even more for people who had received booster shots. They were 53 times less likely than those without the shot to get COVID. Less than half of the country’s vaccinated population has so far received a booster.

In a December study, the nonprofit Kaiser Family Foundation, which tracks U.S. health policy and outcomes, estimated that between June and November of 2021, unvaccinated American adults accounted for $13.8 billion in “preventable” COVID hospitalization costs nationwide.

Kaiser estimates that vaccines could have saved 59% of all COVID hospitalizations for Americans in six months, including the Delta wave. Kaiser estimated that 690,000.000 vaccine-preventable hospitalizations were prevented at an average cost $20,000. The Kaiser report estimated that vaccines could have prevented the deaths of 163,000 Americans during the same period.

Reuters discovered that vaccine hesitancy accounted to half the over 1 million U.S. COVID hospitalizations in December. The additional cost of hospital stays may amount to an additional $10 billion.

One thing is clear: As U.S. insurance providers and hospital networks reckon with vaccine hesitancy, it’s likely that patients hospitalized for COVID will end up shouldering a bigger portion of the bill.

“These hospitalizations are not only devastating for patients and their families but could also put patients on the hook for thousands of dollars,” Krutika Amin, a Kaiser associate director and one of the December study’s co-authors, told Reuters. Amin explained that, unlike in earlier pandemics like the one that occurred during the epidemic, private insurance companies have stopped covering COVID patients hospitalized.

For some insurance plans, the cost to a hospitalized COVID patient can exceed $8,000 just for “in-network” services, she added. For those who are not insured or opting for out-of-network services, the costs could spiral.

Now that Americans have the choice to protect themselves with vaccines, insurance companies are requiring patients to bear more of these costs, but “many people do not have enough money to pay,” Amin said.

More recent data – covering the Omicron wave – underscores the risk for the unvaccinated. State health department data show that in New York State, adults who were not vaccinated during January were nearly 13 times more likely to have COVID hospitalizations than adults who had received their vaccines.

POLICY FLASHPOINT

Federal reports reveal that the U.S. spent more than $19 billion in order to develop vaccines and has thus far, invested billions.

Despite this, America has the highest COVID vaccination rate among high-developed countries. This is because some people question whether they need to get the vaccines or are averse to mandates from the government.

“The subset of the population that is really anti-COVID vaccine, ready to quit jobs or test in order to go to work, is now pretty hardened,” said Julie Downs, a social psychology professor at Carnegie Mellon University.

COVID vaccinations have become controversial. The rates of vaccination vary greatly by location. In Vermont, 84% are fully vaccinated while in Alabama, it is less than 60%.

Nearly 76% of people in the United States have had at least one dose of a COVID vaccine, CDC data shows, but the fully vaccinated figure – across all age-groups – stands at 64%. The Food and Drug Administration hasn’t yet approved a COVID vaccine for children under 5.

Perhaps the biggest financial risk vaccine holdouts have faced is getting laid off from their jobs, said Kaiser’s Amin.

New York City, which requires city workers to be vaccinated, fired more than 1,400 of them last month who hadn’t received a vaccine shot by the city’s deadline, while around 9,000 other workers remained in the process of seeking exemptions to the requirement, city figures show. The vast majority of the city’s 370,000-person workforce is vaccinated.

According to a Kaiser Family Foundation national survey, 25% of respondents said that their employer needed proof of vaccination. Only 1% of workers surveyed — and 5% of unvaccinated workers — reported having left a job due to a workplace vaccine mandate.

According to Fierce Healthcare’s report, a small percentage of healthcare workers have been laid off or put on leave. However, the number of dismissals is still significant.

NO-VAXTAX

Giant employers including J.P. Morgan and Bank of America (NYSE:) have informed their U.S. employees they can expect to pay more – or receive fewer perks through company wellness programs – if they don’t provide proof of vaccination.

Other companies have extended an insurance premium surcharge for unvaccinated spouses or family members of employees if they want to be insured as a dependent under an employee’s health plan.

Reuters reports that insurers are going to be calibrating premiums closer to COVID mortality risk, after they were subject to a greater-than-expected $5.5 Billion in claims over the first nine months 2021.

Vaccination status and other health risks – such as obesity or smoking — are metrics life insurers can probe when customers seek coverage. The U.S. Affordable Care Act, individuals seeking health insurance can’t be denied for pre-existing conditions, including COVID, or charged more for not being vaccinated. But companies who cover some of employees’ health insurance costs can pass along higher costs to unvaccinated employees.

Delta Airlines (NYSE:) said last year it would charge employees who didn’t vaccinate an extra $200 a month for health insurance. Delta Airlines (NYSE:) stated that the added cost was because of the greater risk for COVID hospitalization in those employees. They also pointed out that COVID treatment for employee had been expensive at an average $50,000.

Students at universities can also face financial penalties for choosing to withdraw. At least 500 U.S. colleges have vaccine mandates, some barring enrollment or in-person schooling for those who don’t comply, or requiring them to undergo frequent COVID testing.

Cait Corrigan said she enrolled in a master’s program in theology at Boston University this year and was offered an academic scholarship. Corrigan, who has led public-activism efforts against vaccine mandates, said she got a religious exemption to the school’s vaccine mandate, but the school required that she take regular nasal swab tests to attend. Corrigan said she declined to submit to nasal tests for “medical reasons.”

According to her, the university terminated her employment and withdrew funds. “It was a big loss.” Boston University didn’t respond to a request for comment.

Corrigan is currently running in New York for the Republican congressional seat. Her platform: “medical freedom.”