Who Pays for COVID Tests?

As workplaces require proof of health status, a new debate has started.

The Upshot’s Sarah Kliff highlights a “New Rule Raises Question: Who’ll Pay for All the Covid Tests?

Spurred by rising Covid cases and the Delta variant’s spread, a wave of major employers announced the same rule for unvaccinated workers this week: They will need to submit to regular surveillance testing. The new requirement 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.”

If you had asked me a few days ago, I’d have said that it’s obvious that, if someone is eligible to be vaccinated and refuses, the cost of proving that they’re not infected should be on them. That’s the price of being a sociopath. But, now that we know that vaccinated folks who are infected are almost as likely to be asymptomatic spreaders, it’s not so easy. (UPDATE: Still, as @drj correctly notes in the comments, “vaccinated people have a far, far smaller chance of getting infected compared to unvaccinated people.”)

Indeed, our entire public policy seems out of whack right now.

President Biden announced rules on Thursday that amount to a two-tier system for the country’s four million federal employees. Those who do not get vaccinated will have to social-distance, wear face coverings and comply with limits on official travel. Those who do get vaccinated will have no such requirements.

The unvaccinated will also have to submit to regular coronavirus testing. Each federal agency will come up with a plan for testing its unvaccinated work force. The costs and procedures of each agency’s testing protocols will depend on the number of unvaccinated people they need to monitor.

“The agencies are going to be implementing this program themselves, so they’ll be in charge of how that moves forward,” Ms. Jean-Pierre said.

It’s not all that clear why we’d test only the unvaccinated if the only difference is in the likelihood that they’ll personally get severely ill if infected. Ditto face masks. If the purpose of wearing them is to protect ourselves, then it’s reasonable to make it a personal choice for the vaccinated, who have to balance the extremely low risk of serious illness for otherwise healthy under-65s against however much inconvenience they find masking to be. But, if the point is to prevent the spread to others, it’s not nearly as cut-and-dried.

Among the employers taking a different approach is Rhodes College in Tennessee: It will require 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.

Leaving aside the question of transmissibility, I understand why we’d waive fees for those whose medical conditions preclude vaccination. But, I’m sorry, superstition should not be considered a viable excuse for endangering public health. Being a Christian Scientist is no more protected than being a Trump supporter or Qanon conspiracist.

FILED UNDER: COVID-19
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. drj says:

    now that we know that vaccinated folks are almost as likely to be asymptomatic spreaders

    This is just false.

    From the the WaPo (reporting on unpublished CDC data) a couple of days ago:

    vaccinated individuals infected with delta may be able to transmit the virus as easily as those who are unvaccinated. Vaccinated people infected with delta have measurable viral loads similar to those who are unvaccinated and infected with the variant.

    Even if we take this unpublished data at face value (while noting that it perhaps remains unpublished for a reason), it is still the case that vaccinated people have a far, far smaller chance of getting infected compared to unvaccinated people.

    In short, vaccinated people are far less likely to be spreaders than unvaccinated people. This is absolutely undeniable.

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  2. MarkedMan says:

    But, now that we know that vaccinated folks are almost as likely to be asymptomatic spreaders, it’s not so easy.

    James, a month ago you were castigating the CDC for their messaging because “everyone knows” vaccinated people can’t spread the virus. I’m genuinely curious about how your thinking has changed on this and whether you feel differently about the CDC messaging?

    1
  3. James Joyner says:

    @drj:

    In short, vaccinated people are far less likely to be spreaders than unvaccinated people. This is absolutely undeniable.

    Yes, I think that’s a better way of framing the situation. Infected folks who are vaccinated/unvaccinated are about equally likely to be spreaders, it seems, but vaccinated people are far less likely to be infected.

    @MarkedMan:

    I’m genuinely curious about how your thinking has changed on this and whether you feel differently about the CDC messaging?

    We have a new dominant strain and new, if evolving, information as to how that strain spreads.

    4
  4. Mimai says:

    …if someone is eligible to be vaccinated and refuses, the cost of proving that they’re not infected should be on them. That’s the price of being a sociopath.

    I really wish we’d stop with this “sociopath” business. It’s not true. And it’s not helpful. And I’m not talking about in the strict clinical sense. I’m talking about in the colloquial use of the term. There are lots of reasons people have yet to be vaccinated. Lumping them all into a single “I have negative regard for other people” category is just lazy.

    Also, let’s assume that you are correct in saying that

    vaccinated folks are almost as likely to be asymptomatic spreaders

    If this is indeed the case (or is your position), then what shall we call vaccinated folks who don’t wear masks when in public indoor places? Sociopaths?

    3
  5. Sleeping Dog says:

    The unvaccinated should bear the cost, unless the employer/institution decides that all those who are part of the organization should be tested periodically. Let’s up the pressure, right now the anti-vaxxers don’t feel they are incurring a cost by their resistance. Loss of a job, status or a monetary cost will end that.

    4
  6. Joe says:

    @drj:
    Sorry, I had to read your post three times in order to understand your point, which is (I think) that the quote is limited to the subset of people who are both vaccinated and infected with Delta. If there is some evidence that vaccinated people are still less likely to get infected (which would not surprise me), it does not appear in your post.

    1
  7. James Joyner says:

    @Mimai:

    I’m talking about in the colloquial use of the term. There are lots of reasons people have yet to be vaccinated. Lumping them all into a single “I have negative regard for other people” category is just lazy.

    Aside from those ineligible (under 12) and for whom vaccination is contraindicated for medical reasons, I just have no sympathy for those who refuse at this point. We’ve bent over backward to make the vaccine free and available wherever people might find themselves, including pretty near every grocery, drug, and big box store.

    what shall we call vaccinated folks who don’t wear masks when in public indoor places? Sociopaths?

    I don’t blame people for following local rules in line with CDC guidelines. The unvaccinated assholes going around maskless despite signs on the door saying masks are required for those who are unvaccinated are sociopaths. And there’s a special circle in hell for people who wear a facemask but deliberately pulled down so that it’s useless.

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  8. Mimai says:

    @James Joyner:

    I’m cool with you having no sympathy for these folks. That’s different than calling them sociopaths.

    3
  9. Tony W says:

    It’s not all that clear why we’d test only the unvaccinated if the only difference is in the likelihood that they’ll personally get severely ill if infected.

    The employer-based healthcare system justifies this completely. Even setting aside absenteeism, employer direct costs go up when these folks need expensive care.

    #MedicareForAll

    2
  10. Tony W says:

    @Mimai:

    sociopaths

    I think that’s exactly the right word. They move through their lives completely selfishly with zero regard for the fate of anybody but themselves. They don’t care about the children who cannot yet be vaccinated. They don’t care about the immunocompromised folks who cannot receive the vaccine. They. Don’t. Care.

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  11. drj says:

    @Joe:

    If there is some evidence that vaccinated people are still less likely to get infected (which would not surprise me), it does not appear in your post.

    Are you seriously asking whether Covid-19 vaccines are even working?

    4
  12. MarkedMan says:

    @James Joyner:

    We have a new dominant strain and new, if evolving, information as to how that strain spreads.

    Which was exactly why the CDC was giving the cautious advice they did. They have known about the delta variant for months and have been studying the ways it behaves differently. Their guidance was, “There are new variants and we have to understand them before drastically changing policies.”

    You and I don’t get all the research results, and we certainly don’t get all the anomalous behaviors. What we have access to are early, unvented papers whose authors shared them with the press.

    3
  13. Mimai says:

    @Tony W:

    I agree that there’s a significant “They. Don’t. Care.” group among the unvaccinated. I disagree that this is the only group. Eg, seems to be several groups represented among these numbers.

    2
  14. Mimai says:

    @James Joyner:

    The unvaccinated assholes going around maskless despite signs on the door saying masks are required for those who are unvaccinated are sociopaths.

    Ah, but that’s quite a bit more nuanced than the “unvaccinated = sociopath” formulation. My point was exactly this – more nuance please.

    2
  15. Just nutha ignint cracker says:

    @Mimai:

    If this is indeed the case (or is your position), then what shall we call vaccinated folks who don’t wear masks when in public indoor places? Sociopaths?

    I’m good with that! Then again, I also believe that most, if not all, of the population of most societies–and particularly Western ones–are somewhere on an NPD spectrum, so I have a low opinion of humanity at large. (And yes, Reynolds, you can blame Calvinism if you want.)

  16. charon says:

    In many foreign countries testing is free because the government picks up the tab.

    This is just another example of how unserious, how feckless, the U.S is about all of this.

    3
  17. Andy says:

    Calling people sociopaths will, I’m sure, be highly effective in convincing the vaccine hesitant to change their views.

    2
  18. James Joyner says:

    @Andy:

    Calling people sociopaths will, I’m sure, be highly effective in convincing the vaccine hesitant to change their views.

    I wouldn’t advise President Biden or the CDC communications people to adopt this strategy. But, as a private citizen, I’m free to speak my mind.

    15
  19. Michael Reynolds says:

    I must take you to task, James, as @Mimai says, they’re not all sociopaths, many are cretins.

    3
  20. Andy says:

    @James Joyner:

    You certainly are free to speak your mind.

    To the extent that you actually want people to get vaccinated, name calling is clearly counterproductive (IMO), particularly in such a public venue. So I always wonder what people who do this are actually attempting to achieve.

    3
  21. Mimai says:

    @Michael Reynolds:

    Haha! I feel so validated.

    2
  22. wr says:

    @Andy: “Calling people sociopaths will, I’m sure, be highly effective in convincing the vaccine hesitant to change their views.”

    Are many of them reading this site? If so, they certainly haven’t made their presence known. Personally, I’m pretty sick of right-wing apologists telling me “If you say mean things about right wingers even in private where there’s no chance they will ever hear you, you are helping Trump win.” For all the rightie complaints about “virtue signaling” and “snowflakes,” the entire right wing social media apparatus seems to be insistent that no bad word ever be said about any of them.

    8
  23. wr says:

    @Andy: “So I always wonder what people who do this are actually attempting to achieve.”

    No, you don’t.

    7
  24. Mm says:

    @Andy: As much as I enjoy and appreciate OTB, I suspect you are greatly overestimating its reach, especially among the unvaxxed

    3
  25. Michael Reynolds says:

    @Andy:

    So I always wonder what people who do this are actually attempting to achieve.

    An honest description of reality?

    We’ve done everything we can to get these assholes to behave like adults. We’ve informed, we’ve educated, we’ve pleaded, we’ve bribed. For what purpose? To keep these imbeciles alive. But if they’re so determined to ‘own the libs’ that they’re willing to go to the ICU, to watch loved ones get sick and die, we no longer owe these people anything. Fuck ’em.

    We have reached the point where we can legitimately laugh at these people. It’s all that’s left.

    6
  26. grumpy realist says:

    @Andy: they’re acting like narcissists who threaten stupid things to get everyone else in a tizzy and running around trying to rescue them.

    At some point, the correct response is: go ahead and jump off the bridge if you’re so insistent on doing so. We’re not going to bother about you any more.

    2
  27. Gustopher says:

    @Andy:

    Calling people sociopaths will, I’m sure, be highly effective in convincing the vaccine hesitant to change their views.

    I’m not sure about that. A lot of the vaccine hesitant are really only hesitant because of loosely held political beliefs — if you make it clear that their belief is resulting in ostracism, the ones on the fence will begin falling in line.

    People crave acceptance. Make it clear that something in unacceptable, and they’ll hesitate. Some will double down and latch onto the acceptance of their smaller group, but a lot of others will stop and think.

    Vaccination rates are rising. Is that because people are finally getting the message that covid is bad, or because the vaccinated parts of the country are getting fed up with them and starting to say “fuck you, just die already and get it over with.”?

    Probably both.

    6
  28. JKB says:

    @Andy: Calling people sociopaths will, I’m sure, be highly effective in convincing the vaccine hesitant to change their views.

    The goal is not to get the vaccine hesitant to change their views, but rather to erode the inhibitions that some still have against the wholesale use of government and mob violence against the disfavored group. Find an element of segregation, define it as malevolent, remove the humanity…. Perhaps not overt James’ part, but get enough people saying that and erosion of the reluctance those troubled by such things becomes a dam breach. James doesn’t see it yet, but he’s on his way to being at minimum a ‘good German’ if not a more active participant.

    Assuming we don’t fall into the mid-20th century socialist slaughter mindset, many will have learned things about themselves.

  29. Jax says:

    @JKB: No, I just really, really REALLY want people to get vaccinated so they don’t die and maybe life can go back to normal.

    7
  30. dazedandconfused says:

    @drj:

    Even if we take this unpublished data at face value (while noting that it perhaps remains unpublished for a reason), it is still the case that vaccinated people have a far, far smaller chance of getting infected compared to unvaccinated people.

    In short, vaccinated people are far less likely to be spreaders than unvaccinated people. This is absolutely undeniable.

    Quibble: We can deduce that vaccinated people are less likely to spread the disease but that isn’t as yet clear. Vaccines do not prevent infection, they only prime the immune system to clear it up quicker, yet while infected vaccinated people are just as likely to spread it. I believe that is what the CDC is trying to say.

    True, vaccinated people are undeniable less likely to spread the virus for as long or with the same viral load as the unvaccinated are, but they also undeniably still can spread it, and may be even more likely to if they run around unmasked on account of their status and the unvaccinated remain masked. Around these parts there are businesses which post signs saying if you are vaccinated you can go without a mask. My local Starbucks was running that way, or was until today, when our Gov changed the rules again.

    I wonder of some are conflating the terms “infected” and “symptomatic”.

  31. Mimai says:

    As of July 19, less than half of Black and Hispanic people have received at least one COVID-19 vaccine dose in the vast majority of states reporting data. The vaccination rate for Black people is less than 50% in 38 of 42 reporting states, including 14 states where less than a third of Black people have received one or more doses. Similarly, less than half of Hispanic people have received a COVID-19 vaccine dose in 34 of 40 reporting states, including 10 states where less than a third have received at least one dose. [link]

    To repeat myself, I disagree with the assertion that all (or most or even a large %) of these people are sociopaths, narcissists, evil, etc.

    1
  32. Michael Reynolds says:

    @JKB:
    And JKB with the timely reminder that ‘sociopath’ and ‘cretin’ are not mutually exclusive.

    I’m curious, though. Are we saying that liberals are no longer eating babies? Do we have the bandwidth to both prep the population for total submission to the malevolence of medical science, and still eat babies in pizza parlors?

    6
  33. Gustopher says:

    I think the government should pay for all the tests so we can have Socialist Nasal Probes.

    We can then use the coercive, violent power of the state to seize boogers from JKB under the threat of greater violence. Socialist Nasal Probes, like taxation, are theft.

    What will the government do with its collection of right-wing boogers? I think the better question is this: what won’t the government do with its collection of right wing boogers? (Hint: the mid-20th century socialist slaughter mindset was never limited to the mid-20th century…)

    So keep up the resistance, JKB, as otherwise forced nasal penetration (also known as nasal rape) is the future of “free” America.

    3
  34. Mister Bluster says:

    …mob violence…

    Hang Mike Pence

    1
  35. Mimai says:

    @Michael Reynolds:

    Molecular gastronomy. So, yes.

    3
  36. drj says:

    @dazedandconfused:

    The WaPo reporting mentions that vaccinated people with “milder breakthrough infections” are perhaps able to transmit Covid-19 as easily as infected unvaccinated people.

    It seems unlikely that most/all successful immune responses in vaccinated people should somehow be equated to “milder breakthrough infections.”

    That would be a very strange choice of words.

  37. wr says:

    @Jax: No, I just really, really REALLY want people to get vaccinated so they don’t die and maybe life can go back to normal”

    Fascist.

    4
  38. Lounsbury says:

    I would say the proper policy is the very one I have instituted in my firm.

    (1) Vaccine refusers (I am facing some vaccine shy) must get tested weekly at own cost.
    (2) Persons exposed to a Covid19 case are to be tested at our expense (employer expense) regardless of their vaccination status.
    (3) Persons presenting symptoms regardless of their vaccination status should be tested, again at our expense (for confirmation on tracing purposes ultimately).

    No comment as to the troll-cretin.

    1
  39. Just nutha ignint cracker says:

    @Andy: Maybe some of us are simply venting, realizing that you can’t sell people what they don’t want to buy. Some of us are willing to go so far as to make the assumption that criticism of what we say as “counterproductive” is simply another flavor of virtue signaling.

    2
  40. Just nutha ignint cracker says:

    @Gustopher: This! I’m going to go get my phone so I can upvote it again!

    1
  41. dazedandconfused says:

    @drj:

    My quibble is that vaccinated people do get infected. It’s a common misunderstanding that vaccines prevent infection, which in reparatory tract infections certainly isn’t accurate. The vaccine does not create armor-plated cells which the virus can’t penetrate, they only prime the immune system to detect and destroy those converted-to-virus-factory cells quicker. Particularly in respiratory infections, vaccinated people spread the disease.

    From the first post:

    Vaccinated people infected with delta have measurable viral loads similar to those who are unvaccinated and infected with the variant.

    James’s statement was thereby true, unless one believes that the vaccinated carry a form of the virus which is not transmissible.

  42. Just nutha ignint cracker says:

    @JKB: Wow! And nonsense, but well played!

    1
  43. KM says:

    @Just nutha ignint cracker:
    Yep – we’re getting real tired of being told it’s our fault they’re engaging in bad behavior and we shouldn’t say boo about it. One of the biggest tools an abuser has it turning blame around on the victim. You’re not allowed to call them out or say anything negative about their terrible behavior and if you do, it’s *your* fault they’re acting like that. It’s more important to preserve their fragile feelings so they might, MIGHT consider doing the right thing at some point before the heat death of the universe then to call a spade a spade.

    Do you know what you call the vaccine-hesitant or vaccine-adverse in a sane society experiencing a plague? Selfish asshat anti-vaxxers and yeah, there’s a mental pathology in play there. If they find that insulting, imaging how the rest of us feel that someone’s allowed to risk strangers’ lives and let this disease mutate solely based on lies , fear or just plain contrariness. At this point, there is no real reason for hesitancy other than unfounded mistrust fostered by lies or conspiracy theories made up to push culture wars. I know a lot of people are going to want to jump in with “well what about disadvantaged group X’s bad history with authority?” but nope, no dice – trust is a choice and they are actively choosing bad logic and hard feelings at the cost of people’s lives. So many efforts have been made to reach out on every level to get the urgency out to these folks…. and it’s like watching someone refuse to understand fire is hot till they burn down the house.

    So what people who do this are actually attempting to achieve? Speaking truth to the idiots playing with matches is cathartic in and of itself. We’re not allowed to rip the matches out of their hands because “freedom” and we have to stand here helpless watching them burn down the neighborhood – so you better believe we’re gonna cuss ’em out as their self-immolation threatens to take us out.

    6
  44. flat earth luddite says:

    @JKB:
    What the flaming flock? Really? Because we’re tired of being told we’re (at best) traitors to ‘Merica, and we’re trying to follow the science (which is changing as our knowledge changes), we’re (apparently) proto-Nazis (or Stalinists, I can’t tell which), FFS. Seriously, when you can argue your position with more reason than my friend’s 7 year old grandsons, let me know, ok?

    @Just nutha ignint cracker:
    Yes, it is complete nonsense. I’m not sure, but I think he’s smoking the same stuff BD used to ingest/inhale when he was planning on blowing up the gas station as a distraction for the robbery!

    @Michael Reynolds:
    You realize you grievously and painfully insulted Cretin Americans nationwide with this comparison, don’t you?

    1
  45. JohnSF says:

    @JKB:

    …the mid-20th century socialist slaughter mindset…

    Would that be the one held by socialist(eek!) ministers of the British government of 1940-45?
    Well, I suppose men like Atlee, Bevin, Greenwood Morrison, Cripps etc might get called bit slaughtery, but in all fairness the Germans did start it.

    Or it could be those British socialists who, as members of the armed forces, were required, from time to time, to get their slaughter on, as it were?

    Or perhaps, just an an alternative, it is a foolish term you use because you have about as much grasp of the history of political concepts as a hamster?

    1
  46. Andy says:

    @Just nutha ignint cracker:

    Venting I understand.

    I try very hard not to virtue signal in general including here but of course I’m only human. And I realize now that in a recent comment on another post I called those who don’t get vaccinated “idiots” so I’m also somewhat hypocritical on this.

    What I try to do is to focus more on process and effective action and how we can, as a practical matter, get from point A to point B. I think a lot about how to “operationalize” ideas. That is, for example, a lot of the basis of my skepticism regarding Steven’s desire to remake our national political institutions even though our fantasy solutions are pretty similar.

    Related to that focus is looking at words compared to actions. In our internet age I find that people talk a big game and are quick to judge and condemn other, but the outrage never goes beyond the keyboard. I have little tolerance for those who are unwilling to put their money where their mouth is.

    Unlike some of the more uncharitable commenters here, some of whom go out of their way to interpret and spin what I write in least charitable and honest way (btw, I’m not talking about you with that characterization), I’m not questioning or assuming Jame’s motivations or anyone else’s. Maybe James is venting, but he hasn’t said and I’m not in a position to know and also, unlike some here, I’m not going to strawman him or assume or making up arguments on his behalf. If he wants to share that’s up to him.

    But the reasons or motivations aren’t really relevant to my narrow point I made – that generalizing about a large and diverse group of people by calling them “sociopaths” is neither accurate nor productive. James and Steven have both made that same point many times in other contexts.

    And I do share the general boiled-down sentiment- I’m frustrated with the vaccine hesitant as well, particularly those who work around vulnerable populations. I support vaccine mandates for the military and certain classes of workers for example. But I’ve also researched that issue enough to understand that it’s not as straightforward as some, including James, are claiming. It’s another situation where the details and process matter a great deal.

  47. flat earth luddite says:

    @JohnSF:
    Hey, hey, hey, John, that was unfair and mean… to the hamster.