Testing Burdens for Essential Workers Could Strain Insurance Plans, Spike Premiums 70%

As more workers who require routine COVID-19 testing return to in-person settings, the strain on the private insurance system could cause premiums to spike and force workers off coverage altogether, a new analysis in the journal Health Affairs determined.

Both the federal government and states have mandated varying levels of testing frequency for nursing home employees, but the question of cost remains contentious: Federal law does not require health plans to cover tests for employees that were not exposed to the virus or who are asymptomatic, the authors of the Health Affairs report noted.

And not every worker has health coverage: About 63% of employees at skilled nursing facilities receive insurance coverage through their employers, based on data from the Urban Institute; about 10%, or 188,000 nursing home workers, were not insured.


That’s lower than the 68% of the general workforce covered by employer plans, the authors observed.

Among those skilled nursing workers who have health insurance of any kind, 27% rely on a plan that’s contingent on a family member’s employment, according to the analysis.

“Essential workers who are uninsured or whose spouse loses insurance due to the COVID-19 recession may not only be without financial access to testing, but they are also likely to have limited access to necessary medical care if they fall ill, either from COVID-19 or any other condition,” the report noted.


The problem also isn’t as easy to solve as a simple federal mandate requiring private insurance plans to cover all COVID-19 tests for essential workers, particularly as that group expands beyond health care workers to include larger numbers of teachers, other educational support staff, and day care employees as schools reopen in the fall.

Early estimates of the cost to test essential workers just once per week come in at $5,200 per person, according to the analysis, bumping up against the average annual health insurance premium of $7,188.

“If employer-based insurance for workers in essential industries is required to absorb these costs while maintaining typical spending on other types of care, this would imply a necessary premium increase of more than 70 percent, on average,” the researchers warned. “Such a large price increase would certainly lead to dramatic reductions in insurance coverage in these industries.”