Louisiana’s largest health-care system is giving its employees a choice as it seeks to boost coronavirus vaccination numbers: ensure your spouse has received a shot or face higher health insurance costs.

Beginning next year, employees of Ochsner Health System will see a roughly $200-a-month surcharge if their spouse or domestic partner on the company health plan is not vaccinated against the coronavirus, according to a letter sent to affected employees last week. The surcharge does not apply to child beneficiaries covered by the plan.

“This fee is similar to what’s been in place for tobacco users and is in line with the benefits offered by many health care organizations and companies,” Ochsner President and CEO Warner Thomas said in a statement. Thomas said the policy was not a “mandate” because nonemployee spouses and partners can opt for health insurance outside the company’s plan.

With about 33,000 employees, Ochsner appears to be one of the first large companies in the United States to include dependent spouses and partners in a coronavirus vaccination surcharge policy. With doses widely available in the United States and the Pfizer-BioNTech vaccine fully approved by the FDA in August, a growing number of companies are shifting their vaccine approach from carrot to stick.

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Hospital systems across the country, as well as major employers such as United Airlines and Tyson Foods, are telling workers to either get the vaccine or get a new job. Other companies, such as Delta Air Lines, have not mandated the shot but are adding health-care surcharges for unvaccinated employees.

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Self-insured companies such as Ochsner face an especially strong motivation to discourage potentially costly behavior, including tobacco use and vaccination refusal, through insurance surcharges.

The average cost of a hospitalization for COVID-19, the disease caused by the coronavirus, is $20,000, according to a September estimate by the Kaiser Family Foundation. Over the past year, Ochsner has spent “more than $9 million on COVID care for those who are covered on our health plans,” Thomas said in a statement to The Washington Post.

Vaccination mandates and incentives have been broadly shown to be effective, particularly among groups that initially had high rates of vaccine hesitancy, according to Linda Forst, a professor of environmental and occupational health sciences at the University of Illinois at Chicago’s School of Public Health.

“The more comprehensive the requirement, the better it’s going to be for everyone,” Forst said. She expects more will be revealed in the coming months, once Ochsner’s spousal surcharge takes effect and factors such as consumer confidence, employee infection rates and overall employee vaccination rates can be compared among hospitals with and without more stringent policies.

Ochsner announced in August that “all its physicians, providers and employees” must be fully vaccinated by Oct. 29, and 82% of the company’s employees have complied, Thomas said during a Wednesday call with reporters. Among physicians and company leadership, the rate is near 98%.

The employee vaccination mandate and the surcharge for unvaccinated dependent partners allow for health and religious exemptions. About 300 employees — less than 1% of Ochsner’s workforce — requested one, Thomas said in the call.

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But not all Ochsner employees accept the mandate. On Sept. 20, more than 40 filed a lawsuit seeking to block it, arguing in part that it violates medical privacy.

Similar objections have been raised in response to President Joe Biden’s vaccination rules. Last month, Biden said that all federal workers must be vaccinated and that all businesses with more than 100 employees require vaccination or weekly testing.

Joel Friedman, a law professor at Tulane University who studies discrimination law and labor law, predicted that such lawsuits against private companies “will go nowhere.” Surcharges are legal as long as they allow for certain exemptions and are capped to a percentage of income. (Ochsner’s will withdraw up to $2,400 a year from an employee’s paycheck under the spousal surcharge.)

“People have been required to have vaccines for decades, and there’s no right to do whatever you want in this world, free from government interference,” Friedman said. “Try to drive a car without a license or getting on an airplane without putting on your seat belt and see what happens.”

He notes that while some employees may see vaccination mandates as heavy-handed, others who don’t want to work in a setting with unvaccinated colleagues may welcome them, and that the requirements may reduce liability for hospitals.

Forst agreed and said patients probably would feel safer in a hospital with high vaccination rates among staffers — and, in Ochsner’s case, their domestic bubbles, too.

“It makes sense that a health-care company would be leading this; these organizations are the ones taking care of other people,” she said.

Louisiana has recently seen its highest infection rates since the start of the pandemic. The state averages just over 1,000 new cases a day. Just over 45% of the eligible population in the state is fully vaccinated, lagging well behind the national average, according to data tracked by The Post.

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(Jennifer Luxton / The Seattle Times)

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