Most employers in the United States will implement vaccine mandates this year, according to a recent poll, and companies forgoing official mandates are looking towards other methods, like financial penalties, to encourage people to get vaccinated. 

. Should you mandate a Covid-19 vaccine for your staff? Ask these 5 questions first.

Majority of U.S. employers will implement vaccine mandates 

According to a Willis Towers Watson poll conducted last month, 52% of the 961 companies surveyed said they'll have at least one vaccine mandate in place by the fourth quarter of 2021, a significant shift since May, when 72% of respondents said they didn't plan to require vaccines. 

"The delta variant has made employers take new actions to keep their workers—and workplaces—safe and healthy. We expect even more employers to institute vaccine mandates in the wake of [FDA] approval of the Pfizer vaccine," Jeff Levin-Scherz, population health leader at Willis Towers Watson, said.

Along those employers implementing vaccine mandates are many health care institutions, such as Kaiser Permanente, Trinity Health, Banner Health, Atrium Health, and the Veterans Health Administration. CVS Health also announced last month that employees working directly with patients would be required to be vaccinated. 

In July, the American Hospital Association (AHA) issued a statement saying it "supports hospitals and health systems that adopt mandatory Covid-19 vaccination policies for health care personnel."

And in a joint statement following FDA's approval of the Pfizer-BioNTech Covid-19 vaccine, AHA, the American Medical Association, and the American Nurses Association, said the approval "should further reinforce efforts in the health care field to urge vaccination, and to deploy all reasonable tools to achieve high levels of vaccination, including mandatory vaccination policies."

Health insurers have also started implementing mandates, including Cigna, who announced last month it would require all employees returning to its offices in person to be vaccinated. And CareFirst BlueCross BlueShield late last month announced it would be requiring all employees, boards of directors, and guests to be vaccinated.

Many colleges and universities have also implemented vaccine mandates. As of Aug. 30, over 800 colleges have announced they'll require students to be vaccinated, NPR reports. 

Premium surcharges for the unvaccinated 

In the absence of vaccine mandates, some employers have found other ways to encourage employees to get vaccinated. 

Delta Air Lines, for example, announced last month it would include a $200 monthly surcharge on unvaccinated employees' company health care plans. According to a memo released by Delta, the surcharge "will be necessary to address the financial risk the decision to not vaccinate is creating for our company." 

"We have reached a point in the pandemic where employers that have worked hard to make it easy for employees to get vaccinated are also considering approaches to make it more difficult for employees to remain unvaccinated," Levin-Scherz said. "While some employers will institute more frequent testing, workplace restrictions on the unvaccinated and vaccination mandates, all will have one common goal in mind—to keep their workforce healthy and productive by minimizing the risk of spreading Covid-19 in the workplace."

Delta's policy is something other employers have considered but have been concerned could create administrative and regulatory burdens or lead to some employees leaving, The Hill reports. 

"Lots of employers are very interested in this; none of them have pulled the trigger," Judith Wethall, a partner at McDermott Will & Emery, said. "It's being very carefully thought out and vetted."

However, according to Laura Boudreau, an assistant professor of economics at Columbia Business School, these types of policies may become more common

"I do think we'll see more companies adopting this kind of policy," she said. "It's a very clear rationale that companies can use to explain this type of policy to their employees: As with choices like smoking, especially now that the vaccine is fully FDA approved, it's possible for the employer to say that these employees are imposing a cost by maintaining a non-vaccinated status." 

Covid-19 care costs will likely increase 

As employers consider these policies, it's likely health care costs related to Covid-19 will start to increase, experts say. 

At the start of the pandemic, most health insurers waived all costs associated with treatment for Covid-19. But now, with vaccines widely available, insurers are starting to treat the disease as they would any other, the New York Times reports.

As a result, patients will likely start paying more for care related to Covid-19. 

"Insurers are confronting the question about whether the costs of Covid treatment should fall on everyone, or just the individuals who have chosen not to get a vaccine," Cynthia Cox, a VP at the Kaiser Family Foundation, said.

Blue Cross and Blue Shield of Florida, for example, recently announced it will start requiring its patients to pay their regular deductibles and copayments for treatment related to Covid-19. New policies like these generally apply to all patients, including the vaccinated; people who get sick with breakthrough infections; and those still ineligible for vaccination, such as children, the Times reports.

"When the Covid-19 pandemic began last year, we implemented several emergency provisions to temporarily help our members," Toni Woods, a spokesperson for the insurer, said. "Medical diagnostic testing for Covid-19 as well as vaccinations continue to be available to members at $0 cost share." (Kacik, Modern Healthcare, 9/1; Muoio, Fierce Healthcare, 9/1; Minemyer, Fierce Healthcare, 8/26; Nadworny, NPR, 8/30; Evers-Hillstrom, The Hill, 8/31; Mueller et al., Politico, 8/25; Kliff, New York Times, 9/2)

Should you mandate a Covid-19 vaccine for your staff?

Ask these 5 questions first. 

Across the country, health care employers are facing a pressing question: How do you increase the number of staff vaccinated against Covid-19? Advisory Board's Miriam Sznycer-Taub, Lauren Woodrow, and Heather Bell spoke with Kimberly Daniel, partner at the health care law firm Hancock, Daniel & Johnson, P.C about the implications of mandating Covid-19 vaccines for your employees.