MINOT, N.D. — This morning, a reader emailed me to ask "whether because of COVID" are health insurance premiums "due for a substantial increase."

He also asked "whether there will be an opportunity" for business owners to "reduce your premium by mandating vaccines."

Those are good questions, and I took them to North Dakota Insurance Commissioner Jon Godfread, a Republican who has held that office since his 2016 election.

The answer to the first question is no, though with some caveats.

"Premiums did go up this year. COVID factors were included in some of the carrier's filings which did have an impact on the rates," Godfread told me. "Another impact to the rates may have been that last year, we held our insurance companies even, so no real rate increases."

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Paradoxically, the pandemic put both upward and downward pressure on premiums. "During the pandemic, people still paid their health insurance premiums, but utilization during the height of the pandemic was down," he said. This means people were paying for their insurance but accessing medical care less. We all heard the stories about people choosing to postpone medical care during the pandemic.

On the other side of the ledger, though, the people who got COVID-19 used a lot of care, and the insurance companies were generous when it came to copays and other out-of-pocket expenses. "Also, during this time, most of our insurance companies waived cost-sharing for COVID treatments and other COVID-related issues," Godfread said.

So premiums went up, but there was no substantial increase, and the reasons why are more complicated than just the pandemic.

What does the future hold? "From what I can tell, claims are about back to what you would expect in N.D. despite the pandemic," Godfread said. "At this point, we have not seen the projected big spike in claims that some were predicting."

"People may still be deferring or delaying care, but we did not see a rush back to the hospital this summer when our numbers were much lower either," he continued.

Medical scrubs and marker filled messages on signs and bodies highlighted a divided medical community in Dickinson on Thursday as protestors gathered in front of CHI St. Alexius Health Dickinson in opposition to employment dependent mandates for the COVID-19 vaccine. (Josiah C. Cuellar / The Dickinson Press)
Medical scrubs and marker filled messages on signs and bodies highlighted a divided medical community in Dickinson on Thursday as protestors gathered in front of CHI St. Alexius Health Dickinson in opposition to employment dependent mandates for the COVID-19 vaccine. (Josiah C. Cuellar / The Dickinson Press)

How about employer vaccine mandates and their impacts on premiums? As things stand now, it would be illegal for insurance companies to adjust rates based on vaccination status.

Ironically, given that hostility to vaccines is mostly coming to the right, while support for policies pressuring people into vaccinations is mostly coming from the left, Obamacare is why health insurance companies change charge higher premiums for the unvaccinated.

"This is something that had certainly been talked about, but up to this point and based on the non-discrimination rules for ACA plans, plans cannot discriminate based on health factors. This includes vaccination status," Godfread said. "It is something that might be allowed in the future, as a wellness program of some kind for groups ... but at this point, it is not allowed to rate based on vaccination status."

Godfread noted that wellness programs, which see insurance companies offering lower rates for insured pools that meet specific goals for healthy lifestyles, do have some exemptions from Obamacare's discrimination policies.

Should insurance companies charge higher premiums for the unvaccinated? Many conservatives who opposed Obamacare and its sweeping regulations of the insurance markets will likely say "no." A lot of liberals, who were very much for the ACA's new restrictions on insurance rate flexibility, are going to say "yes."

Count me in the latter group. Insurance is about mitigating risk. Going unvaccinated, like choosing to smoke, is a risk, and insurance companies should have the flexibility to adjust their premiums accordingly.

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Rob Port, founder of SayAnythingBlog.com, is a Forum Communications commentator. Reach him on Twitter at @robport or via email at rport@forumcomm.com.