Last week, President Joe Biden, expressing frustration about the low vaccination numbers, issued an executive order that would expand mandatory vaccination requirements to federal workers, contractors, health care workers and all employers with more than 100 employees. The plan could affect as many as 100 million people, more than two-thirds of the U.S. workforce. Those who receive Medicare or Medicaid would also be subject to the mandate.

“Because it’s so political, this takes the heat off of employers to mandate vaccines,” said David E. Williams, president of Boston-based Health Business Group, a health care consulting firm. He thinks mandates will make a difference in hospitalizations.“Each incremental percentage in vaccination is valuable to the country as a whole.” 

In addition to mandates, the financial risks will grow for people who contract the virus and are hospitalized. While insurers initially waived cost-sharing requirements early in the pandemic for people hospitalized with the virus, patients will pick up more of the tab going forward. At least 72% of the plans among the largest insurers no longer waive these costs, and another 10% of plans will phase out the waivers by the end of October, according to KFF. 

Most insurers reported record profits last year—because more people put off routine medical visits. But the pandemic has been a disaster for hospitals. While they were well reimbursed for care of COVID patients, hospitals were forced to turn down elective surgeries—such as knee and hip replacements—that are far more profitable and require less space, time, and risk to staff. It led to burnout and resignations among doctors, nurses, and technicians. More than half of U.S. hospitals closed the fourth quarter of 2020 with negative margins, and half a dozen filed for bankruptcy. “They had a lot of customers,” Williams said, “but the wrong kind.”