Don’t want a vaccine? Be prepared to pay more for insurance.

America’s COVID-19 vaccination rate is about 60% for ages 12 and up. That’s not enough to reach so-called herd immunity, and in such states as Missouri — where a number of counties have vaccination rates under 25% — hospitals are overwhelmed by serious outbreaks of the more contagious delta variant.

The vaccine resisters offer all kinds of reasons for refusing the free shots and for ignoring efforts to nudge them to get inoculated. Campaigns urging Americans to get vaccinated for their health, for their grandparents, for their neighbors, or to get free doughnuts or a free joint haven’t done the trick. States have even held lotteries with a chance to win millions or a college scholarship.

And yet there are still huge numbers of unvaccinated people. Federal, state and municipal governments as well as private businesses continue to largely avoid mandates for their employees out of fears they will provoke a backlash.

So, how about an economic argument? Get a COVID-19 shot to protect your wallet.

Getting hospitalized with COVID-19 in the United States typically generates huge bills. Those submitted by COVID-19 patients to the NPR-Kaiser Health News “Bill of the Month” project include a $17,000 bill for a brief hospital stay in Marietta, Ga. (reduced to about $4,000 for an uninsured patient under a “charity care” policy); a $104,000 bill for a 14-day hospitalization in Miami for an uninsured man; and a bill for possibly hundreds of thousands for a two-week hospital stay — some of it on a ventilator — for a foreign tourist in Hawaii whose travel health insurance contained a “pandemic exclusion.”

» READ MORE: With a ‘vaccine parade,’ a few more Camden residents got shots in arms

Even though insurance companies negotiate lower prices and cover much of the cost of care, an out-of-pocket bill for a deductible of more than $1,000 — plus more for copays and possibly some out-of-network care — should be a pretty scary incentive.

In 2020, before COVID-19 vaccines, most major private insurers waived patient payments — from coinsurance to deductibles — for COVID-19 treatment. But many if not most have allowed that policy to lapse. Aetna, for example, ended that policy Feb. 28; UnitedHealthcare began rolling back its waivers late last year and ended them by the end of March.

More than 97% of hospitalized patients last month were unvaccinated. Though the vaccines will not necessarily prevent you from catching the coronavirus, they are highly effective at assuring you will have a milder case and are kept out of the hospital.

For this reason, there’s logic behind insurers’ waiver rollback: Why should patients be kept financially unharmed from what is now a preventable hospitalization, thanks to a vaccine that the government paid for and is making available free of charge? It is now in many drugstores, it’s popping up at highway rest stops and bus stops, and it can be delivered and administered at home in parts of the country.

A harsher society might impose tough penalties on people who refuse vaccinations and contract the virus. Recently, the National Football League decreed that teams will forfeit a game canceled because of a COVID-19 outbreak among unvaccinated players — and neither team’s players will be paid.

But insurers could try to do more, such as penalizing the unvaccinated. And there is precedent. Already, some policies won’t cover treatment necessitated by what insurance companies deem risky behavior, such as scuba diving and rock climbing.

The Affordable Care Act allows insurers to charge smokers up to 50% more than what nonsmokers pay for some health plans. Four-fifths of states follow that protocol, though most employer-based plans do not do so. In 49 states, people caught driving without auto insurance face fines, confiscation of their car, loss of their license, and even jail. And reckless drivers pay more for insurance.

The logic behind the policies is that the offenders’ behavior can hurt others and costs society a lot of money. A person who decides not to get vaccinated and contracts a bad case of COVID-19 is not only exposing others in the workplace or neighborhoods; the tens or hundreds of thousands spent on care could mean higher premiums for others as well in insurance plans next year. What’s more, outbreaks in low-vaccination regions could help breed more vaccine-resistant variants that affect everyone.

» READ MORE: Philly adds a mask mandate, Pa. to require vaccination or tests for some workers

Yes, we often cover people whose habits may have contributed to their illness — insurance regularly pays for drug and alcohol rehab and cancer treatment for smokers.

That’s one reason, perhaps, that insurers, too, have so far favored carrots, not sticks, to get people vaccinated. Some private insurers are offering people who get vaccinated a credit toward their medical premiums, or gift cards and sweepstakes prizes, according to America’s Health Insurance Plans, an industry organization.

Tough love might be easier if the Food and Drug Administration gives vaccines full approval, rather than the current emergency use authorization. Even so, taxpayer-financed plans such as Medicaid and Medicare must treat everyone the same and would encounter a lengthy process to secure federal waivers to experiment with incentives, according to Larry Levitt, executive vice president of the Kaiser Family Foundation, a nonprofit focusing on health issues. (Kaiser Health News, where Rosenthal is editor-in-chief, is one program under KFF.) These programs cannot charge different rates to different patients in a state.

KFF polling shows such incentives are of limited value, anyway. Many holdouts say they will be vaccinated only if required by their employers.

But what if the financial cost of not getting vaccinated were just too high? If patients thought about the price they might need to pay for their own care, maybe they would reconsider remaining unprotected.

Kaiser Health News is a national newsroom that covers health issues. It is part of the Kaiser Family Foundation, an endowed nonprofit organization providing information on health issues.