They’ve tried information campaigns and incentive programs, including lotteries. Now, in an effort to increase the rate of COVID-19 vaccinations and stop the spread of the delta variant, businesses, governments and even insurance companies may be eying the pocketbook of the vaccine-opposed or hesitant as a way to give vaccination efforts a shot in the arm.

A Kaiser Family Foundation Health News analysis said about 60% of those eligible for one of the COVID-19 vaccinations have received shots — with great variation depending on location. Meanwhile, hospitalization rates are climbing across the nation, primarily among those who are not vaccinated — including children who are still too young. Kaiser said 97% of those hospitalized with COVID-19 last month were unvaccinated.

That’s prompted a surge of efforts to get people to roll up their sleeves and get one of the several vaccines available.

But where a gift-laden carrot hasn’t worked, some are wielding a stick. The National Football League says if a game is canceled because an unvaccinated player gets COVID-19, the game is forfeited and no one’s getting paid for the missed play, either.

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Some companies have mandated at least some groups of their employees be vaccinated, including Google, Walmart, Tyson Foods and United Airlines, among others. Companies often require it of office staff or front-line workers, but not everyone is included in the mandate, according to CNBC. Some have a blanket requirement that says everyone needs to be vaccinated to work there. Others, like Frontier Airlines, require proof of vaccination or regular testing.

The Equal Employment Opportunities Commission has said that as long as such mandates don’t run afoul of the Americans With Disabilities Act or the Civil Rights Act of 1964, any employee who physically enters the workplace can be required to be vaccinated.

Now insurance companies are changing policies regarding COVID-19 and some experts predict more action on that front. During the first year of the pandemic, insurers typically covered related costs and often shielded policyholders if they got COVID-19 and needed treatment. Those policies are beginning to change. By late March, for instance, United Healthcare was handling COVID-19 as it has other illnesses, and applying copayments and deductibles to COVID-19 cases, too.

The Kaiser article lays out the argument: “Why should patients be kept financially unharmed from what is now a preventable hospitalization, thanks to a vaccine that the government paid for and made available free of charge?”

There’s speculation, Kaiser reported, insurers could go a step further, carving out exemptions to coverage for people who do not get a vaccination without a valid medical reason. Not having a vaccine is a personal choice that could prove expensive if insurance companies opt not to cover treatment should one get COVID-19 or even just levy higher co-pays and deductibles.

As hospitals grapple with another rise in those requiring hospitalizations, some have discussed prioritizing care based on vaccination status. Whether that would hold is unknown. The law firm Mandelbaum Salsburg says in its blog a health care worker doesn’t have to treat someone with whom there’s no established relationship.

Signs remind customers to wear a mask while shopping at the Harmons grocery store in downtown Salt Lake City on April 6, 2021. | Steve Griffin, Deseret News

Still, the “bottom line:” according to the blog post, “Doctors and other health care providers in places of public accommodation, such as hospitals, clinics and doctors’ offices, who are provided masks and other protection, must treat patients they suspect have coronavirus unless there remains objective proof that the patient still poses a direct threat to their health or the health or safety of others.”

The New York Times said more than 400 colleges and universities are mandating that students be vaccinated for COVID-19. Many major hospitals and health care systems are requiring vaccination unless workers want to be tested every week for the virus. President Joe Biden already issued a mandate that civilian federal employees be vaccinated or undergo regular testing.

Not everyone’s on board. Officials in Texas, Florida and Arkansas are among those who have banned businesses or government from requiring proof of vaccination.

And proponents of vaccination wonder what might change minds or overcome hesitation. Some of the incentives tried have been pretty striking.

Ohio offered a chance to win a lot of cash for getting vaccinated, with five $1 million prizes in a lottery for those 18 and up and a chance at in-state college scholarships for adolescents. Vaccine rates reportedly jumped by 28% within a week. New York offered a cash lottery, scholarships and free admission to popular venues. Other states have offered everything from big bucks to hunting rifles and free beer, according to a vaccine-incentive recap by Scientific American.