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Sun May 13, 2012, 12:01 AM

The underside of employer wellness programs.

Health Affairs
Health Policy Brief
May 10, 2012
Workplace Wellness Programs

The Affordable Care Act of 2010 will, as of 2014, expand employers' ability to reward employees who meet health status goals by participating in wellness programs--and, in effect, to require employees who don't meet these goals to pay more for their employer-sponsored health coverage. Some consumer advocates argue that this ability to differentiate in health
coverage costs among employees is unfair and will amount to employers' policing workers' health.

What are the concerns?

There is widespread support for wellness initiatives in the workplace among both employers and employees. At the same time, there is conflict over programs that tie rewards or penalties to individuals achieving standards related to health status--and especially over those arrangements that affect employee health insurance premiums or cost-sharing amounts.

In general, business groups want employers to have maximum flexibility to design programs with rewards or penalties that will encourage employees to not only participate but also to achieve and maintain measurable health status goals, such as quitting tobacco use or reducing body mass index. They argue that individuals should bear responsibility for their health behavior and lifestyle choices and that it is unfair to penalize an employer's entire workforce with the medical costs associated with preventable health conditions as well as the costs of reduced productivity.

Unions, consumer advocates, and voluntary organizations such as the American Heart Association are generally wary of wellness initiatives that provide rewards or penalties based on meeting health status goals. They are concerned that, rather than improving health, such approaches may simply shift heath care costs from the healthy to the sick, undermining health insurance reforms that prohibit consideration of health status factors in determining insurance premium rates.

They argue that such incentives are unfair because an individual's health status is a result of a complex set of factors, not all of which are completely under the individual's control. For example, genetic predisposition plays a significant role in determining many health status factors, including such attributes as excess weight, blood pressure, blood sugar, and cholesterol levels. Consumer advocates also caution that poorly designed and implemented wellness initiatives may have unintended consequences, such as coercing an individual with a health condition to participate in an activity without adequate medical supervision.

Another concern is that tying the cost of insurance to the ability to meet certain health status goals could discriminate against low-income individuals or racial and ethnic minorities. These individuals are more likely to have the health conditions that wellness programs target and also may face more difficult barriers to healthy living.

These barriers may include some that are work related, such as having higher levels of job stress; job insecurity; and work scheduling issues, including shift work. Barriers outside of work may include personal issues, such as financial burdens, and environmental factors, such as unsafe neighborhoods, poor public transportation, and lack of access to healthy food.

In addition, some critics warn that wellness program requirements may be used to discourage employees from participating in their employers' health benefits plan by making their participation unaffordable. Employers might use a system of rewards or penalties totaling thousands of dollars annually to coerce employees who cannot meet health status goals to seek coverage elsewhere, such as through a spouse's plan; a public option, such as Medicaid; or a separate private plan purchased through the new health insurance exchanges.

Comment by Don McCanne of PNHP: Altruistic employers who, out of the goodness of their hearts, offer wellness programs to their employees, also theoretically benefit by improving productivity through having a healthier work force. These are admirable goals. But employers are now playing the blame game as they use their programs to penalize employees who have medical needs, by reducing their health care benefits and increasing financial barriers to care.

Employers can enhance employee health through work-sourced exercise and nutrition programs, through work safety measures, and through programs such as smoking cessation. In sharp contrast, disease screening should be provided privately in an entirely separate primary care environment where the screening is a part of a comprehensive, integrated health care program that belongs to the patient, not the employer.

Above all, whereas the medical health status of employees should be maintained through the health care delivery system, never, never should the employer be allowed to reduce health care benefits because the employee has greater needs.

This is yet one more reason why health insurance should be totally dissociated from employment. If we had an improved Medicare that covered everyone, health care access would be continuous throughout life, and barriers to care could never be used to punish individuals unfortunate enough to have manifested or contracted medical problems.

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Arrow 8 replies Author Time Post
Reply The underside of employer wellness programs. (Original post)
eridani May 2012 OP
limpyhobbler May 2012 #1
HiPointDem May 2012 #5
Lionessa May 2012 #2
eridani May 2012 #3
xchrom May 2012 #4
StitchesforSnitches May 2012 #6
marlkonim Oct 2012 #7
littlemissmartypants Oct 2012 #8

Response to eridani (Original post)

Sun May 13, 2012, 12:20 AM

1. Another great reason to end the employer based health system.

At my last job people were saving up to $100/month by participating in the wellness program. All you had to do to save the $100/month was fill out a complete personal medical questionnaire twice per year. In other words, give your boss your private info which they have no right to. People need that extra money though, so it's compeling to trade away that privacy for cash.

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Response to limpyhobbler (Reply #1)

Sun May 13, 2012, 04:04 AM

5. "give your boss your private info which they have no right to." = exactly.


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Response to eridani (Original post)

Sun May 13, 2012, 02:06 AM

2. Y'know, I could almost live with this if it was divvied fairly, but it isn't


For example, how many knee and shoulder repairs replacements happen every year from playing amateur sports and going hiking or camping, or skydiving, or motorcycle riding. . . hell my son's broken himself numerous times snowboarding, in the hospital broken. Will they call those "preventable conditions?" Because they are.

But of course if they present it fairly, there'd be an uprising, so they just go after the habits that people have become conditioned to demonize, smokers and eaters.

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Response to Lionessa (Reply #2)

Sun May 13, 2012, 02:38 AM

3. Our HMO magazine had a story a few years back about an 80 year old man

--who had a second hip replacement because he had ground his first into powder with high-impact endurance sports. The general tone of the article was admiring. The longer you live, the higher your lifetime health care costs will be. That's why the fat smokers save everyone money.


Preventing obesity and smoking can save lives, but it does not save money, according to a new report.

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

"It was a small surprise," said Pieter van Baal, an economist at the National Institute for Public Health and the Environment in the Netherlands, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."

In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

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Response to eridani (Original post)

Sun May 13, 2012, 02:54 AM

4. I don't want my employer involved in my life like this.

My spouse...maybe.

But not my employer.

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Response to eridani (Original post)

Sun May 13, 2012, 07:17 AM

6. It has already started


Some insurance companies are telling employees if you don't have any tobacco users we will reduce your rates...don't have any obese people we will reduce you rate....

Health and lifestyle will become the new discrimination in America and corporations are going to cherry pick the healthy and exclude the not so healthy and undesirables not only form insurance but from a job.

If America does not shift to single payer millions of Americas will not only lack Health insurance they will be permanently unemployable.

Right now what the insurance companies and employers are doing is 100% legal.

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Response to eridani (Original post)

Mon Oct 8, 2012, 12:38 AM

7. Spam deleted by Paulie (MIR Team)


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Response to marlkonim (Reply #7)

Mon Oct 8, 2012, 02:17 AM

8. Welcome to the DU!

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