Wellness Incentives Could Create Health-Care Loophole

Health-care legislation could use wellness incentives to pressure employees to stop smoking, lose weight or lower cholesterol.
Health-care legislation could use wellness incentives to pressure employees to stop smoking, lose weight or lower cholesterol. (By Nikki Kahn -- The Washington Post)
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By David S. Hilzenrath
Washington Post Staff Writer
Friday, October 16, 2009

Get in shape or pay a price.

That's a message more Americans could hear if health-care reform provisions passed by the Senate finance and health committees become law. By more than doubling the maximum penalties that companies can apply to employees who flunk medical evaluations, the legislation could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol.

The bipartisan initiative, largely eclipsed in the health-care debate, builds on a trend that is in play among some corporations and that more workers will see in the benefits packages they bring home during this fall's open enrollment. Some employers offer lower premiums to workers who complete personal health assessments; others limit coverage for smokers.

The current legislative effort would take the trend a step further. It is backed by major employer groups, including the U.S. Chamber of Commerce and the National Association of Manufacturers. It is opposed by labor unions and organizations devoted to combating serious illnesses, such as the American Heart Association, the American Cancer Society and the American Diabetes Association.

Critics say employers could use the rewards and penalties to drive some workers out of their health plans.

President Obama and members of Congress have said they are trying to create a system in which no one can be denied coverage or charged higher premiums based on their health status. The insurance lobby has said it shares that goal. However, so-called wellness incentives could introduce a colossal loophole. In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems such as diabetes, heart disease and stroke.

"Everybody said that we're going to be ending discrimination based on preexisting conditions. But this is, in effect, discrimination again based on preexisting conditions," said Ann Kempski of the Service Employees International Union.

The legislation would make exceptions for people who have medical reasons for not meeting targets.

Supporters say economic incentives can prompt workers to make healthier choices, thereby reducing medical expenses. The aim is to "focus on wellness and prevention rather than just disease and treatment," said John J. Castellani, president of the Business Roundtable.

BeniComp Group, an Indiana company that manages incentives for employers, says on its Web site that the programs can save employers money in a variety of ways. Medical screenings catch problems early. Employers shift costs to others. Some employees "choose other health care options."

Douglas J. Short, BeniComp's chief executive, said the incentives he uses focus on outcomes, not conditions.

"I can't give you an incentive based on being a diabetic or not being a diabetic, but whether you're managing your blood glucose level -- I can give you an incentive based on that," he said.

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