Editorial: Wellness Incentives May Not Be "Fair" - But Is That OK?
A previous Health Care Lawyer Blog post highlighted the “wellness” amendments to the Senate Finance Committee’s health overhaul bill (a.k.a. the Make American Health Act), which was voted through the Committee last week. The provision, championed through by Sens. John Ensign (R-NV) and Tom Carper (D-DE), expands existing HIPAA wellness program regulations that allow employer-sponsored insurance plans to reduce premiums for employees who lose weight, quit smoking, control their blood pressure or practice other healthy behaviors.
“Weight gain and unhealthy lifestyles that focus on smoking and lack of exercise have sky-rocketed our healthcare costs,” Ensign said in a statement on his website. “These costs could be lowered by focusing on what makes us healthy - through weight loss programs, smoking cessation and preventive care. Voluntary employee participation in these areas should naturally be reflected in lower healthcare costs.”
Some employers have already noticed the benefits associated with such wellness incentives – a previous post centered on the success of the plan introduced by the supermarket chain Safeway. However, the wellness amendment has been met with protest from groups such as the American Cancer Society, American Heart Association, and American Diabetes Association. Specifically, the groups are concerned that lowering premiums for some people may mean raising them for others, and that those others are usually unhealthier people.
"The whole point of health care reform is to make sure that everyone gets insurance," says Dick Woodruff, senior director of federal relations at the American Cancer Society-Cancer Action Network in an NPR interview. "And if people have to pay more because they're unhealthy, that's a barrier. It defeats the whole purpose."
After the jump - why wellness incentives make sense
While this may be true, this statement ignores the second major challenge to health care reform, which is the making sure quality health care is actually affordable and available. Otherwise, simply having an insurance plan will be of little use to the American populace.
This begs the question – why shouldn’t someone have to pay more if they are unhealthy? I’m not talking about patients with non-behavior-associated illnesses, such as breast cancer, leukemia, cystic fibrosis or other ailments. What I’m referring to are individuals such as smokers, fast-food junkies, or those with sedentary lifestyles who, through their behavior, acquire illnesses such as lung cancer or diabetes. If they choose to engage in behaviors that make them unwell, and in turn add to the costs of health care, why shouldn’t they have to pay for it?
It is important to note that the HIPAA provisions and Ensign/Carper amendment do not allow unhealthy employees to be penalized, but only that incentives be given in the form of reduced premiums. For example, if the cost of an employee plan is X number of dollars, an employee who smokes or has diabetes cannot be requested to pay $X + $100. Instead, an employee who meets certain wellness “benchmarks” such as low blood pressure, engaging in smoking cessation therapies, etc. will receive a discount on the premiums.
The argument is often advanced that not everyone has the time – or resources – to exercise or have a healthy diet. While I cannot speak for everyone, each day I see examples of individuals who make sacrifices in order to stay healthy. I know a working mother of three who gets up at 5 a.m. every morning in order to cram in a cardio or aerobics session before the day starts. I know a college student who takes the time to scrutinize the label of every grocery item she buys to make sure that it does not contain fatty and unhealthy additives like palm oil, excess sugars, or partially hydrogenated oils. If the item does, she finds something else. And most notably, I know a heart-attack survivor who, at the age of 64, decided that he wanted to participate in a marathon relay. After several months of training, he successfully completed his 3-mile leg of the race and plans to participate in additional races in the future.
I truly believe that if we as a country are going to be serious about health care reform, we need to make changes in our own lifestyles instead of hoping that a magical piece of legislation will take care of it for us. Hopefully, measures such as the Ensign/Carper amendment will encourage Americans to lead healthier lives, and thus help reduce health care costs for everyone.
*The opinions expressed in this editorial are solely those of the author and do not necessarily represent the views of other attorneys or staff at Frank, Haron, Weiner and Navarro.
