Recent news reports have featured stories about U.S. employers instituting “wellness programs” that wind up requiring some employees to pay more for their health insurance than other employees, sometimes termed “health penalties.” In the U.S., a majority receive their basic health care coverage through employer-sponsored health plans purchased from insurance companies. Most employers pay for a portion of the health insurance premium, and pass along a portion of the health insurance premium to the employee. In essence, the “health penalty” results when employers require some employees to pay a larger premium than others. These health penalties, which will disproportionately affect fatter people, can be based on “results” or on “participation.”
“Results” include a variety of metrics that employers and health insurance companies deem beneficial to health. Unfortunately, employers all too often require that employees lose weight or have a certain waist measurement in order to avoid the health penalty. A recent Wall Street Journal article entitled “When Your Boss Makes You Pay for Being Fat” reported that Michelin dictates that employees meet required levels in three out of five health metrics (waist size, blood pressure, glucose, cholesterol, and triglycerides) in order to receive the lower health insurance premium.
Tying health penalties to “participation” rather than “results” may sound like a kinder and gentler approach, but can also be very problematic. Employers are increasingly asking employees to “participate” in wellness programs by providing personal health data such as weight, blood pressure, and other health metrics. Employers such as CVS Caremark claim that a primary purpose of collecting the data is to make employees “aware” of their own health. The data may then be used to tailor health messaging directed at the employee. So, the kinder, gentler version is that in order to have affordable health insurance, many of us will have to submit to intrusive exams, surrender private health information, and receive unwanted health messages.
Moreover, these wellness programs are often run by third-party consultants who collect employees’ health data and create the tailored messaging based on the collected data. These companies promise confidentiality, but frankly, the more widely my confidential health information is scattered, the more nervous I get. Readers will forgive my cynicism in an era when health insurers buy data from credit card companies to find out such things as what food we buy and whether we shop in plus-size clothing stores.
Employers have long had the legal right to put such wellness programs in place, but the Affordable Care Act of 2010 (ACA) increases the incentives so that starting in 2014, employers will be able to charge noncompliant employees up to 30% more. It appears that recent media reports (CVS, Michelin) are just the beginning of the tide. The following figures from a recent poll demonstrate that employers are just getting started:
Currently: 21% of employers use health penalties tied to participation or results in workplace wellness programs
Next 3-5 Years: 58% of employers plan to use health penalties tied to participation or results in workplace wellness programs
Currently: 24% of employers give rewards for specific health results*
Next 3-5 Years: 66% of employers are considering giving rewards for specific health results*
*I would argue that these rewards actually constitute a health penalty on the employees who cannot or choose not to achieve the required “results.”
Shifting Costs, Not Lowering Them
One might conclude from the institutionalization of health penalties and creation of even higher incentives in the ACA that there is evidence to support the notion that such penalties lower health care costs. Employers exult over their lowered costs, but research suggests that the costs actually remain the same and are simply being shifted from employers to certain employees: namely, those whose physical characteristics are deemed problematic by the current medical paradigm. UCLA law professor Jill Horwitz, lead author of a Health Affairs Journal article on how employers are utilizing wellness programs to reduce costs, doubts that employers are actually reducing overall costs; she told a Washington Post blog: “The question is whether charging those higher premiums leads to the slowing of spending, or is [it] a cost-shift onto less healthy employees.”
What’s most disturbing to me about these health penalties is not the greed demonstrated by the employers who seek to shift health care costs to some of their employees; I am prepared to believe that most corporations will seek to reduce costs in any legal way they can. It’s the rank healthism of the enterprise that really sticks in my craw. In this context, healthism may be defined as the view that one is morally responsible for one’s own health status, and that it’s not just ethically permissible, but socially desirable to penalize those our culture deems to have acted in an irresponsible manner with respect to their own health. Apparently, being fat or having high blood pressure constitutes a moral lapse in our healthist culture.
Of course, many of us saw this coming. In 2009, a number of ASDAH and NAAFA members went to Capitol Hill for a coordinated day of visits with Senate and Congressional staffers to advocate for omitting these incentives from what eventually became the ACA. I don’t regret speaking out against health care policies that negatively affect fat people, even though we lost that battle. If anything, we need to speak out more. The healthism in our culture is accelerating and must be countermanded. I was disturbed to note that in a poll accompanying the WSJ article mentioned above, almost 64% of respondents seem to be perfectly OK with employers shifting health care costs to employees who don’t meet “company specified health and lifestyle standards.”
Sounds good until you are one of the people who doesn’t meet the health standard du jour. Here’s what I have to say to the 64%: Be careful what you ask for, people. You just might not be thin or in perfect health forever…
ASDAH has started a website to collect employees’ stories about their experiences with workplace wellness programs. Please visit the site and share your story about weight and workplace wellness programs at Sizing Up Workplace Wellness.
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ASDAH Educational Conference – June 28-30, 2013
To learn more about these issues and brainstorm strategies for fighting bias in healthcare, make sure and attend the upcoming ASDAH Educational Conference in Chicago on June 28-30, (Early bird registration rates available through May 1 only!)