On Capitol Hill, lawmakers seem eager to encourage employers to create and expand programs that tie a portion of workers' health insurance premiums to their willingness to change unhealthy behaviors. But there's growing concern that some of those programs represent a new way to discriminate against those in less than perfect health.
By a vote of 18-4, the Senate Finance Committee added to its health overhaul bill an amendment offered by Sens. John Ensign (R-NV) and Tom Carper (D-DE) that would expand existing rules that let workplace "wellness" programs pay bonuses in the way of reduced premiums to workers to lose weight, quit smoking, control their blood pressure or practice other healthy behaviors.
Current rules allow premiums to vary by up to 20 percent of a worker's total health insurance premium. Under the amendment adopted by the committee, that could rise to as much as 50 percent.
"We know that the more we pay for things, the more we're going to get. And so we need basically to pay for healthy behaviors," Ensign said.
But the potential change has alarmed groups like the American Cancer Society, American Heart Association and American Diabetes Association. They say that lowering premiums for some people inevitably means raising them for others, and that those others are usually sicker 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. "And if people have to pay more because they're unhealthy, that's a barrier. It defeats the whole purpose."
Woodruff says groups like his are all for encouraging workplace wellness programs — but not by using health insurance to do it. "Companies, if they want to have healthy employees, they should offer gym memberships or healthy meals in the cafeteria or opportunities to exercise," he says.
But tying wellness to health insurance "is a sort of a backdoor way of underwriting for people who are overweight or who have high cholesterol or they smoke," he says, "and a way of getting them out of the system. It allows insurers and employers to cherry-pick."
Karen Pollitz, a Georgetown University research professor who studies the insurance industry, says some existing wellness programs already clearly separate the sick from the healthy.
One plan, for example, starts everyone out with a $2,500 annual deductible. Then it offers $500 discounts from that total to those who can pass tests related to smoking, weight, cholesterol and blood pressure.
"So if you can pass all of the tests, you're back to having a $500 deductible, which is kind of standard for employer plans today," she says. "If you can't, if you're unhealthy, you have a $2,500 deductible."
She says that can produce two possible results: "One is that the unhealthy employees just have to pay $2,000 more of the cost of their care every year. But second, some of those employees may say, 'Forget it, I'm going elsewhere. I want to get covered under my spouse's plan.' "
Both options save the employer and the insurer money, but don't necessarily improve anyone's health.
The Cancer Society's Woodruff says the groups have another worry about employer wellness programs: Do workers really want their employers to have so much of their personal information?
"I think it's incredibly intrusive for a person to go to work and have to undergo, for instance, a cheek swab. And the results of that information get filed away somewhere. You don't know what happens to that information," he says, either when you're working for that employer or after you leave the job.
Backers of the wellness language, however, insist that the emerging health bills should include patients among those asked to make sacrifices.
"If you look at [the bill], we have not done a whole heck of a lot with respect to saying to individuals that we have some responsibility here, too, to do a better job of taking care of ourselves," Carper said.
It's a debate that's likely to continue when the bill reaches the Senate floor.
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STEVE INSKEEP, host:
Safeway's program is a hit with lawmakers who would like employers to use it as a model. They had a language to the health overhaul bill in the Senate Finance Committee. Some lawmakers call it the Safeway Amendment. The amendment means healthy people could save a lot of money.
As NPR's Julie Rovner reports, the problem comes with people who might pay more.
JULIE ROVNER: Under current roles, wellness programs like Safeway's can only reward workers who lose weight or stop smoking up to a certain amount: 20 percent of the total cost of their insurance premium. The amendment added the Finance Committee's health bill could boost those rewards to as much as 50 percent. The justification is obvious, said Republican sponsor John Ensign of Nevada.
Senator JOHN ENSIGN (Republican, Nevada): When you offer financial incentives to individuals, they will respond. People are more likely to change behavior if the rewards are even higher.
ROVNER: The amendment passed by a vote of 18 to four, but among those opposing it are a long list of groups representing people who have existing health conditions, including the American Cancer Society, American Heart Association and American Diabetes Association.
Dick Woodruff of the Cancer Society says the groups are all for encouraging healthy behavior at the work place.
Mr. DICK WOODRUFF (American Cancer Society): The problem is when you begin to tie the incentives to the insurance system in premiums, and when you take a selected number of your employees and give them a deep discount, that cost gets transferred over to the least healthy employees.
ROVNER: Karen Pollitz, an insurance expert at Georgetown University, has been studying some of the wellness plans already on the market. She says that while they say they encourage healthier behavior, some are more of a backdoor way of separating people who are healthy from those who are sick. One plan, she says, starts everyone out with an annual deductible of $2,500, then offers $500 discounts from that total to those who pass tests related to smoking, weight, cholesterol and blood pressure.
Ms. KAREN POLLITZ (Research professor, Georgetown University): So if you can pass all of the tests, you're back to having a $500 deductible, which is kind of standard for employer plans today. If you can't, if you're unhealthy, you have a $2,500 deductible.
ROVNER: And the result of that is two-fold, she says.
Ms. POLLITZ: One is that the unhealthy employees now just have to pay $2,000 more of the cost of their care every year, but second, some of those employees may say, forget it. I'm going elsewhere.
ROVNER: Both of which save the employer and the insurer money, but don't necessarily improve anyone's health. Pollitz says she also questions just how voluntary these plans would be if employers could vary more of the premium.
Ms. POLLITZ: This year, the average cost of an employer-sponsored family policy topped $13,000. So an individual's penalty for not voluntarily signing up to participate in this program might be four, five, $6,000 a year. That's pretty coercive.
ROVNER: Dick Woodruff of the American Cancer Society says the groups have another worry about employer wellness programs. Do workers really want their employers to have so much of their personal information?
Mr. WOODRUFF: At least, you know, when you go to the doctor, you have some confidence that the things that you talk about and the things that happen there will be kept confidential. With your employer, you don't.
ROVNER: Woodruff says the groups do support a lot of ways to encourage wellness on the job.
Mr. WOODRUFF: They way to do this if for companies, if they want to have healthy employees, they should offer gym memberships or healthy meals in the cafeteria or opportunities to exercise, or whatever.
ROVNER: But backers of the proposal to tie wellness programs to premiums, like Democratic Senator Tom Carper of Delaware, say the language is fair in context with other pieces of the overall health bill.
Senator TOM CARPER (Democrat, Delaware): We've not done a whole heck of a lot with respect to saying to individuals, you know, that we have some responsibility here, too, to do a better job of taking care of ourselves.
ROVNER: It's an argument likely to continue on the Senate floor. Julie Rovner, NPR News, Washington.
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