So, what's wrong with the workplace wellness programs included in the Senate's health care reform bill? That's a fair question, and one you may have asked yourself if you saw some of the recent coverage of the issue.
To be clear, many workplace wellness programs are innovative, effective, and help employees and their families get and stay healthy, which benefits employees and employers alike. These workplace wellness programs should be implemented, studied, and then the best of them should be replicated (as the House health reform bill proposes.)
Unfortunately, in the name of "workplace wellness" the Senate bill creates a loophole that would allow employers and insurance companies to discriminate against people based on their health status.
Some may say, "What's wrong with wellness? How can you be against that?" As usual, the devil is in the details, and the language in the Senate bill is so nuanced that answering the question "what's the problem" can stump even the top policy wonk or the most informed journalist.
Here's my attempt at a plain English explanation. To start, there are two important things to know in order to understand why the Senate bill would create a loophole that would allow insurance companies to continue to discriminate based on pre-existing conditions.
First, under current law employers are allowed to do some cost-shifting. - Did you think corporations would take money from their own profits to help motivate people to get healthy? Yeah, right. No, what's happening is that employers raise everyone's insurance premium, and then give a "reduction" to those who meet certain health targets and call it a reward. - Those who can't meet the health targets -- for whatever reason -- get charged more than their healthier co-workers.
Second, current law says a reward or penalty to an employee under these programs cannot exceed 20 percent of the cost of their health plan. The Senate bill ups the ante and could eventually allow employers to charge an employee up to 50 percent of their health plan. - With the cost of insurance soaring - an average family policy could cost $20,000 by 2016. This means people could be charged as much as $10,000 more for their insurance than their co-workers, simply because they have high cholesterol, high blood pressure, or weigh more than they should. - If this sounds like discrimination based on health status (something lawmakers have promised health reform would fix in our current system), that's because it is!
Knowing that, consider the many reasons an employee may not be able to meet a health target and keep in mind that not all those reasons are within the employee's control. - Scientists have understood for some time that some conditions like high cholesterol are often a function of genetics. Also, certain ethnic and racial groups face genetic predispositions to conditions such as hypertension and diabetes. Recent studies have also suggested that, because of the disruption to their body's natural circadian rhythm, people who work the night shift are more at risk for high blood pressure, high cholesterol, and heart disease.
Women, in particular, stand to lose the most if this back-door discrimination is allowed.
Women want to make healthy lifestyle choices for themselves and their families, yet in practice they often neglect their own health because they put the needs of their children, spouses and aging relatives before their own. And research shows that women are more likely than men to suffer from chronic conditions, meaning that women could pay disproportionately more for health insurance under these programs than their male colleagues. Such disparities are even more acute for low-income women and women of color.
This potential for discrimination is particularly troubling for the many women with lower incomes who work multiple jobs to support their families. These women often lack access to healthy food choices and have limited time or ability to access safe environments for physical activity. In effect, these programs will make health coverage less affordable to the very people who need it the most.
Employers can help everyone prioritize their health by providing a supportive environment for health and wellness in the workplace. But, if Congress adopts the language in the Senate's health reform bill on workplace wellness programs, we'll see employers and insurance companies using this loophole as a way to discriminate. That's not good for anyone, and it undermines the promise of reform.
To learn more about workplace wellness programs under health reform, please see our recent Issue Brief: