Are big insurance discounts for healthy behavior unfair?
By Mary Agnes Carey
http://www.JewishWorldReview.com | (MCT)
Employers and health insurers could give larger discounts to employees who lose weight or lower their cholesterol under one health care overhaul proposal that's moving through
The discounts are being pushed by
The proposal, which involves the sensitive issue of how aggressive employers can be in trying to induce workers to change their behavior to reduce their risks of disease, draws skepticism from many patient advocates.
"If you give one person a discount, someone else is going to end up paying more," said
Under current law, employers and insurers are permitted to give discounts of up to 20 percent on premiums, co-payments or deductibles to workers who take part in wellness programs, which include anti-smoking and weight-loss programs. Some wellness programs simply require participation in order to get the discount, but others require employees to reduce their weight, blood pressure or cholesterol by specific levels.
Health care overhaul legislation passed by the
Proponents say the measure would improve health and lower costs, and that workers who can't hit specific targets could seek a medical exemption.
"There is significant savings and significant positives to encouraging people to live healthy lifestyles and reward people monetarily for doing it," said Sen.
The groups fighting the provision say that while many employees might want to exercise and eat right, some might find that work schedules and family commitments prevent them from making the lifestyle changes needed to improve their health. Lower-income workers, in particular, might not be able to afford gym memberships, even with employers' subsidies.
"We are very concerned that individuals not be penalized — either financially or by exclusion from coverage or services — if they are sick or if they presently engage in specific behaviors or have certain health conditions, such as smoking or obesity," the groups wrote to
Some health advocates are more comfortable with linking financial incentives to other factors, such as refilling prescriptions or monitoring blood sugar on a regular basis, as opposed to meeting a specific fitness target.
"Once you get into paying more for specific outcomes, for many people that does cross over the line," said
Employer groups are urging lawmakers to increase the discounts in premiums, co-pays and deductibles they can give to workers who participate in wellness programs.
"The value of health insurance premium discounts or rebates to promote employee participation in wellness programs has had and will continue to have a cost savings effect on multiple levels for our health care system," the groups, which include the Business Roundtable and the
A Senate GOP aide said the amendment includes language to prohibit any discrimination against individuals who can't attain specific fitness goals because of medical reasons or other factors. People who feel they can't meet the standards can request waivers or alternative standards from their employers. Employers can also ask for physician to certify that employees have existing medical conditions that would prevent them from meeting specific health goals. The programs must be "reasonable" and not "overly burdensome," open to all employees, and participation must be voluntary.
Critics say Burd's data haven't been independently verified. A
Every weekday JewishWorldReview.com publishes what many in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.
Comment by clicking here.
© 2009, Kaiser Health News McClatchy-Tribune Information Services.