Overweight? Smoker? Health bills hit hard
Bills could put workers under pressure to lose weight, stop smoking
By David S. Hilzenrath
The Washington Post
updated 8:18 p.m. CT, Thurs., Oct . 15, 2009
Get in shape or pay a price.

That's a message more Americans could hear if the health care reform bills passed by the Senate Finance and Health committees become law.

By more than doubling the maximum rewards and penalties that companies can apply to employees who flunk medical evaluations, the bills could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol.

The initiative, largely eclipsed in the health care debate, builds on a trend that is already in play among some corporations and that more workers will see in the packages they bring home during this month's open enrollment. Some employers offer lower premiums to people who complete personal health assessments; others offer only limited benefit packages to smokers.

The current legislative effort takes the trend a step further. It is backed by major employer groups, including the U.S. Chamber of Commerce and the National Association of Manufacturers. It is opposed by labor unions and groups devoted to combating serious illnesses, such as the American Heart Association, the American Cancer Society, and the American Diabetes Association.

A colossal loophole?
President Obama and members of Congress have declared that they are trying to create a system in which no one can be denied coverage or charged higher premiums based on their health status. The health insurance lobby has said it shares that goal. However, so-called wellness incentives could introduce a colossal loophole. In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems like diabetes, heart disease and stroke.

"Everybody said that we're going to be ending discrimination based on preexisting conditions. But this is in effect discrimination again based on preexisting conditions," said Ann Kempski of the Service Employees International Union.

The legislation would make exceptions for people who have medical reasons for not meeting targets.

Supporters say economic incentives can prompt workers to make healthier choices, thereby reducing medical expenses. The aim is to "focus on wellness and prevention rather than just disease and treatment," said Business Roundtable president John J. Castellani.

BeniComp Group, an Indiana company that manages incentives for employers, says on its Web site that the programs can save employers money in a variety of ways. Medical screenings will catch problems early. Employers will shift costs to others. Some employees will "choose other health care options."

Douglas J. Short, BeniComp's chief executive, said the incentives he uses focus on outcomes, not conditions.

"I can't give you an incentive based on being a diabetic or not being a diabetic, but whether you're managing your blood glucose level — I can give you an incentive based on that," Short said.

National epidemic of obesity
The incentives could attack a national epidemic of obesity. They also cut to a philosophical core of the health care debate. Should health insurance be like auto insurance, in which good drivers earn discounts and reckless ones pay a price, thereby encouraging better habits? Or should it be a safety net in which the young and healthy support the old and sick with the understanding that youth and good health are transitory?

Under current regulation, incentives based on health factors can be no larger than 20 percent of the premium paid by employer and employee combined. The legislation passed by the Health and Finance committees would increase the limit to 30 percent, and it would give government officials the power to raise it to 50 percent.

A single employee whose annual premiums cost him and his employer the national average of $4,824 could have as much as $2,412 on the line. At least under the Health Committee bill, the stakes could be higher for people with family coverage. Families with premiums of $13,375 — the combined average for employer-sponsored coverage, according to a recent survey — could have $6,687.50 at risk.

An amendment passed unanimously by the Health Committee would allow insurers to use the same rewards and penalties in the market for individual insurance, though legislative language subsequently drafted by the committee's Democratic staff does not reflect that vote, Sen. Mike Enzi (Wyo.), for the committee's ranking Republican, has said. The bill drafted by the Senate Finance Committee would set up a trial program allowing insurers in 10 states to use wellness-based incentives for individuals.

America's Health Insurance Plans, an industry lobby, has argued that insurers should be allowed to consider participation in wellness programs when setting individual premiums.

Wellness incentives voluntary
Employers and other advocates of expanded wellness incentives say taking steps to get healthier would be voluntary. Sen. John Ensign, a Nevada Republican and lead sponsor of the Finance Committee's wellness provision, said his proposal "would guarantee that the incentive is strong enough for Americans to want to participate."

Wellness incentives have been spreading rapidly in the corporate world. Unlike the legislative proposals, which address incentives based on results, the corporate programs typically compensate employees based on effort alone — for example, enrolling in smoking cessation programs even if they fail to kick the habit, or undergoing detailed medical assessments regardless of the findings. But there are exceptions: The Safeway supermarket company allows certain employees to reduce their premiums by meeting standards for body mass and other measures. Safeway chief executive Steve Burd has framed it as an issue of personal responsibility.


Valeo, a supplier of auto parts, four years ago raised the deductible on an employee health plan to $2,200 from $200 for individual coverage and to $4,400 from $400 for family coverage. Then it gave employees the opportunity to reduce the deductible to its starting point by being nonsmokers and meeting goals for blood pressure, cholesterol, and body mass index, said Robert Wade, Valeo's director of human resources for North America.

"If they don't comply they end up being penalized, if you will, but we refer to it as a Healthy Rewards program," Wade said.

Workers who choose not to submit to yearly medical assessments have been offered a different health plan that carries higher premiums, Wade said.


Results are mixed for some programs
The results are mixed. The number of employees meeting some targets in the Healthy Rewards program has risen while the number meeting others has fallen, Wade said. On average, employees have succeeded in bringing their deductibles down to about $600 in the case of individual coverage. Meanwhile, Valeo has managed to keep annual increases in health care costs per employee down to about 1 percent, he said, which is far below average.

Higher deductibles alone could explain some of the savings. They can make people more cost-conscious when deciding whether to go to the doctor or obtain other medical services.

Paychex, a payroll management company, offers incentives for participation in wellness programs but refrains from pegging them to biometric targets.

"Employees could be doing everything right and still not achieve the desired outcome. And so then you're holding them accountable for something that may not be achievable," said Jake Flaitz, the company's director of benefits.

Workers at a company called Bemis, which makes packaging, went on strike this year partly because the firm was insisting that they and their spouses submit to health risk assessments to remain eligible for their health insurance, the Workers United union said in an August news release. The union called the assessments "invasive."


North Carolina has angered some state employees by introducing a wellness program that would limit the most generous benefits package to those who meet body mass targets and don't smoke. The state would allow employees to satisfy the requirement by enrolling in weight management or smoking cessation programs.

When fully implemented, the program is projected to reduce the state health plan's medical expenses by 1.2 percent, spokeswoman Linda McCrudden said by e-mail.

The top executive at the health plan, Jack W. Walker, predicted that over the long run the federal government will pay for North Carolina's success. State workers who live longer will spend more time collecting benefits from Medicare, the federal insurance program for older Americans, he said.


© 2009 The Washington Post Company
URL: http://www.msnbc.msn.com/id/33336289/ns/politics-washington_post/

Frazzled wrote:And this from MSNBC no less. As its not Fox it has to be accurate.

Zip Napalm wrote:We are living in Douglas Adams' head.

The Green Git wrote:"Change you can believe in..." whether you like it or not!

Fateweaver wrote:So like a Snickers bar.

youngblood wrote:One problem that I see here is that most people that are lower income can't afford to eat healthy. Processed foods are much cheaper than organic, so by making someone's insurance cost more due to weight issues only perpetuates the problem. More money spent on health insurance = less money spent on some what healthy food.

Another issue: stop persecuting the damn smokers!

Fateweaver wrote: stress =/= a reason to start

Fateweaver wrote:

youngblood wrote:One problem that I see here is that most people that are lower income can't afford to eat healthy. Processed foods are much cheaper than organic, so by making someone's insurance cost more due to weight issues only perpetuates the problem. More money spent on health insurance = less money spent on some what healthy food.

Another issue: stop persecuting the damn smokers!

Oh poor smokers. Choose to start doing something unhealthy and dumb even though the warning signs have been in place for what now? 50+ years? and you get all aggrieved when people don't feel sorry for you. 100 years ago I could see not knowing the dangers as even then doctors didn't know the dangers. Ever since they put warning labels on cigs there is not one good reason for people to start up smoking. Peer pressure =/= an excuse to start; stress =/= a reason to start; health factors = a reason to stay away. Yet people start up every day. I'm glad cigs doubled in price (at least in this State) and I'd love for the state of Mn to jack cigs up to about $8 a pack for generics and use the money to fix the roads or build a new stadium for the Vikings football team. So forgive me if I don't feel sorry for someone starting something that that person had total control of NOT to start doing.

Drinking radiator coolant isn't good for your health either and it clearly says so on the jugs so I'm not going to feel sympathy for someone who decides it is in their best interest somehow to start drinking it.

inquisitor_bob wrote:You know, I actually see this as an interesting argument. Weight and health issues are not protected under the US Constitution, therefore companies and even the government can regulate health insurance as long as they do no discriminate base on the usual categories. Discrimination based on weight is ok as far as I can tell. Thus it would fall under rational scruitny.

Would it pass Congress? Well, that depends on whether or not voting for this legislation will impact re-election chances. I think most people are not well informed to make that determination.

Great article !!

dogma wrote:I assume no one here has seen the height/weight restrictions on most life/medical insurance policies?

dietrich wrote:How is being overweight, smoking, driving a car without a seatbelt, or riding a motorcycle without a helmet (aka Donor Bike) not increasing your risk of health problems, injuries, and/or death? They all do. Hey, maybe if I had to pay Uncle Sam $40 a month, I'd get a little more serious about losing weight.

dogma wrote:I assume no one here has seen the height/weight restrictions on most life/medical insurance policies?

Redbeard wrote:If you want to overeat yourself into oblivion, I don't see why I should be footing the bill.

Zip Napalm wrote:
If I don't like the restrictions from one insurance company I can try another. The process is a little more involved when dealing with the government.