A linchpin of health reform is an end to medical underwriting -- charging people higher premiums, or even refusing to sell them coverage at all, if their health history isn’t to an insurance company’s liking. Both the Senate and House bills rightly outlaw this practice, which ends up denying coverage to the very people who need it the most.
But lurking within the Senate bill (Section 2705, page 83, for those who have the patience to download and search the bill’s text) is a stealth version of medical underwriting disguised as a “wellness program.” It means you could be hit with a premium surcharge of as much as 50 percent if you don’t meet certain wellness targets such as a specific BMI.
Anyone who works for a large employer has probably already run into a conventional “wellness program” such as a stop-smoking support group or reimbursement for a gym membership. And, indeed, the Senate bill says that employers can offer these as long as they’re available to all workers.
But it also allows another kind of “wellness program” that allows employers to penalize people who can’t satisfy a “standard that is related to a health status factor.” The bill says the penalty can be as much as 30 percent of the s health plan premium – more than $4,000 a year for a typical family plan. The penalty could be increased to as much as 50 percent if the secretaries of Labor, Treasury and Health and Human Services decide they want it to.
Wait. It gets worse.
There’s no definition of what kinds of “health status” factors could be covered. Smoking and weight are obvious ones, but, said Karen Pollitz, an insurance expert at the Georgetown University Health Policy Institute, there’s nothing to stop employers from penalizing workers who can’t get their cholesterol, blood pressure, or blood sugar down to levels the company deems satisfactory. “It’s medical underwriting all over again,” she said. “It’s a giant loophole.” Nor are employers required to do anything much to help the employee achieve a wellness goal other than threaten them with a hefty premium increase.
The measure is also a “real threat to medical privacy,” said Stephen Finan, senior director of policy for the American Cancer Society Cancer Action Network. “Employees might be required to disclose personal information they’d rather not share. We have a president who is struggling to quit smoking and apparently has relapses. If you smoke once a year, does that make you a smoker? If you don’t tell your employer, could you be terminated from your insurance?”
The Cancer Action Network, American Diabetes Association, and American Heart Association have put out a fact sheet on why they think all this is a terrible idea. Among other things, they address the question that some readers of this blog may already be composing in their minds: “I work out and take care of my health. Why should I pay more for my health insurance because of those who make no attempt to watch what they eat?”
The organizations point out that:
(1) Overweight, hypertension, and high cholesterol have a strong genetic component. Some people lucky in their genes would be able to avoid the penalty without lifting a finger, while others might fail to hit targets despite earnest efforts.
(2) Many people, especially those with limited incomes, live in neighborhoods where it’s unsafe to exercise outdoors, can’t afford health clubs, don’t have time to work out because they’re holding several jobs or taking care of children, and may not have access to stores that sell healthful foods. It makes no sense to heap more penalties on people already struggling to stay healthy.
If anyone supports effective wellness programs, Finan said, it’s a group like the American Cancer Society. “An integral part of our mission is to promote personal responsibility and healthy behavior,” he said. “We oppose smoking as strongly as anyone in the country. We think the Senate bill could be counterproductive because it may result in insurance being unaffordable, which would mean the very people who need medical assistance are not going to get it.”
Consumers Union, our parent organization, also opposes this provision.
-- Nancy Metcalf, senior program editor