"Wellness" — Or Else

Maggie Mahar on “The Health Beat” gives us a head’s up on yet another perverse incentive, this time one that superficially looks like one of those bleeding-heart lefty Wellness provisions, but will have the opposite effect if not patched up. (Note: Maggies post is built on AlterNet post here.

How Insurers May Use “Wellness Programs” To Target Pre-Existing Conditions

Under reform, insurers will still do their best to shun the sick…one way they may do it: by using “wellness programs” to penalize those who can’t meet health targets…

…A little-discussed provision of the Senate bill allows insurers to expand so-called wellness programs that let insurers penalize subscribers by hundreds—and even thousands—of dollars for not meeting certain ‘wellness targets,’ such as a particular cholesterol number, blood sugar measurement or body-weight target.

…one of the pro-business innovations of the Bush administration was to introduce into health insurance regulations a provision allowing employers to offer loosely defined “wellness” programs that carry incentives for employees meeting certain standards of premium reductions of as much as 20 percent. Sounds like a pretty good deal, right? Sure, until you realize that there’s no baseline for the original premium, meaning that, in reality, people who don’t meet the standards are really carrying the burden of others’ discounts and then some—paying as much as 20 percent more for a policy in which a family member’s failure to meet a wellness target forces up the entire premium for that family’s policy…


…while insurers may no longer be able to drop your coverage for a preexisting condition such as high blood pressure, under the Senate bill they will be able to charge you and your employer as much as 50 percent more for your total premium cost if you fail to meet a targeted blood pressure or cholesterol measurement.

For instance, there is the widespread problem of obesity.

“Obesity doesn’t seem like a subtle disease,” adds Dr. Lee Kaplan, who heads the Weight Reduction Program at Mass General Hospital. “But it is. If something is off kilter by just 1 percent in your system that can lead to a 100 pound weight gain. More than 400 genes are involved in weight regulation. And that doesn’t include the environmental factors.”

…Dr. Michael Rosenbaum, a Columbia University researcher working on an NIH-funded study on weight control [points out that] “Obesity is the one disease where your body fights the cure.”


Under the wellness programs Stan [at AlterNet] describes, employees suffering from such a flaw in body chemistry would be punished.

[T]he American Heart Association does not object to employer-sponsored wellness programs per se, but only to financial penalties imposed on those who don’t participate in “voluntary” wellness programs or cannot meet wellness targets. As the AHA points out; “the causes of obesity, hypertension, and high cholesterol are many, and vary between individuals.” For instance, genetic predisposition is an important factor in many conditions. Therefore, penalizing individuals for their risk factors sometimes means penalizing them for their genetic makeup which is beyond their control.


Moreover, the AHA points out, “Even health factors that are theoretically controllable in the best of circumstances may be vastly more difficult to control for those who are: (1) low income; (2) working more than one job; (3) working parents; (4) dealing with chronic mental or physical conditions; or (5) caring for sick parents, children or other family members.


Stan concludes that what is most troubling is how the penalties zero in on “people least likely to be able to control the circumstances that lead to their inability to meet wellness targets—the poor and those with genetic predispositions to certain conditions … So, unless regulators intervene, insurers will continue to discriminate against those who most need high quality, affordable care.

Go read both articles, there’s quite a lot more over there.