Patient Advocates Fear Bias In Wellness Incentives Lawmakers seem eager to encourage employers to create and expand programs that tie a portion of workers' health insurance premiums to their willingness to change unhealthy behaviors. But critics say lowering premiums for healthy workers inevitably means raising them for the unhealthy.
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Patient Advocates Fear Bias In Wellness Incentives

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Patient Advocates Fear Bias In Wellness Incentives

Patient Advocates Fear Bias In Wellness Incentives

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Safeway's program is a hit with lawmakers who would like employers to use it as a model. They had a language to the health overhaul bill in the Senate Finance Committee. Some lawmakers call it the Safeway Amendment. The amendment means healthy people could save a lot of money.

As NPR's Julie Rovner reports, the problem comes with people who might pay more.

JULIE ROVNER: Under current roles, wellness programs like Safeway's can only reward workers who lose weight or stop smoking up to a certain amount: 20 percent of the total cost of their insurance premium. The amendment added the Finance Committee's health bill could boost those rewards to as much as 50 percent. The justification is obvious, said Republican sponsor John Ensign of Nevada.

Senator JOHN ENSIGN (Republican, Nevada): When you offer financial incentives to individuals, they will respond. People are more likely to change behavior if the rewards are even higher.

ROVNER: The amendment passed by a vote of 18 to four, but among those opposing it are a long list of groups representing people who have existing health conditions, including the American Cancer Society, American Heart Association and American Diabetes Association.

Dick Woodruff of the Cancer Society says the groups are all for encouraging healthy behavior at the work place.

Mr. DICK WOODRUFF (American Cancer Society): The problem is when you begin to tie the incentives to the insurance system in premiums, and when you take a selected number of your employees and give them a deep discount, that cost gets transferred over to the least healthy employees.

ROVNER: Karen Pollitz, an insurance expert at Georgetown University, has been studying some of the wellness plans already on the market. She says that while they say they encourage healthier behavior, some are more of a backdoor way of separating people who are healthy from those who are sick. One plan, she says, starts everyone out with an annual deductible of $2,500, then offers $500 discounts from that total to those who pass tests related to smoking, weight, cholesterol and blood pressure.

Ms. KAREN POLLITZ (Research professor, Georgetown University): So if you can pass all of the tests, you're back to having a $500 deductible, which is kind of standard for employer plans today. If you can't, if you're unhealthy, you have a $2,500 deductible.

ROVNER: And the result of that is two-fold, she says.

Ms. POLLITZ: One is that the unhealthy employees now just have to pay $2,000 more of the cost of their care every year, but second, some of those employees may say, forget it. I'm going elsewhere.

ROVNER: Both of which save the employer and the insurer money, but don't necessarily improve anyone's health. Pollitz says she also questions just how voluntary these plans would be if employers could vary more of the premium.

Ms. POLLITZ: This year, the average cost of an employer-sponsored family policy topped $13,000. So an individual's penalty for not voluntarily signing up to participate in this program might be four, five, $6,000 a year. That's pretty coercive.

ROVNER: Dick Woodruff of the American Cancer Society says the groups have another worry about employer wellness programs. Do workers really want their employers to have so much of their personal information?

Mr. WOODRUFF: At least, you know, when you go to the doctor, you have some confidence that the things that you talk about and the things that happen there will be kept confidential. With your employer, you don't.

ROVNER: Woodruff says the groups do support a lot of ways to encourage wellness on the job.

Mr. WOODRUFF: They way to do this if for companies, if they want to have healthy employees, they should offer gym memberships or healthy meals in the cafeteria or opportunities to exercise, or whatever.

ROVNER: But backers of the proposal to tie wellness programs to premiums, like Democratic Senator Tom Carper of Delaware, say the language is fair in context with other pieces of the overall health bill.

Senator TOM CARPER (Democrat, Delaware): We've not done a whole heck of a lot with respect to saying to individuals, you know, that we have some responsibility here, too, to do a better job of taking care of ourselves.

ROVNER: It's an argument likely to continue on the Senate floor. Julie Rovner, NPR News, Washington.

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