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The dirty little secrets of wellness programs

Your employer makes you a deal: Fill out a questionnaire about your health and you can get $25 off your biweekly health insurance premiums. Sound good?

Maybe not, says John Borsos, secretary-treasurer of the National Union of Healthcare Workers.

If you're truthful and you admit you are more than a few pounds overweight, have high cholesterol or blood pressure, smoke cigarettes, or drink a few beers every night, your employer could use your answers to penalize you, Borsos says.

Borsos looks at wellness programs that offer such incentives this way: Employees who have few risk factors for diseases and conditions qualify for the discount and therefore pay less for their health insurance than their unhealthy coworkers. That leaves employees who have risk factors (perhaps through no fault of their own other than genetics) to pay more because they don't get the discount. And that, Borsos says, is a penalty or discrimination.

Secrets of wellness programsEmployers moving toward punitive programs

Lewis Maltby, president of the National Workrights Institute in Princeton, N.J., agrees with Borsos. "Employers justify this kind of punitive wellness program by saying, 'Your off-duty consumption of fast food is running up my health care bills. I don't want to subsidize your atrocious diet so you won't be eligible for any discounts on your health care premiums.'"

The Affordable Care Act allows employers to discriminate in this way, Borsos says. Under the law, health insurance companies can offer discounts to workers who meet specific metrics for factors such as weight (body-mass index), blood pressure and cholesterol. In addition, while health plans can no longer charge more if you have a medical condition, they can charge more for smokers.

Say your health plan's standard is a cholesterol (blood fat) count of less than 200. The employer's insurance plan can give employees whose cholesterol is greater than 200 some options: take cholesterol lowering drugs, or attend classes on nutrition and diet and show improvement by a certain deadline or pay an additional 30 percent of your health plan premiums each pay period.

"It's a way employers can have influence over their employees' lives, not just at work, but outside of work," Borsos says.

Borsos has no problem with wellness programs that are completely voluntary and do nothing more than promote wellness. Such programs might encourage smokers to join cessation classes or provide discounts to gyms. What bothers him is when employers tell employees that if they don't participate in the smoking-cessation classes or if they don't lose weight they will be penalized.

And Borsos and Maltby are afraid more penalties will be coming, as employers try to reign in health insurance costs even more.

"We are seeing most employers moving toward punitive wellness programs, where if you don't participate, you get fined," Maltby says.

William Hoover is wellness manager for AllOne Health in Natick, Mass., and manager of the QuitPower Smoking Cessation Program, and he finds when employees fill out wellness questionnaires and identify themselves as smokers, their health insurance premiums for themselves and their families go up.

"It would be interesting to see if employees refused to fill out the forms, what their employers would do," he says.

Study shows no cost savings

Ironically, a study by RAND Health found forcing wellness programs on employees may be a losing battle. The study, published in the January issue of the journal Health Affairs, found that encouraging employees to adopt a healthy lifestyle did not lead to lower costs for employers.

The study looked at PepsiCo's Healthy Living wellness program, which included a health risk assessment, on-site wellness programs and screenings, a "complex care" manager and a nurse to provide advice over the phone. Researchers looked at the experience of more than 67,000 workers over seven years.

They attributed any lower costs the company saw over that time to its disease-management program and not the lifestyle-management program.

An earlier RAND study found that about half of the employers in the U.S. with at least 50 employees offered a wellness program and that more than 90 percent of companies with more than 50,000 employees do.

More from Beth Orenstein here

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