A growing number of US companies are now urging their employees to slim down, exercise more, reduce their cholesterol and blood pressure levels, or quit smoking—all socially desirable goals. But if these workers fail to cooperate with the new corporate “wellness” regime and adopt a healthier lifestyle (under the tutelage of their employer), the penalty, for many, will be higher out-of-pocket payments.
Corporate America has long been shifting the burden of medical costs onto workers. Cost-sharing negotiated with unions or, more commonly, imposed unilaterally by non-union firms has raised labor’s share of health insurance premiums to an average of 18 percent for individual coverage and nearly 30 percent for families. Workers or their dependents also face escalating deductibles, co-pays and co-insurance, which can add hundreds or thousands of dollars to their annual healthcare spending.
Now, under the banner of health promotion, management is also making some workers pay more for their insurance based on individual differences in their medical condition or lack of adherence to “wellness” standards. This new, more individualized form of cost-shifting threatens to stigmatize and penalize the chronic health conditions of millions of workers, expose some to job discrimination and undermine labor solidarity in the process. In addition, workplace privacy advocates are warning about the invasiveness of so-called “health risk assessments”—now commonly required in corporate wellness programs—because these surveys probe off-duty behavior related to sex, drugs and alcohol.
Under the federal Health Insurance Portability and Accountability Act (HIPAA), management can already compel some workers to pay up to 20 percent more than others covered by the same medical plan. According to Lewis Maltby of the National Workrights Institute, “all that is required is that the penalty be ‘designed to promote good health.’ The employer is not required to demonstrate that the amount approximates the increase in cost due to an employee who engages in any unhealthy behavior.” Under President Obama’s Affordable Care Act, “this abuse will continue to grow,” Maltby predicts, “when the penalty employers can charge without justification increases to 30 percent” next year.
Among the other groups sounding the alarm about this trend are Families USA, Georgetown University’s Health Policy Institute, the American Cancer Society and the American Heart and Diabetes Associations. A report by the HPI at Georgetown called in February 2012 for new federal and state standards that will protect consumers from “programs that inappropriately punish workers in poor health, are overly coercive, or create perverse financial incentives that result in poorer health outcomes.”
As Cancer Society lobbyist Dick Woodruff told National Public Radio, “The whole point of healthcare reform is to make sure that everyone gets insurance. And if people have to pay more because they’re unhealthy, that’s a barrier. It defeats the whole purpose.”
California Nurses Association co-president DeAnn McEwan, an RN for nearly forty years, sees great risk of “discrimination through backdoor redlining for individuals with pre-existing conditions and disabilities.” She points out that the workers “more likely to have the health conditions that wellness programs target are low-income individuals and racial/ethnic minorities.” By no coincidence, she says, they also “face barriers to health such as unsafe neighborhoods; poor air quality; substandard, decaying housing and lack of access to affordable, healthy food.”