The rules about workplace wellness programs under the Affordable Care Act were released jointly by the U.S. Departments of Health and Human Services, Labor and the Treasury. The include provisions to charge employees up to a 30% penalty (sometimes couched as an “incentive”) if they fail to meet a” specified health-related goal such as a specified cholesterol level, weight, or body mass index.”
There are a couple of obvious issues. BMI and weight are body size measures, not health measures (there are healthy and unhealthy people of every weight and size); and, body size, cholesterol and other measures are multi-dimensional and not entirely within our control.
And it’s not like they don’t know. At a briefing sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation, panelists were refreshingly honest that there is no proof of the financial or health improvement value of these wellness programs. In fact, a Rand Corporation study on wellness programs that was actually requested by HHS found:
- No significant reductions in levels of total cholesterol
- Insignificant cost savings
- People typically quit smoking for the short term only
- Almost no reduction in emergency rooms or hospital cost or use
- Participants lost an average of only 3 pounds in 3 years
So, employees are going to be penalized for failing at programs that have been shown to fail in a study that was requested by the people who created the penalty structure. Charming. I wish for the good old days when the government was just going to give every fat person a pony.
But the absolutely most ridiculous bit for me was the quote by Troyen Brennan. He is the Executive Vice President and Chief Medical Officer of pharmacy chain/pharmacy benefits manager for CVS Caremark. He said “We’re not sure what works. There’s got to be peer-reviewed data and it’s simply not there…[CVS Caremark is] embedding experiments in all of our wellness programs…The annals of health care are full of things that seem like a good idea but show no effect.”
I know you’re thinking “that makes a lot of sense Ragen, why would that upset you?” It’s because CVS Carmark bragged about implementing a so-called wellness program in which employees must go to a doctor to get their weight, body fat, glucose, cholesterol, and blood pressure measured, and submit those measurements to a third party healthcare company. They are required to sign a form saying that they are giving this information voluntarily, but if they don’t “volunteer” they are charged an extra $600 a year by CVS. The CVS policy states “Going forward, you’ll be expected not just to know your numbers – but also to take action to manage them.” If Troyen Brennan knows that “peer reviewed data” is necessary, why in the hell is he bragging that they are conducting poorly controlled, non peer-reviewed “experiments” that are funded by the subjects (also known as typically lower income workers.)
When I did a piece for iVillage on Michelin’s corporate wellness program that fines employees up to $1,000, I contacted the Employment Equal Opportunity Commission to see if this is even legal. Justine Lisser, Senior Attorney-Advisor for the EEOC informed me that “While normally the ADA [Americans with Disabilities Act] would prohibit an employer with 15 or more employees from asking questions about disabilities or requiring a medical exam (like a blood test to measure cholesterol), an exception is made for voluntary wellness programs…[But] if an employee fell outside some of the metrics imposed by the employer due to an underlying disability — for example, if a person needed to take medication for a psychiatric disability that caused weight gain — it might violate the ADA for the employer to penalize that individual for not meeting certain benchmarks.”
According to the HHS, “The final rules also protect consumers by requiring that health-contingent wellness programs be reasonably designed, be uniformly available to all similarly situated individuals, and accommodate recommendations made at any time by an individual’s physician based on medical appropriateness.”
Which might help in a world where fat people aren’t prescribed weight loss to cure everything from strep throat to broken bones by doctors who don’t know the difference between body size and health and often carry a serious personal prejudice against us. But I’m sure they’ll be super happy to sign our “Please don’t charge me more money for existing” permission slip.
Penalizing people for their body size sets a precedent that it’s ok to charge people more because they share a single physical characteristic. Penalizing people for their health ignores the complexities of health, and since their tends to be a strong link between lower socioeconomic status and lower income, the burden of these programs is likely to be shifted to those who are least able to afford it. Also, and this can’t be said enough, it doesn’t work.
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