If you’re like most people, you started 2015 with a list of New Year’s resolutions. And if you have, chances are the list of resolutions includes something along the lines of lose weight, get fit, or maybe even quit smoking. It’s also likely few of those resolutions will be met or even still be around next month. But there’s a stronger chance than ever that your employer wants to help you with that resolution.
More employers are offering workplace wellness programs. An annual survey of employer-provided health benefits found 3 out of 4 firms that offer health benefits offer some kind of wellness program, such as weight loss programs, biometric screening, nutrition counseling, or lifestyle coaching. Linking that program to a financial incentive is less likely: 12% of firms offered a financial incentive to complete a wellness program. But that share could grow with enhanced flexibility under the Affordable Care Act, which allows employer-sponsored wellness programs to link up to 30% of the health plan premium (including both the employer and employee shares of the premium) to completing a wellness program. In other words, a $1,000 monthly premium for coverage can turn into $1,300 for those who fail to participate in or complete the program. For example someone who refuses to undergo a biometric screening or fails to hit a target weight loss goal could be charged 30 percent higher premiums.
In an earlier post, we summarized HIPAA nondiscrimination rules on workplace wellness programs, but now wellness programs are back in the news, with recent action at the Equal Employment Opportunity Commission (EEOC) and a suit filed against Honeywell International. The EEOC enforces the Americans with Disabilities Act, which prohibits employers from asking workers to undergo medical tests or answer questions about their health unless it is voluntary on the part of the employee or “job-related and consistent with business necessity.” The EEOC said the Honeywell program, which can penalize workers and their families up to $4,000 for failure to undergo medical tests, is not a voluntary program and therefore does not comply with the ADA.
Employers take issue with EEOC’s action. In a letter to the Obama Administration, business leaders make the case for proceeding with ACA-compliant wellness programs without interference from the EEOC. But the ACA is clear that the HIPAA rules that govern workplace wellness programs aren’t the only consideration. The preamble to the workplace wellness rule states, “compliance with the HIPAA nondiscrimination and wellness provisions is not determinative of compliance with any other applicable Federal or State law, which may impose additional accessibility standards for wellness programs.” That leaves plenty of room for the EEOC to consider whether workplace wellness programs comply with the ADA and other federal nondiscrimination rules within its purview.
When CHIR researchers looked at workplace wellness programs as federal ACA rules were being developed, we found no evidence for the claims that tying financial rewards or penalties to wellness activities leads to improved health outcomes. There continues to be little evidence that they work and even more skepticism that they save money. Yet we know that increasing the cost to enroll in coverage or obtain care may mean some individuals forgo coverage or needed treatment. There’s also evidence that workplace wellness programs shift costs to the most vulnerable – those employees with lower incomes or a higher incidence of health risks.
This debate will continue, and business leaders will get to make their case this week in a hearing in the Senate HELP committee. But at least one business representative has confirmed fears that wellness programs are less about producing better health for workers and more about shifting costs to the sickest. In defending the Honeywell program, a company representative said, “We don’t believe it’s fair to the employees who do work to lead healthier lifestyles to subsidize the health-care premiums for those who don’t.”