Wednesday, October 21, 2009

Shape up—or the sunscreen police might get you

Picture this—it’s a sunny, pleasant fall afternoon and, knowing that you could stand to lose a few pounds, on the spur of the moment, you decide to go for a walk and enjoy the great outdoors. After an hour or so, you’re feeling hungry after all that exertion and decide to stop at a sidewalk café and have lunch. While indulging in a tasty, though greasy, cheeseburger washed down with a cold beer or two (after all, good intentions can carry you only so far), you notice someone standing behind you with a clipboard, taking notes on your behavior.

Far-fetched, you say? True, this is almost certainly an exaggeration, but it’s not that far beyond the realm of possibility if the Senate Finance Committee has its way. Under the SFC version of health reform, upon enactment, your employer might be able to charge you 30 percent less for your health insurance (50 percent less if government regulators approve) if you don’t engage in risky health behaviors and can meet certain wellness standards. As a result, some employees could have thousands of dollars on the line.

Maintaining an unhealthy weight, smoking, drinking excessively, not wearing sunscreen or even not wearing a car seatbelt or not having a working home smoke detector could potentially result in your forfeiting the premium discount, depending on what behaviors your employer considers as unhealthy and how it structures its program. If your blood pressure, body mass index, or cholesterol numbers are too high, your wallet could end up being much lighter.

The SFC provision includes an exception for those people who have a valid medical reason for not meeting a particular target. In this situation, the wellness program could offer a reasonable alternative compliance standard or even a waiver. According to the SFC, the wellness program could require “verification of these circumstances, including a statement from an individual's physician.”

Controversy. Not surprisingly, the law change is backed by major employer organizations and opposed by unions and some major health organizations. Supporters say that substantial economic incentives could prompt employees to make better health choices.

However, as the Washington Post points out, “critics say employers could use the rewards and penalties to drive some workers out of their health plans.” Given that the stated goal of health reform is to increase health insurance coverage, and among other things, getting rid of preexisting condition exclusions, the wellness program rule could actually end up having a curious result: driving employees out of their employer-sponsored health plans by making these plans unaffordable.

Effects of the change. Currently, there’s only a 20 percent maximum penalty for engaging in unhealthy behaviors and many employers reward effort not results. In fact, right now, many employer wellness programs consist of filling out a health risk questionnaire (including questions on sunscreen and seatbelt usage, exercise habits, blood pressure, and other health-related issues) in exchange for a more modest premium discount. Employees get credit for “the old college try,” for instance, an employee can get the discount by participating in a smoking cessation program, though not necessarily stopping smoking completely. Even so, some companies already have taken this a step further and mandate certain results, increasing insurance premiums but then giving employees discounts if they can meet specified standards for blood pressure readings and cholesterol numbers.

So, what’s the bottom line? Eat your vegetables, stop smoking, cut back on your drinking, get plenty of exercise, drink plenty of water, always wear sunscreen, always wear your seatbelt, get a good night’s sleep every night, and keep those smoke detector batteries replaced, and you might see a hefty discount on your health insurance premiums. If not, and the SFC provision is included in the final bill, you might want to watch out for the sunscreen police (or fast food police or seatbelt police).


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