For those who have been following the various elements enacted through the Affordable Care Act, you are now fully aware of the new rule that will actually benefit some health enthusiasts but upset many others.
The final rule (TD 9620; CMS-9979-F under Employee Benefits Security Administration) has upheld an increase in rewards and penalties for those participating (or not) in employee wellness programs. What that means is employers can now increase the financial incentives from 20 to 30 percent of health premiums starting in January 2014. Those participating in tobacco cessation programs can receive a 50 percent incentive. Basically, if you participate in an employee wellness program, you could qualify for hundreds or thousands of dollars in premium or deductible discounts.
That’s the good news, but here’s the not-so-great news. If you do not participate or use tobacco products, you could be eligible for a penalty of those same amounts – 30% more for not participating in wellness programs and/or 50% for using tobacco products.
Okay, so there’s good news and not-so-good news. Now, here’s the worst of it…If you are unable to participate in such a program because of valid medical problems or conditions, including pregnancy, you could actually be penalized with an increase in your premium.
I’m a huge proponent of higher premiums for those who knowingly and willingly partake of unhealthy behaviors such as smoking, illicit drug use, and sedentary lifestyles. It is those people who will eventually end up costing the system more money because they run up hospital bills from medical issues associated with those behaviors such as emphysema, lung cancer, diabetes, stroke, heart attack, and more. That “system” is actually the rest of society footing the bill to underwrite the costs of their unhealthy behaviors.
Yet, I am not in favor of penalizing those who truly cannot be part of a wellness program. According to the Kaiser Health, the theory behind the incentives is to encourage people to make healthier choices in an effort to reduce significant health care costs associated with obesity, high blood pressure, and diabetes. Some studies have shown that money can be a strong incentive for changing our behaviors.
But, how fair is it that a woman with a difficult pregnancy would be penalized because she was physically restricted? What about the man bound to a wheelchair from a car accident that wasn’t his fault several years earlier? There are so many valid reasons for not being able to participate in a wellness program that penalties should probably be determined on an individual basis – or not enacted at all.
Two types of wellness programs were outlined in the rules, one which provides the opportunity for all employees to participate – such as sitting through a wellness class/seminar. The other program focuses on meeting goals (such as weight loss, or reducing blood pressure) or participating in activities (such as walking programs or fitness classes). It is this second program type that has produced the controversy.
According to Kaiser Health, the rule, filed on May 29 with the Federal Register, gives employers leeway, saying the programs must simply have a ‘reasonable chance’ of improving health. What does that mean? It means that every individual is given the opportunity to improve their health status starting from where they are today (or rather, as of January 1, 2014).
I am truly in favor of projects like employee wellness programs that can not only improve the health of the employees but improve productivity and overall economic wellbeing for the community. In fact, employers that cover the costs for gym memberships are really making it easy for their employees to improve their health.
Considering that employers have the option of enacting these discounts and penalties, I strongly recommend leaning towards a rewards system. Give those discounts to those participating in wellness activities, whether on site or in the community. And, for cases where there is a valid medical reason for lack of participation, the discount should still be offered. Yet, for those who flat-out refuse, I wouldn’t penalize them; but I certainly wouldn’t offer the reward.
Positive rewards have proven to be more successful than negative reinforcement. Any parent can tell you that!
References
Appleby, J. (2013). Final rule upholds increased rewards, penalties for wellness participation. Retrieved from http://capsules.kaiserhealthnews.org/index.php/2013/05/final-rule-upholds-increased-rewards-penalties-for-wellness-participation/.
Internal Revenue Service, Department of the Treasury, Employee Benefits Security Administration, Department of Labor, Centers for Medicare & Medicaid Services, Department of Health and Human Services. (2013). Final Rule: Incentives for nondiscriminatory wellness programs in group health plans. Retrieved from http://www.ofr.gov/(S(ztwp1tthdztmqqh35iza2ek4))/OFRUpload/OFRData/2013-12916_PI.pdf.
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