Could Health Overhaul Incentives Hurt Some?

(New York Times) The new health care law promises to extend coverage to millions of Americans and to cut costs by cultivating healthy habits and preventive care. But could its emphasis on wellness undermine one of its central achievements: putting an end to the practice of charging sick people more for health insurance?

Workplace wellness programs are becoming more and more popular as businesses try to rein in runaway health costs. At American Express, for instance, employees are offered a $100 reward just for coming in for a health assessment; the company also provides an array of free support services, including health coaching, maintenance drugs and preventive care.

The program helped Wade Hindell, 37, of Jersey City, a technology director at Amex’s New York City headquarters, lose more than 40 pounds last year after a cafeteria health check alerted him he was overweight — obese, actually — and had high cholesterol and triglycerides. “My wife was very happy about it,” he said. “I don’t snore anymore.”

The new law gives employers more leeway to offer workers an even more valuable incentive: steeply discounted health insurance for those who reach certain goals — for example, keeping their weight, blood pressure, blood sugar or cholesterol within normal range.

While advocates for people with chronic ailments like diabetes, cancer and heart disease say they welcome initiatives that enable employees to incorporate exercise or weight counseling into their workday, they warn that tying premium discounts to achieving certain health standards (which American Express does not do) will inevitably shift costs to less healthy employees.

“On the one hand, it’s a great idea — let’s encourage people to be healthy,” said Timothy Stoltzfus Jost, a law professor at Washington and Lee University specializing in health and a consumer representative to the National Association of Insurance Commissioners. “But if I have pretty serious asthma, there are a lot of wellness programs that I can’t be a part of. Isn’t this going to mean people who are already unhealthy are going to pay higher premiums?”

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