"Attainment incentives provide welcome rewards for employees who manage to comply but may be unfair for those who struggle, particularly if they fail," wrote Harald Schmidt of the Harvard School of Public Health in a recent "Perspective" published in the New England Journal of Medicine. "In some cases, the incentives are really sticks dressed up as carrots."
"This is not workplace wellness, this is cost-shifting," added AHA's Nelson, arguing that costs would likely move from healthy employees to sick employees, and from employers to employees.
Schmidt said the incentive programs would unfairly penalize lower-paid workers, who are more likely to be unhealthy.
Advocates say it's unfair to expect the same level of exercise and diet from a law school graduate who has a gym in his condo and a single mother who works two jobs, can't afford a gym membership, and lives in an area with a limited supply of healthy foods.
"It's really important to ask what is the motivation behind these programs," Schmidt told reporters. "Is it really to make people more healthy or to reduce costs? Or to do both? In the end, there is nothing wrong if we can achieve both, but we do have a problem if ... it leads to unfairness and inequity."
Sen. Tom Carper (D-Del.), a co-sponsor of the amendment said the provision contains "strong protections against discrimination" for employees.
"Companies using similar incentives have not only seen their employees' health improve, but they have seen a significant decrease in healthcare costs," Carper said in an e-mail.
During the health care reform debate, the grocery store chain Safeway was referenced countless times as a company that implemented a successful employee wellness program that helped workers quit smoking, lose weight, and eat healthily while saving the company money.
But critics say that because the Senate bill doesn't include guidelines on what a workplace wellness program should look like, one might involve nothing more than testing cholesterol levels while ignoring fitness and motivational components, said Nelson.
Employers would have little incentive to spend money to install a workplace gym or hire smoking cessation counselors, she said.
Nelson said the AHA and other groups are working with congressional staff to remove the provision and instead have the final bill include the House language, which would merely set up pilot programs to test the idea.
A spokesperson for Senate Majority Leader Harry Reid declined to comment on whether the provision would be eliminated during conference, but said "differences will be negotiated with the House."