'Wellness' Provision in Health Care Bill Meets Protest

Advocate groups say incentives for wellness may hurt the poor and elderly.

ByABC News
January 8, 2010, 5:37 PM

WASHINGTON, Jan. 10, 2010— -- Incentives within the U.S. Senate health care bill designed to encourage healthy lifestyles unfairly target the poor, elderly, overweight and disabled, and could be exploited by insurance companies for financial gain, advocacy groups claim.

Dozens of health, justice, and disability organizations have signed a letter urging senators to remove a provision in the health care reform bill that would allow insurers to provide reimbursements or incentives to workers who meet certain fitness goals laid out in workplace wellness programs.

In rewarding healthy people for making good choices, those who don't meet fitness goals would be unfairly penalized, the groups said.

"It's indistinguishable from medical underwriting," Sue Nelson, vice president for federal advocacy of the American Heart Association (AHA), told reporters during a Thursday call.

"This is a loophole that [insurance companies] will drive right through on day one," added Andrew Kurz, former chief financial officer of Wisconsin Blue Cross-Blue Shield. "This can lead to huge differences in premiums."

Under the existing Health Insurance Portability and Accountability Act, group health insurance plans can't discriminate based on an individual's health status by varying insurance premiums.

But the law does allow insurers to provide incentives tied to voluntary "wellness programs," either solely for participating in a workplace wellness program, or for meeting certain health and fitness benchmarks, such as reaching a certain body mass index target.

Those incentives can take the form of extra reimbursements, but they can't top more than 20 percent of the employer's cost of covering the employee.

The Senate bill would raise that figure to 30 percent, so an individual who doesn't meet the wellness goals could hypothetically be paying up to $1,410 more in annual premiums than an employee who met wellness goals.

The amount could be raised to 50 percent, with government approval. People with medical conditions that preclude participation would be offered an alternative program, the bill says.