Socking It to the Unhealthy

HHS finally released the RAND study it commissioned under the Affordable Care Act. As previously reported at this blog, the study shows that wellness programs don’t work.

Ironically, on the very same day HHS announced its final rule on wellness programs. Employers will be able to penalize employees who fail to meet targets on weight, cholesterol, etc., by 30% beginning next year ― up from the current 20% level. Smokers can be penalized as much as 50%. (See our previous post.) The government gives this example:

The annual premium for coverage in an employer’s group health plan is $6,000, of which the employer pays $4,500 and the employee $1,500. The employer offers a $600 discount to employees who participate in a wellness program focused on exercise, blood sugar, weight, cholesterol and blood pressure.

In addition, the employer imposes a $2,000 surcharge on premiums for employees who used tobacco in the last 12 months. The combination of rewards and penalties, $2,600, is less than half of the total premium and is acceptable, if employees can avoid the surcharge by participating in a tobacco cessation program.

Robert Pear, NYT.

Comments (11)

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  1. Nick says:

    Wellness programs are why smart people don’t take evidence-based medicine seriously.

  2. JD says:

    So, as long as you participate in prevention and cessation programs, you aren’t penalized, although, you don’t actually have to change your behavior. This will become a big joke in a few years.

  3. Studebaker says:

    The new rules have too many loopholes. Heaven forbid those with unhealthy lifestyles have to change their bad behavior — if that behavior has been demonstrated to increases health costs.

  4. Tommy says:

    This is ridiculous. Another way for the government to control behavior. Its disturbing to see.

    • Jim says:

      Exactly, the government is merely pressuring businesses into cost saving regulations.

  5. Bubba says:

    Why do health policy folks get so upset about charging sick people more than their healthy counterparts? We will all get old, how we take care of ourselves exacerbates the aging process. The only age banding and community rating that should be allowed (if any) is a high-deductible plan with, say, $10,000 deductible. Between, say, $5,000 in claims and $10,000 in claims, older enrollees should have to pay higher premiums to reflect higher risk. Up to that a $5,000 deductible, people should bear their entire individual cost.

    This is not necessarily my preferred proposal. It’s just one that comes to mind when discussing how to work around differences in health status. This is a limit to how much society should insulate people from the natural costs of aging and unhealthy lifestyles.

  6. Roget says:

    I’m not so sure the underlying issue is that healthy people are subsidizing those with poor habits. Rather should the government push incentives which favor a nanny state?

  7. Jordan says:

    At what point does it stop? Should an employer find out that someone has a genetic predisposition to a particularly costly illness.. should that person be discriminated against through insurance surcharges?

  8. Cory says:

    Its discriminatory too:

    “Older people tend to have more medical problems than the young, and “many health conditions, like obesity, diabetes and hypertension, disproportionately affect members of racial minorities””

  9. CarolT says:

    The pretext of “saving costs” is all a big lie. They pretend that costs paid by people with so-called unhealthy lifestyles were paid by others; that diseases caused by infection are caused by lifestyle; and that costs of “healthy lifestyles” don’t exist at all – e.g., the CDC’s SAMMEC.

    “In this study we have shown that, although obese people induce high medical costs during their lives, their lifetime health-care costs are lower than those of healthy-living people but higher than those of smokers. Obesity increases the risk of diseases such as diabetes and coronary heart disease, thereby increasing health-care utilization but decreasing life expectancy. Successful prevention of obesity, in turn, increases life expectancy. Unfortunately, these life-years gained are not lived in full health and come at a price: people suffer from other diseases, which increases health-care costs. Obesity prevention, just like smoking prevention, will not stem the tide of increasing health-care expenditures. The underlying mechanism is that there is a substitution of inexpensive, lethal diseases toward less lethal, and therefore more costly, diseases.” Table 1 gives the bottom line: At age 20, smokers’ lifetime health costs will total 220k Euros, obese peoples’ costs will total 250k Euros, and the “Healthy Living” will cost 281k Euros. (Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure. PHM van Baal, JJ Polder, GA de Wit, RT Hoogenveen, TL Feenstra, HC Boshuizen, PM Engelfriet, WBF Brouwer. PLoS Medicine 2008 Feb;5(2):e29.)

    That study presumed that “prevention” works, which it doesn’t, because their health pseudo-science is as corrupt as their economics.