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Provisiones propuestas golpe médico de la salud de los grupos

por Brendon Nafziger, DOTmed News Associate Editor | October 28, 2009
A health incentive could
turn into a loss of coverage
An amendment that could expand wellness provisions in employer-given health care coverage raises the ire of medical groups.

Co-sponsored by Sen John Ensign (R-NV) and Tom Carper (D-DE), the plan, nicknamed the "Safeway amendment," which passed the Senate Finance Committee earlier this month, would allow employers to increase the discounts they give for an employee's premium up to 30 percent of the total cost, or even 50 percent if, after reviewing the subject, the U.S. Department of Health and Human Services agrees to raise it by that amount.

Named after the supermarket chain Safeway, which gives employees an insurance discount for keeping their BMI (body mass index) under 30, the plan would allow bosses to reward employees who don't smoke, have their weight under control or even have low blood pressure. Employee health would be checked through questionnaires, body measurements and maybe a cheek swab.

Currently, employers can only charge up to 20 percent of the premium, though this limit only applies to programs that measure health outcomes, not participation.

"Right now, companies can offer 100 percent off on your insurance, the sky is the limit, for simply participating in the wellness program. The limitation only comes to bear when the employee meets some health outcome," Dick Woodruff, policy director of the American Cancer Society (ACS), tells DOTmed News. "For instance, an employer can give all employees a 50 percent discount for enrolling in a smoking-cessation course, but not for actually quitting smoking," he says.

Proponents of the plan believe this is a way to encourage healthy behavior while controlling burgeoning health care costs. In a recent interview with NPR, Safeway CEO Steve Burd said that most of his employees approved of his plan, in which workers with a BMI above 30 pay an extra $318, but are still eligible for a year-end discount if their BMI drops by 10 percent.

But, perhaps unexpectedly, many medical and health groups, such as the American Heart Association and the American Cancer Society, disagree.

"It's a way for companies to cherry-pick employees," Woodruff says.

Woodruff says that a worker with a family who does not meet the wellness guidelines under the new plan could be forced to pay almost $6,000 more a year. "They can be priced out of the market," he says. "Insurance becomes expensive to them, too expensive to buy. It becomes a barrier to coverage and access to care."

Woodruff, along with leaders from other health groups, fears that because employees who get an increased premium will not be able to pay for it, they will drop it altogether, perhaps by joining a plan that their spouse holds, thereby saving their employers money.

"We support the whole idea of workplace wellness. Wellness in general and prevention are hugely important for this organization," Woodruff says. He thinks that companies who want to encourage healthy living could give other incentives, such as bonuses, gift cards, vacation days or even time off to exercise.

He also suggests that some of the targets might not even be in the employee's control. "To suggest all overweight people can somehow lose weight, isn't right. The evidence doesn't support that," he says, and he adds the same could be true of high blood pressure or high cholesterol.

"The only groups really pushing this are the employer community," he says.

Still, the plan does require that employers offer employees an alternative if they have a disability or are otherwise unable to meet the guidelines. What exactly this would mean in practice has not been defined.