Although the Affordable Care Act (Obamacare) broadens access to health insurance through medicaid expansion and baning the pre-existing conditions exclusion, a little noticed provision worsens access for many of the 155 million who already had coverage through their employers. Obamacare’s wellness program provisions enable employers to shift costs to the sickest employees. These programs pose as an employee benefit, but are in fact, a regressive redistribution scheme designed to save employers money.
Wellness Programs: A gift to corporate America
Employers who sponsor “Wellness” programs (>50% of large employers) can offload 30% of healthcare costs to employees who do not participate in, or fail to successfully complete these programs. They can shift 50% of costs if the employee develops a tobacco related condition.
Wellness programs start by employee screening to identify risk factors and bad health habits. Next comes behavior change plans that “nudge” employees to improve their diet, exercise levels, tobacco and alcohol use, and other habits related to health risks. Smartphone apps, Apple watches and other devices monitor program compliance. Finally, employees who successfully complete the program are rewarded and those who fail or don’t participate are penalized. Losers can end up paying more for healthcare in the form of higher premiums, deductibles or copayments.
The wellness industry is booming under Obamacare. Revenue ballooned from $1 billion in 2011 to $6.8 billion in 2016. Last year almost a quarter of employers increased their wellness offerings.
Wellness Program as Neoliberal Fairytale
The star of the wellness fairytale is the caring employer who is committed to the health and well-being of his employees. Grateful employees happily participate in the new, seemingly free, benefit. Attractive incentives keep motivation high. Employee health improves and healthcare costs decline. Savings are shared by employer and employees. The virtuous circle is complete as happier, healthier employees become more productive and the company thrives.
Let’s see how this narrative holds up? We’ll review the evidence for each element of this tale saving the employer motivation for last.
Are wellness programs a free added benefit?
Many are mandatory or de facto mandatory. Here is how a West Virginia teacher described the Go365 wellness program to a NY Times reporter:
“They implemented Go365, which is an app that I’m supposed to download on my phone, to track my steps, to earn points through this app. If I don’t earn enough points, and if I choose not to use the app, then I’m penalized $500 at the end of the year. People felt that was very invasive, to have to download that app and to be forced into turning over sensitive information.”
“Optional” programs coerce cooperation. How many teachers, most of whom are living paycheck to paycheck, can afford not to participate when it means taking a $500 hit?
Also note the invasion of employees’ free time as they try to meet exercise goals, or refrain from smoking or drinking; and the invasion of privacy as their daily activities are tracked and sensitive health information becomes part of the wellness program database.
Do Wellness programs improve health?
The short answer is no. A recent (2017) randomized control study from the University of Illinois showed no benefit from wellness program participation. Unsurprisingly, industry promoters cite proprietary evidence to suggest dramatic success. But, whole books have been written on how the wellness industry uses duplicitous statistics to make claims that are not supported by evidence. courtesy counterpunch.
Published in Daily Times, April 2nd 2018.