Wellness Programs Require Unhealthy Employees to Pay More

The Wall Street Journal reports:

In an effort to motivate workers to kick unhealthy habits, U.S. companies are hitting them where it hurts: in their wallets.  Employers who provide health insurance often use financial incentives, such as contributions toward premiums, to encourage workers to participate in wellness programs like smoking-cessation courses.

Now some employers are wielding a stick as well as a carrot.  Employees at some companies who are overweight, smoke, or have high cholesterol, for instance, and who don't participate in supplementary wellness programs, will pay more for health insurance.  In extreme cases, employees' insurance deductibles could rise by $2,000.

See Some Firms Tell Workers to Get Healthy or Pay Up.

There are two potential legal problems with requiring unhealthy employees to pay more.  First, it may violate the Americans with Disabilities Act -- and the EEOC has this on its radar screen.  Second, ERISA requires that all employees covered under the same plan must pay the same premium regardless of health, though there are exceptions for some wellness programs.

Outraged?  I'm not.  While I don't believe employees should pay more for health conditions that are beyond their control (the purpose of insurance, after all, is to spread the risk of events that we can't control), I have no problem at all with imposing higher premiums on employees who choose to engage in behaviors that detrimentally affect their health.  A non-smoking employee who exercises 10 hours a week and regularly eats vegetables instead of fast food will cost much less to insure -- and probably will be far more productive on the job -- than the typical American couch potato.  Why shouldn't an employer be permitted to reward healthy behavior?

Part of the rub, of course, is that it can be difficult to determine causation: is a given person's high blood pressure caused by genetics, or by physical inactivity and poor diet?  That's why the wellness programs can be a good compromise -- it would be unfair to penalize someone merely because she has high blood pressure, but it seems to me entirely appropriate to penalize someone who has high blood pressure and refuses to do anything about it.  That's a lifestyle choice -- but with choice comes consequences.

Comments are welcome.

rb