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Being Obese Can Weigh On Employees' Insurance


As Yuki just reported, employers are looking very closely at using carrots and sticks to get workers to change their unhealthy ways. Let's learn more now about that provision in the health care law which allows employers to put in place wellness programs aimed at improving health and managing health care costs. Morgan Downey is an advocate for people with obesity. He's also the editor of the Downey Obesity Report.

Thanks for joining us.

MORGAN DOWNEY: Not at all. It's my pleasure.

MONTAGNE: What, exactly, is a wellness program?

DOWNEY: Well, wellness programs come in two varieties: voluntary, participatory programs, where the employer may provide classes on smoking cessation or diet or lifestyle, maybe a membership in a gym - totally voluntary. And the rewards there are usually, you know, a baseball cap or tickets to a movie or a baseball game, or something like that.

The other type of program is a mandatory program where employees take a biometric, it's called - like blood pressure, for hypertension; like body mass index, for obesity - and set a target for what change they want to see. And if the employee meets the target, the employee would receive a benefit, an incentive. But if he or she doesn't, then they could be charged, in effect, up to 30 percent of their health insurance premium.

MONTAGNE: So - but what's the downside to that? That would seem to be quite a powerful incentive.

DOWNEY: Well, my concern is if you look at the literature - and there's now a lot of studies that have been done - the results are very, very modest. Some have improvements, like in diet or physical activity, but no improvement - significant improvement - in weight.

MONTAGNE: Well, then, wait. Your concern is that these programs that you know of and might be used, do not work and therefore, are unfair?

DOWNEY: That's right. It's also not that they don't work but remember, the whole point of the Affordable Care Act - or Obamacare - was not to penalize people for pre-existing conditions. And under this formulation, individuals could end up paying an additional $1,500. If it's a family coverage, it could be an additional $5,000. So it's a very significant penalty, and the whole purpose of the law was not to go in this direction.

MONTAGNE: But you're saying that employers could, in effect, mandate these programs that don't work, or have never been proved to work; and then that would end up having the employees carry a heavier burden of the cost of their own insurance, or being penalized in some way. Is that something that you think could really happen widely or...

DOWNEY: Sure. We know that employers are adding these wellness programs at a very high rate. I think something on the order of 80 percent of large employers have them. And the ones that have - in effect - a penalty provision is growing very rapidly.

MONTAGNE: But, you know, it does seem reasonable - and obviously, it was reasonable enough to get into the Affordable Care Act - to ask employees in some way, and motivate them, to be healthier. Could you give us an example - one example of a big wellness program that an employer might use?

DOWNEY: Here's the problem - some employers have been using programs which are designed to encourage physical activity or to improve the nutritional quality of the employees' food. Fine. They're great. Provide them support and encouragement when motivation starts to wane. And I think those can make differences, but we know that that doesn't always mean there's going to be a difference in body weight.

MONTAGNE: Thank you very much for joining us.

DOWNEY: My pleasure.

MONTAGNE: Morgan Downey is the editor of the blog the Downey Obesity Report.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.