Wellness programs and lifestyle discrimination--the legal limits.
چکیده
“Personal responsibility” has become a recurrent theme in debates about health care financing.1 In addition to asking consumers to make betterinformed choices in seeking care, many payers are focusing on individual health behaviors as drivers of health spending. In a recent national poll, 91% of employers believed that they could reduce their health care costs by influencing employees to adopt healthier lifestyles.2 Many health plans and employers now not only provide access to wellness programs but also offer incentives for participation.3 Incentives can be framed as rewards or penalties and may take the form of prizes, cash, or the waiver of payment obligations. FedEx, for example, pays $50 to employees with diabetes who participate in its diseasemanagement program and get both a test for glycated hemoglobin and a retinal examination.4 More controversially, some employers have begun penalizing employees financially or taking other adverse action on the basis of health risks such as smoking and obesity. In an extreme case, the lawn care company Scotts Miracle-Gro fired an employee on the basis of the results of a drug test that detected tobacco use.5 The ethical issues surrounding wellness incentive programs have stirred considerable discussion,6,7 but the legal dimensions are not well understood. In this article, we examine the extent to which employers and health plans can provide rewards or otherwise adjust individual health insurance costs based on the steps employees or plan members take to reduce their health risk.