It’s a provision that allows employers to increase the amount that they may fine their employees for “lifestyle” conditions, such as being overweight or having high blood pressure or high cholesterol.
Almost 37% of Americans are overweight or obese. The supposed goal is to use financial penalties to reduce obesity, the health costs of which exceed $200 billion per year. But this idea, while well intended, will not help Americans suffering from obesity, a medically defined disease and disability. In fact, it will likely make their situation worse.
For years, the country’s “wellness” industry has offered health-enhancement and obesity-reduction programs to corporations, from gym memberships to dietary counseling. For obesity, this approach has not worked. Research on these programs shows that they have not significantly reduced weight or cholesterol levels, or improved any other health outcomes.
Even the most successful programs, such as Weight Watchers, achieve an average two-year weight loss of only about 3% for their members— and even that tiny weight loss often returns later.
The failure of such programs arises from the complexity of our obesity epidemic. For one thing, some people have a genetic predisposition to obesity. If you are unlucky enough to have certain genes, you are up to 12 times more likely to be clinically obese – something that will be difficult to correct, even with a good diet and exercise.
Much obesity starts in childhood, when environmental factors cause children to drink too much soda, consume high calorie foods, and watch too much TV. By the time these kids become adults, they suffer from both obesity and diabetes – conditions that are almost impossible to reverse. In short, once you are obese it is extremely difficult to lose enough weight, even with financial penalties as an incentive.
These problems will only become worse under the Affordable Care Act. Under the Act, starting this year companies are allowed to increase the surcharges to employees with medical conditions to 30 percent of their health insurance premiums for an average charge of about $1620 per year.
(Prior to 2014, companies could assess a 20% surcharge.)
This is cause for serious concern. Not only does the change lend credence to a discredited approach to fighting obesity, but it in effect allows companies to punish their employees for pre-existing conditions, something that Obamacare was designed to avoid.
Worse that being simply ineffective, financial penalties for obesity have significant negative effects. They erode trust between employers and employees, prompting some workers to quit or suffer the genuine fear that the release of private health data will endanger their future employability.
These penalties also discriminate against the poor — many of whom live in neighborhoods with limited access to nutritional foods but plenty of cheap junk food available – and against people with mobility problems who are more likely to be obese. Large controlled studies show that increasing health care charges actually steers people away from essential medical care, exacerbating high blood pressure, worsening vision, and increasing mortality by 10% among low income people with chronic diseases.
Large increases in insurance premiums- up to $5000 for a family of four- also result in uninsurance or switches to cheap but stingy high deductible insurance plans (with very high up-front payments of up to $12,000 before medical care is covered). Our research shows that such plans have been linked to reductions in life-saving care, including colorectal cancer screening, ER visits, and diabetes medicines. The new surcharge will only make this worse.
There is no magic bullet for solving the costly epidemic of obesity, but fining those who suffer from the condition is unethical, disrespectful, and counterproductive. It is likely a violation of federal laws to discriminate against employees based on obesity (a disability) or genetic make-up. Yet that is what this ill-conceived ACA penalty allows.
The Equal Employment Opportunity Commission (EEOC) and other legal advocates for those with pre-existing conditions should seek a reversal of these discriminatory penalties in the courts. In the meantime, the EEOC needs to issue guidelines with strong nondiscrimination protections for employees in “wellness programs”—as they have been called upon to do for some time now.
Rather than penalize individuals, we need to emphasize population-based obesity prevention, such as using financial incentives to increase healthy food access in low-income neighborhoods. We should increase budgets for physical education in schools, not reduce them; raise taxes on soda and other high calorie beverages, and institute proven programs that limit sedentary TV and screen time.
And among those who are already obese, offer respectful long-term behavioral programs that reduce a few realistic pounds at a time, rather than fining those who fail to achieve what are nearly impossible goals.
Stephen Soumerai is Professor of Population Medicine and Director of the Drug Policy Research Group at Harvard Medical School and Harvard Pilgrim Health Care Institute.