News & Politics  
comments_image Comments

10 Pounds Overweight? Got High Cholesterol? It Could Cost You Big Unless the Dems Fix the Health Care Bill

A little-discussed provision of the Senate bill allows insurers to penalize subscribers by hundreds -- and even thousands -- of dollars for not meeting certain "wellness targets."

When House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid agreed to negotiate a final health care bill without a formal conference committee, they did so to cut short the number of procedural obstacles Republicans could place in the path to a final health care package. The downside of that decision means that the contours of the less progressive Senate bill—with no public health insurance plan and a tax on employers who offer excellent health insurance for their employees—are likely to shape the final outcome. And that could mean even less reform than we thought we were about to settle for.

After the ditching of the public option and the trashing of a Medicare buy-in, the Senate health care bill, we were told, was still worth passing because it would end discrimination by insurers based on a subscriber's health status. No more discrimination based on preexisting conditions, right? Well, not exactly.

A little-discussed provision of the Senate bill allows insurers to expand so-called wellness programs that allow insurers to penalize subscribers by hundreds—and even thousands—of dollars for not meeting certain "wellness targets," such as a particular cholesterol number, blood sugar measurement or body-weight target.

Remember all those Democrats pleading plaintively, in the face of Republican accusations that the GOP had been cut out of the health care debate, that actually they included many Republican ideas in their health care bills? Well, this is one of them. One of the pro-business innovations of the Bush administration was to introduce into health insurance regulations a provision allowing employers to offer loosely defined "wellness" programs that carry incentives for employees meeting certain standards of premium reductions of as much as 20 percent. Sounds like a pretty good deal, right? Sure, until you realize that there's no baseline for the original premium, meaning that, in reality, people who don't meet the standards are really carrying the burden of others' discounts and then some—paying as much as 20 percent more for a policy in which a family member's failure to meet a wellness target forces up the entire premium for that family's policy. 

If you think that's a raw deal, consider the Senate health care bill provision introduced by Sen. John Ensign, the disgraced Republican of Nevada. Now that percentage of discount or penalty, depending on which end one finds oneself, can amount to a differential in one's premium to 30 percent, and eventually to 50 percent.

"Insurers can spot profits a mile away, and this is a loophole they will drive right through on day one," said Andrew Kurz, the former chief financial officer of Wisconsin Blue Cross-Blue Shield on a recent conference call with reporters convened by the advocacy group, Health Care for America Now. "We got into this mess because insurers unfairly targeted sick people and charged higher premiums based on illness status. To now charge lower premiums based on wellness status can lead to the same result. Like the water glass, half full or half empty, it is still the same amount of water."

In other words, while insurers may no longer be able to drop your coverage for a preexisting condition such as high blood pressure, under the Senate bill they will be able to charge you and your employer as much as 50 percent more for your total premium cost if you fail to meet a targeted blood pressure or cholesterol measurement. These wellness programs are predicated on the notion that your workplace will offer support for meeting your targets, though standards for that support are nearly nonexistent. For example, if your employer, in the guise of a wellness program, offers little more than an aromatherapy session for reducing stress, you could still be penalized for your stress-exacerbated condition, according to Sue Nelson, vice president of federal policy for the American Heart Association.