October 16, 2009


One of the bloggers on a conference call with Sen. Arlen Specter this week was pressing him on increasing health insurance premiums for overweight Americans. Specter gently corrected her. He said his son, a resident psychiatrist, has explained to him weight is a matter of many complex factors and it wouldn't be fair to financially penalize an entire group based on things they couldn't control.

I was appalled at the question. I've put on 50 pounds in two years of inactivity as a result of my (until recently undiagnosed) ankle injury and the last thing I need is someone charging me more money for it.

As policy, this is an especially uninformed and insensitive position because every study shows that rural and inner-city residents (who have the highest obesity rates) actually have little access to affordable, healthy food. (And that's not even touching the research showing that the chemicals in foods have all kinds of harmful effects on your body that encourage weight retention.)

So if people could educate themselves about these issues, we won't have to waste time on discussing what amount to punitive measures:

Get in shape or pay a price.

That's a message more Americans could hear if health-care reform provisions passed by the Senate finance and health committees become law. By more than doubling the maximum penalties that companies can apply to employees who flunk medical evaluations, the legislation could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol.

The bipartisan initiative, largely eclipsed in the health-care debate, builds on a trend that is in play among some corporations and that more workers will see in the benefits packages they bring home during this fall's open enrollment. Some employers offer lower premiums to workers who complete personal health assessments; others limit coverage for smokers.

The current legislative effort would take the trend a step further. It is backed by major employer groups, including the U.S. Chamber of Commerce and the National Association of Manufacturers. It is opposed by labor unions and organizations devoted to combating serious illnesses, such as the American Heart Association, the American Cancer Society and the American Diabetes Association.

Critics say employers could use the rewards and penalties to drive some workers out of their health plans.

President Obama and members of Congress have said they are trying to create a system in which no one can be denied coverage or charged higher premiums based on their health status. The insurance lobby has said it shares that goal. However, so-called wellness incentives could introduce a colossal loophole. In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems such as diabetes, heart disease and stroke.

"Everybody said that we're going to be ending discrimination based on preexisting conditions. But this is, in effect, discrimination again based on preexisting conditions," said Ann Kempski of the Service Employees International Union.

The legislation would make exceptions for people who have medical reasons for not meeting targets.

Supporters say economic incentives can prompt workers to make healthier choices, thereby reducing medical expenses. The aim is to "focus on wellness and prevention rather than just disease and treatment," said John J. Castellani, president of the Business Roundtable.

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