Coercive Wellness Programs Create New Headaches
Author: Jane Slaughter
Date of source:
Employer-created wellness programs are about what workers should do on their own time, not what the employer could do to stop making them sick at work. Photo: Jim West, jimwestphoto.com
The New Year brings promises to ourselves: to join the gym, quit smoking, get back on the diet wagon. Many employers now have wellness programs to help us out.
But it's a juicy irony: Employers' wellness programs are about what workers should do on their own time, not what management could do to stop making them sick at work. Employers who run workers ragged with stress, speedup, and forced overtime suddenly want to encourage them to be "well."
"Not everybody trusts that," says Dan Campbell, who negotiated a wellness program for city employees in one Wisconsin town. "And rightly so. Employers all of a sudden say, 'Here's something that's good for you and good for us,' and people say, 'we've heard that before.'"
Wellness programs are designed to bring down employers' health insurance costs by preventing illness. Some provide gym memberships or smoking cessation programs. Others require workers to pay more for their insurance if they don't get certain screenings. The most coercive programs require workers to meet health targets or pay a penalty.
"If employers are really concerned, why don't they start with something they can control and provide a safe and healthy workplace?" asks Nancy Lessin, a health and safety specialist with the Steelworkers. "As they are required to do by law."
Some unionists argue that unions must proactively promote wellness, both as a benefit to members and to keep health care costs down. The rising cost of insurance, after all, is partly responsible for stagnant wages over the last decade.
Teamsters Local 1149 in Syracuse, New York, is fighting Pepsi's health care policy that charges employees $50 a month if they smoke or have medical issues that may trigger weight gain. But Secretary-Treasurer Steve Richmond points out, "As trustee of a health and welfare fund, seeing smoking-related illnesses and the claims we pay on behalf of our members--not only employers are interested in saving money. Every time we sit down at the table, talks will turn to health care."
Others are more alarmed at the invasion of privacy and employer control over members' lives. "This coercive component, that's where the line needs to be drawn," says John Borsos, secretary-treasurer of the National Union of Healthcare Workers in California.
Gene Elk bargains with General Electric for the United Electrical Workers (UE). He says smokers at GE pay more for their insurance and decries what he calls a "blame the victim" approach.
Elk (a former three-to-five-pack-a-day man) says, "They want to blame it on people who've fallen for Big Tobacco's advertising. I don't see them knocking Big Tobacco out of the fraternity of corporations and shunning them." Elk predicts GE will put a "tax" on body mass index (BMI) next.
Connecticut state employees have bargained a Health Enhancement Program with strict requirements of members. About 200,000 employees, dependents, and retirees are part of the plan.
Sal Luciano, executive director of AFSCME Council 4, says HEP was bargained in 2011 when the governor was demanding concessions from state workers because of a budget deficit. "We could go two ways," Luciano said: "push more costs on employees or look at what was driving health care cost increases."
Robert Krzys has been the Service Employees' (SEIU) representative on Connecticut's health care cost containment committee for 25 years. In pushing for HEP, he says, the union cited the 880 members treated for colon cancer in one year, at a cost of $15,000 per month each. Four years later half were dead. And colon cancer is largely preventable with regular colonoscopies.
Connecticut state employees under 40 years old must now take a free physical every three years or pay $100 more per month for their insurance, plus a $350 deductible. Those over 50 take a physical every year.
But there's more. Workers must also get the additional free screenings doctors recommend for their age group: immunizations, vision tests, colonoscopies, mammograms, Pap smears. They must get their teeth cleaned twice a year.
Those with any of five chronic health problems (asthma, heart disease, high blood pressure, high cholesterol, diabetes) must talk to a counselor every six months and pick up any prescribed medicines at no cost. "We can't force you to take them," Luciano points out.
The unions thought costs would go up in the first year, because so many more people would be getting medical care. But that didn't happen, because emergency room visits fell off.
The unions predicted a 50 percent participation rate--but, whether the carrot or the stick gets the credit, it is seeing more than 99 percent, with only 178 out of 45,000 union employees not participating.
Luciano says privacy is protected because a third party administers the program, with union and employer receiving only general statistics.
Lessin notes that the received wisdom on screenings changes repeatedly and there's often no consensus among practitioners. Researchers have adjusted their advice on mammogram frequency more than once. Tests for prostate cancer are now questioned as possibly causing unnecessary surgery, incontinence, and impotence.
"Unilateral decisions on what's good for you--when an employer dives into this to save money, it may come back to bite them," Lessin said.
The Affordable Care Act pushes these programs. Those like Connecticut's fit the ACA guidelines, but so do programs that require members to obtain or maintain a certain health outcome (such as being a non-smoker, getting specified results on biometric screenings, or exercising a certain amount), what the government calls "health-contingent wellness programs."
The ACA-allowed bonus or penalty for those who don't meet guidelines may be up to 20 percent of the cost of employee-only coverage--and that amount will rise to 30 percent in 2014.
The only safeguard against discrimination is that a "reasonable alternative standard" must be made available to those for whom it is "unreasonably difficult due to a medical condition to satisfy the original standard."
It's unclear how these rules will be interpreted. Is it unreasonable to expect a worker whose boss yells at her all day to quit smoking within 90 days? Is a yelling boss a medical condition?
Most unions are negotiating programs that pay for participation (or penalize for non-participation) rather than requiring results. In Oregon, state employees in SEIU Local 503 originally had to pay a $17.50 surcharge per pay period if they didn't sign up for the "Health Engagement Model" and participate in two activities, such as classes, per year. The stick's been changed to a carrot: they now get $17.50 for participating.
Members taking a class on diet, for example, aren't measured for weight loss. "I don't think our members would accept being monitored," said Keary Debeck from the union's bargaining team.
In Chicago, teachers fought the wellness plan pushed by Mayor Rahm Emanuel in their contract campaign and strike last year but eventually accepted it in exchange for freezing insurance rates.
Under the program, to begin in January, members and covered spouses must take five free biometric tests: cholesterol, sugar, blood pressure, weight, and BMI. Based on their results, they will be hooked up with a coach.
Members must also earn points each month by logging into a wellness website to read articles or watch videos. They're fined $50 if they don't, but they're not fined for failing to reach goals set by their coach.
Members can opt out of the program by paying a $600 fee up front. "We don't recommend that," says Annette Rizzo, the local's health and benefits coordinator.
But some programs go further. John Borsos of the National Union of Healthcare Workers sees problems in the ominously named "Total Health" program negotiated by rival union SEIU's United Healthcare Workers West (UHW) at Kaiser Permanente in California. Employees are to receive a collective bonus if they improve their biometric scores (weight, smoking, blood pressure, and cholesterol) and if those improvements result in savings.
That creates an incentive for co-workers to become wellness cops. It's a similar model to safety programs that pay a bonus to teams with so many work-days without a reported injury. Both are supposed to create positive peer pressure, but in the safety programs, it just creates pressure not to report accidents. With "Total Health," it is likely to add stress as co-workers eye each other to see if they've gained weight.
The Total Health survey used at Kaiser includes questions like "During the past four months, how much did your health problems affect your productivity?" and "Have you ever taken more of any prescription medication than was prescribed?" Management wants to know, "During the past week. . . I felt lonely (yes or no)."
At another SEIU workplace, Alta Bates Summit Medical Center in the Bay Area, workers who don't participate in wellness must pay 20 percent of their monthly premium. No one can afford not to participate, says transport dispatcher Keesha Johnson, even if they think it's "overkill."
Workers must sign up for either a coach-directed or physician-directed program, and they receive points for such activities as blood pressure fairs, she said.
"The ironic thing," Johnson said, "is that most of my stress is caused by my employer." Hiring has been frozen for more than two years, she said, even when patient numbers increase.
"I'm a little overweight. I have a teenager," Johnson said. "But it's the job that causes me to do anything that's a reaction to stress."
LOTS OF STICKS
Robert Krzys says that in Connecticut, negotiators "argued for all carrots," but the program includes a financial stick of $1,200-$1,500 a year. What kind of program will management implement in non-union workplaces? "Lots of sticks," said Krzys.
Wellness programs may certainly do some good. The worker who wants to quit smoking, for instance, may appreciate access to a free cessation program. But at an employer truly concerned with health, and not just savings, managers would look in the mirror to see how their own actions are making their workers sick. They'd consider how much stress they're adding to workers' lives by imposing more requirements or more costs.
In the words of Kaiser Permanente's Total Health questionnaire, "In the last month, how often have you been angered because of things that were outside your control?"
[Jane Slaughter is the editor of Labor Notes. firstname.lastname@example.org ]
TEXT BOX: EPIDEMIC OF WELLNESS
Wellness programs are growing fast. In firms with more than 200 workers, 94 percent had such programs in 2012, according to a survey by the Kaiser Family Foundation. While programs like a health fair are innocuous, and even potentially helpful, more coercive programs are on the rise.
Eleven percent of firms with more than 200 employees say those who've been identified with a risk factor such as obesity are required to participate in a wellness program in order to avoid paying more for their insurance.
Nine percent of large companies that ask employees to complete a health risk assessment say they are financially rewarding or penalizing workers based on whether they meet specific biometric outcomes, such as a cholesterol number or body mass index (BMI).
Refusing the intrusive tests is no escape, since another survey, by benefits consultant Aon Hewitt, found even more companies impose penalties for that.
Seventy percent penalize workers who don't take a health risk questionnaire and more than half dun those who don't undergo biometric screening. One-fifth impose some form of consequence if targeted workers don't participate in lifestyle modification classes like weight management and quitting smoking.
"Less than 20 percent of employers provide an incentive to employees who achieve targeted clinical results," Aon Hewitt complains. "This focus on participation and access to information rather than outcomes and results won't move the needle when it comes to health improvement, and is unlikely to produce any relief for employers who need to mitigate cost."
If a wellness program starts out with relatively benign requirements, look for management to up the ante to "outcomes and results" as soon as it can.