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As companies rapidly embrace employee wellness programs, some employers say regulators are stymieing their efforts to help workers improve their health.
Companies are increasingly cutting workers' health insurance premiums if they improve their scores on health screening tests for blood pressure, diabetes and other chronic illnesses.
The Affordable Care Act (ACA) doesn't let insurers or employers charge people more for insurance based on their pre-existing conditions, but it does encourage them to offer wellness programs by allowing health care premium cuts or other incentives if workers participate and show improvement on screening tests.
Companies risk running afoul of the Americans with Disabilities Act if they don't offer other options for employees who are physically or mentally unable to participate. But federal rules under the ACA require businesses to offer alternative ways to comply even for for those who simply don't want to do what it takes to, say, reduce their cholesterol. And these employees can also go to their doctor and get another option -- perhaps to read a book -- that the company has no say in.
Some employers, including Caesars Entertainment CEO Gary Loveman, say these rules let workers off too easy. Loveman, co-chairman of the health and retirement committee for the CEO association Business Roundtable, says members of the group believe the Obama administration "made it very difficult to provide any sort of tangible motivation" to employees to improve scores on blood pressure and other tests.
"I hate to sound skeptical about human motivation -- but a lot of people will just not read the book, they'll read the Cliff's Notes," Loveman says.
Advocates for workers say some programs already go too far.
There are "whole demographics" the programs can discriminate against, says Judith Lichtman of the National Partnership for Women & Families. These include women, minorities and low wage workers who are disproportionately afflicted with chronic illnesses, she says.
Problems include wellness programs that require attendance at events outside of normal business hours, which would make it difficult for many to attend if they have to pay extra for day care. Besides, she says, incentives are often made out to be carrots "when it is really a stick."
The Equal Employment Opportunity Commission, which held hearings on possible discriminatory aspects of wellness programs last year, is expected to issue rules or guidance soon to help companies meet the ADA.
Although Lichtman questions whether there's "hard research" linking wellness programs to good health outcomes, companies say they are making a difference.
A peer-reviewed study conducted for Interactive Health, which administers wellness programs for about 2,000 companies, found 85% of 15,550 employees and spouses improved or maintained their level of health risk and companies' health care costs rose 6% more slowly.
"We know we save people's lives," says Cathy Kenworthy, CEO of Interactive Health.
Along with incentives for surveys and screening, wellness programs include reimbursement for gym membership and online coaching for weight management, says United Healthcare's Tracey Lempner
Despite the federal roadblocks, companies are increasingly telling employees, "We want you to do more than show up and listen; we want you to actually take action and try to achieve a result," says Randy Abbott, a senior consultant at employee benefits consulting firm Towers Watson.
CVS hasn't adopted them yet, but chief human resources officer Lisa Bisaccia says these outcome-based programs are a "natural successor" to those that ask or require workers to be tested.
Once workers "understand what their numbers are," you can "move on to something that improves them," Bisaccia says. "You have to take it step by step."