The ACA and Wellness – Another Reason to Dump Obamacare

The Republicans are trying to find a way to remove most or all of the provisions of Obamacare since its inception in 2010.  Never mind that you can’t keep your doctor – your monthly premiums are too high for basic services, and the entire program is nothing more than a “gift” to health insurance companies.  Is there any other reason to get rid of this monstrosity and get to the business of real healthcare reform?
 
One is wellness.  Above all other types of health “procedures” wellness may be one of the few that can cross over from primary prevention to long-term therapy and tertiary preventive strategies.  Let’s take a look at the absurdity of the ACA as it related to wellness, and then ask ourselves why they even discuss it.
 
According to healthcare.gov – the US government site on Obamacare, they pride themselves on the amount of wellness components they have included in ACA after January 1, 2014.  The first thing they discuss is workplace wellness “participatory programs”.  These are available to anyone in the work place independent of his or her general health status.  Makes sense, as both healthy and not so healthy should be able to participate in different types of wellness activities.
 
The first example they give is reimbursement for health club memberships.  In my opinion – this should be the hallmark of the ACA – as many types of health club programs (worker’s comp, Silver Sneakers, cancer recovery, weight management) have proven themselves to be both vast health improvement mechanisms, and tremendous cost savings in terms of both disease prevention, cost prevention, and long term recovery / survivorship from medical diseases.
 
The next area of participation is monthly health education seminars (at no cost to employees), and provides for “rewards” for persons who complete a health risk assessment without requiring them to take any further action.

 
So – you want people to fill out a HRA on paper or on a computer, gather a bunch of data on them that the health companies can use for other purposes, but not require them to do anything if they have a potential medical or health incident that needs intervention?  Talk about a waste of money.  In my experience working for a large employer – taking the yearly HRA online meant that I may (or may not) get a $100 gift certificate, but there was no real incentive for me to do anything the other 364 days of the year.  Lucky for me I am into fitness and health, and do all of my programming on my own.  But what about most people?
 
The ACA also looks at nondiscriminatory “health-contingent wellness programs” which require employees to meet certain standards related to their health in order to get a reward.  Now this is more like it.  If you want to get something from your health plan, you have to be accountable.  Drop your blood pressure, lose your weight, get into the gym 3-4 days a week, and then some.  If you don’t smoke, or decrease your use of cigarettes, you get something.  If you drop your cholesterol levels, you get something.  If you lose some weight, you get something.  I get it.
 
However, even if you don’t meet your target (at least you tried), you still may get something.  At least the insurers are meeting employees half way here.
 
The issue with the ACA is that it is a blatantly politically correct health bill.  Programs must be designed to accommodate similarly situated individuals.  If not – reasonable alternative programs must be available.  Employees can also be given the opportunity to qualify for the same reward through other means.  This means they can qualify for a reward if they achieve their goal from other means (diet vs. exercise for weight loss).
 
The ACA states that a health plan’s group wellness reward should range from 20-30% of employees.  How they got that number I have no idea.  This is 20-30% of the cost of coverage.  For things like tobacco reduction, the reward may go up to 50%.  
 
In order to maintain rewards, employees must – maintain a smoke free status, maintain weight loss, and maintain a reduced blood pressure. Persons will continue to get biometric screenings in order to satisfy this criteria.  Any staff person can qualify for a reward at least once per year.  Persons with health plans that already have some of these criteria in place are grandfathered into ACA provisions.
 
In a nutshell – ACA wellness plans must:  A) be non-discriminatory  B) must provide a reward / incentive to staff  C) members must maintain standards to receive rewards.
 
For companies that fall back from these standards – there are surcharges that may apply (higher taxes for employees who fail to meet criteria over time).
 
The ACA tries to use simple language to get their point across.  They acknowledge that previous health legislation used fancy language that most did not understand, or apply correctly.  However – in only concentrating on benefits that may be gained from smoking cessation, weight loss, or cholesterol reduction, the ACS misses the point of changing our health care system from trying to take care of sickness at the office to a preventive and wellness-based approach.
 
Fully paid health club dues (from $20-100 per month) are much less expensive than diagnostics and one day in the hospital.  The ACA does not cover the cost of a total program plus ancillary expenses (nutrition, personal or group training, assessments and outcomes).  Even with these add on items it is still much less to work out then go to a hospital.  And with 2,170 hospitals vs. 31,400 health clubs (not including studios and other types of wellness programs like community rec. centers, or kids clubs or YMCAs), it makes more sense to have health clubs become more of a provider since they by far have the larger networks.  Health clubs and wellness programs have also had specialty certification programs in clinical exercise, and medically-based fitness networks for years, so they have built on the prospect of taking care of the 35% of Americans who may need specialty exercise services now and in the future.

 
Secondly – the ACA does NOTHING about nutrition – only weight loss.  We see this every day on TV – but we are in the midst of a nutrition revolution in the USA, and the Federal Government does not even acknowledge it.  From urban farming to organic farmers markets to organics in Trader Joe’s and Whole Foods nationally, we are seeing more people want to eat more food that is nutritious, tasty, and organic / pesticide-free than in the last 100 years.  The entire GMO food debate is a line in the sand, and making the movement go forward much quicker.  There should be a lot of information in ACA about healthy eating – but there is not.  For now, it is still a consumer issue.
 
The ACA should be a consumer issue too.  It is now a government issue, and again, they didn’t do a very good job.  When you give a gift to health insurance companies vs. a right to the American consumer, then eventually you will have to scratch what you have for something else.  It will take more time, more money, and probably cause more division until the situation is righted.  Until then Americans will continue to see substandard health care with little true wellness as a part of it, and will seek out their best efforts with the help of CAM providers, friends, and solid information sources like this one.

 

Lastly – in reading posts of families who have signed up for Obamacare, their premiums for a family of four have escalated in the past year from $400-600 per month, to well over $1000.  This payment is usually only good for prescription drugs, surgeries, and hospital / doctor visits.  So – paying all of this money only keeps you in the medical system.  If you want to have any complementary medical procedures done – chiropractic, acupuncture, etc., you pay for them out of pocket, (while still paying your outrageous premiums).  So you are essentially paying twice for medical care – the one you want, and the one you are forced to pay.  This is not health care – it is extortion.  The only way for the ACA to really be a health plan is to cover the cost of preventive services – and not just mammograms and vaccines, but health club memberships, good eating plans, and other proven methods of disease risk reduction.  I doubt this is going to happen, so my vote is to get rid of this “law” in the next presidential cycle, and start from scratch with something that make sense, and doesn’t brake this nation economically.

 

References

Ameringer, C.F.  Health Care Revolution.  From Medical Monopoly to Market Competition.  2008. University of California Press, London, England.

Baiker, K, Cutler, D, Song, Z.  Workplace wellness program can generate savings.  Health Aff. 2010.  10:29; 304-311.


Joint Consensus.  Guidance for a Reasonably Designed, Employer-Sponsored Wellness Program Using Outcomes-Based Incentives.  2012.  JOEM.  54(7):889-97.

 

Mattke, S, Hangsheng, L. Caloyeras, JP, Huang, CY, et al.  Workplace wellness programs study.  2013, RAND Corporation, Santa Monica, CA
 
Rath, T, Harter, J. The Economics of Wellbeing.  2010.  Washington, DC.  Gallup Consulting.
 
Schmidt, H, Voigt, K, Phil, D, Wikler, D.  Carrots and sticks and health care reform – problems with wellness incentives.  N Engl J. Med. 2010; 362:e3.

Seat, E, Sundstrom, E.  Groupthink.  2004. In Encyclopedia of Health Care Management.  Pg. 233-35, Michael Stahl, Ed.  Sage Publishers, Thousand Oaks, CA
 
Tu, HT, Mayrell, RC.  Employer wellness initiatives grow, but effectiveness varies widely.  NIFCR Newsletter.  2010, No. 1. Pg. 1.  Washington, DC.