Companies to charge smokers, obese more for healthcare

A pair of smokers stand outside of an office building in the Times Square region of New York April 1, 2009.  REUTERS/Lucas Jackson

By Jilian Mincer

Sun Oct 30, 2011 7:19pm EDT

(Reuters) – Like a lot of companies, Veridian Credit Union wants its employees to be healthier. In January, the Waterloo, Iowa-company rolled out a wellness program and voluntary screenings.

It also gave workers a mandate – quit smoking, curb obesity, or you’ll be paying higher healthcare costs in 2013. It doesn’t yet know by how much, but one thing’s for certain – the unhealthy will pay more.

The credit union, which has more than 500 employees, is not alone.

In recent years, a growing number of companies have been encouraging workers to voluntarily improve their health to control escalating insurance costs. And while workers mostly like to see an employer offer smoking cessation classes and weight loss programs, too few are signing up or showing signs of improvement.

So now more employers are trying a different strategy – they’re replacing the carrot with a stick and raising costs for workers who can’t seem to lower their cholesterol or tackle obesity. They’re also coming down hard on smokers. For example, discount store giant Wal-Mart says that starting in 2012 it will charge tobacco users higher premiums but also offer free smoking cessation programs.

Tobacco users consume about 25 percent more healthcare services than non-tobacco users, says Greg Rossiter, a spokesman for Wal-Mart, which insures more than 1 million people, including family members. “The decisions aren’t easy, but we need to balance costs and provide quality coverage.”

For decades, workers – especially with large employers – have taken many health benefits for granted and until the past few years hardly noticed the price increases.

But the new policies could not only badly dent their take home pay and benefits but also reduce their freedom to behave as they want outside of work and make them resentful toward their employers. There are also fears the trend will hurt the lower-paid hardest as health costs can eat up a bigger slice of their disposable income and because they may not have much access to gyms and fresh food in their neighborhoods.

“It’s not inherently wrong to hold people responsible,” says Lewis Maltby, president of the National Workrights Institute, a research and advocacy organization on employment issues based in Princeton, New Jersey. “But it’s a dangerous precedent,” he says. “Everything you do in your personal private life affects your health.”

Overall, the use of penalties is expected to climb in 2012 to almost 40 percent of large and mid-sized companies, up from 19 percent this year and only 8 percent in 2009, according to an October survey by consulting firm Towers Watson and the National Business Group on Health. The penalties include higher premiums and deductibles for individuals who failed to participate in health management activities as well as those who engaged in risky health behaviors such as smoking.

“Nothing else has worked to control health trends,” says LuAnn Heinen, vice president of the National Business Group on Health, which represents large employers on health and benefits issues. “A financial incentive reduces that procrastination.”


The weak economy is contributing to the change. Employers face higher health care costs – in part – because they’re hiring fewer younger healthy workers and losing fewer more sickly senior employees.

The poor job market also means employers don’t have to be as generous with these benefits to compete. They now expect workers to contribute to the solution just as they would to a 401(k) retirement plan, says Jim Winkler, a managing principal at consulting firm Aon Hewitt’s health and benefits practice. “You’re going to face consequences based on whether you’ve achieved or not,” he says.

And those that don’t are more likely to be punished. An Aon Hewitt survey released in June found that almost half of employers expect by 2016 to have programs that penalize workers “for not achieving specific health outcomes” such as lowering their weight, up from 10 percent in 2011

The programs have until now met little resistance in the courts. The 1996 Health Insurance Portability and Accountability Act (HIPAA) prevents workers from being discriminated against on the basis of health if they’re in a group health insurance plan. But HIPAA also allows employers to offer wellness programs and to offer incentives of up to 20 percent of the cost for participation.

President Barack Obama’s big health care reform, the 2010 Patient Protection and Affordable Care Act, will enable employers beginning in 2014 to bump that difference in premiums to 30 percent and potentially up to 50 percent.

Read more: