CVS Pharmacies recently announced a change to their employee health insurance policy [i]. All employees will have until May 1, 2014 to make an appointment with a physician for a physical, in order to collect health data including weight, body fat, blood glucose, and blood pressure. This data will then be sent to a third party data collection site, which can track the changes in these measures of health for the company at the overall, not the individual, employee level. Employees who do not wish to have their data recorded face an annual fine of $600 in order to maintain their enrollment in the company’s health insurance plan. The company states that these actions are intended to improve the health of their employees, as well as cut healthcare costs for the future. The company will also provide wellness and smoking cessation programs for those who take part in the data collection program.
Data collection has been going on for the past year. So far, few have participated because the fine was much lower before this year’s update. However, the company states that it has seen improvement in the patient data since the program’s inception. This could be due to the selection bias of employees who were willing to provide their information early in the program.
While the pursuit of better employee health seems noble, in addition to being a smart business practice (the aim of the policy change is to decrease costs), many are concerned that this program is a breach of privacy; there are limits to what an employer is entitled to know about an employee’s personal life. Employers’ interest in their workers’ health, for either self-serving reasons or for the benefits of those concerned, is not a new phenomenon. Programs promoting healthy behavior have been around for years. However, this new policy presents a shift in the mechanism for encouraging employee health from an incentive-based to a punitive-based approach. Commentary on the subject has cited our culture’s acceptance of variable insurance rates that fluctuate based on a person’s age or marital status, and the use of traffic ticket fines in response to policy violations as justification for these new health insurance requirements, which work in a similar way [ii]. There is, however, a large difference between the types of information presented to automotive versus health insurance companies.
In addition, the collection of data by one’s employer provides another set of concerns. Wellness programs may allow insurance companies or employers to discriminate against individuals with pre-existing conditions or unhealthy lifestyle choices that would increase the expense required to provide them with health care. Soon after laws permitting employers’ use of employees’ premiums for incentive programs were initially written, a letter was sent to federal officials warning against the legalization of this discrimination in the guise of a “wellness program.” The letter also described what an effective, fair, employee-centered program would consist of [iii]. It was signed by many health advocacy organizations, most notably the American Heart, Diabetes and Stroke Associations, and the American Cancer Society.
Along with fears about unfair employment practices, many are concerned that employees who are unwilling to give data to their employer, and subsequently opt out of health care coverage through CVS, will chose an inadequate, low-level alternative health insurance plan, or be uninsured entirely. This creates much more personal risk for these individuals. Also, the evidence remains unclear in terms of which type of program – punitive- or incentive-based – is more effective in improving employee health. A recent study in the New England Journal of Medicine looked at these workplace-based health programs and suggested that they may not actually be very effective, even when they use the most scientifically-supported mechanisms for motivation [iv].
The new CVS employee health insurance policy is ringing alarm bells for multiple reasons. One question many are asking is: What is the line between acceptable cost-cutting and coercion of workers? Despite the obvious and well-documented positive effects of a healthy lifestyle, many question the employer’s right to enforce this on employees, at least through punitive measures. Although supported by law, company policies like the one enacted by CVS may lead to more negative consequences than anticipated, including an increased number of uninsured patients, unfair hiring procedures, and practices that are burdensome but not actually effective in improving employee health.
Jennifer Norris is a full-time student in the Einstein-Cardozo Master of Science in Bioethics program (M.B.E.). In 2012, she graduated with a B.S. in Exercise Biology from UC Davis. Her background as an intern in athletic training and emergency medical research inspired her pursuit of bioethics. She graduates from the M.B.E. program this summer and is applying to osteopathic medical school.
[i] Thomas, Katie. “Companies Get Strict On Health Of Workers.” The New York Times. The New York Times, 26 Mar. 2013. http://www.nytimes.com/2013/03/26/business/companies-offer-workers-more-incentives-for-health-changes.html?ref=todayspaper&_r=0
[ii] Coutermarsh, Patrick. “CVS: Use of Rewards and Penalties for Improving Employee Health on the Rise.”Business Ethics in the News. Santa Clara University, 28 Mar. 2013. a href=”http://www.scu.edu/ethics-center/ethicsblog/business-ethics-news.cfm?c=15807&comm=1” target=”_blank”>http://www.scu.edu/ethics-center/ethicsblog/business-ethics-news.cfm?c=15807&comm=1
[iii] Nelson, Sue. “Re: Proposed Changes to 71 FR 75014: Nondiscrimination Based on a Health Factor and Wellness Programs.” Letter to Secretary Timothy Geithner, Secretary Hilda Solis, Secretary Kathleen Sebelius. 30 Mar. 2011 http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_434107.pdf
[iv] Volpp, Kevin G., David A. Asch, Robert Galvin, and George Loewenstein. “Redesigning Employee Health Incentives — Lessons from Behavioral Economics.” New England Journal of Medicine 365.5 (2011): 388-90. http://www.nejm.org/doi/pdf/10.1056/NEJMp1105966