Posted on 10 March 2010.
By Debi Brazzale, COLORADO NEWS AGENCY
State lawmakers are poised to debate a bipartisan measure this week that supporters say will create incentives to stay healthy and opponents say will create yet another tier of winners and losers in the country’s much-debated health-care system.
House Bill 1160 expands current law to allow small-group and individual health-care markets to offer wellness incentive programs in exchange for a discount on insurance premiums that larger group markets, self-funded and government plans are already allowed to offer. Under the measure, an additional discount could also be allowed for individuals who actually participate in a wellness program.
Yet, Kelli Fritts, Colorado associate director for the American Association of Retired Persons, contended the bill is not about wellness programs but rather is another way for insurance companies to play gatekeeper. Fritts said the measure will exacerbate a market that needs more healthy people to join to stave off rising premiums.
“This bill is a way to segment the health insurance market—to cherry pick and lemon drop,” said Fritts. “The goal that AARP is seeking is to bring everyone into the pool and this bill doesn’t bring everyone into the pool.”
House Sponsors of the bill, Rep. Joe Rice, D-Littleton, and Rep. Amy Stephens, R-Monument, say the proposal simply provides an incentive that creates a win-win for both the insured and the insurance company.
“We know that participation in an exercise program will reduce risk and reduce cost–which is where the self-interest of the insurance company comes in,” said Rice. “In order to induce people to (participate), they are willing to give the discount.”
Wellness programs can include things such as smoking-cessation classes, gym memberships or nutrition programs that are voluntary for the insured, but the financial incentive, said Rice, is key.
“When you say, ‘Here’s an incentive,’ some people will participate that don’t now. It’s good for their own health, but it kind of becomes a part of the office culture or in your own mind when participating in these programs,” said Rice
The market that the AARP is concerned about is the 50-to-65 year-olds who are too young for Medicare but old enough to have pre-existing conditions or emerging health needs. The bottom line, said Fritts, is that financial incentives based on health outcomes should not be tied to premiums.
“We support community ratings where everyone is paying the same rate regardless of health status and claims history. If the industry is given the ability to underwrite–or set the criteria—based on wellness programs the losers will be older people,” said Fritts.
The bill is scheduled for debate by the full House as early as Tuesday.