Do you smoke? Skip the gym? Can’t lose those extra five pounds you gained last Christmas? Took a pass on the flu shots your employer made available?

You’re gonna have to pay, under an amendment slipped into the Senate healthcare bill by Sen. John Ensign (R-Nevada) and passed by the Senate Finance Committee on a 19-4 vote. Ensign’s amendment would allow employer health plans to charge up to 50 percent more to those deemed to have bad health habits. Those habits can include smoking, weight gain, high blood-cholesterol levels, refusal to exercise, and failure to participate in the “wellness programs” that are an employer fad these days.

The rationale:

“Weight gain and unhealthy lifestyles that focus on smoking and lack of exercise have sky-rocketed our health care costs,” Ensign said in a statement. “These costs could be lowered by focusing on what makes us healthy – through weight loss programs, smoking cessation and preventive care.”

Sounds creepy, doesn’t it? Big Brother–or actually Big Nurse–monitoring your Krispy Kreme intake and how often you plop down in front of the TV at the end of the day instead of working out?

Here is how a “healthy living intitiative” is working in North Carolina, a state that sprung the concept on its employees a couple of months ago (from Junkfood Science):

North Carolina State University employees, state employees, teachers, retirees and other members of the North Carolina State Health Plan received a mailing last week about changes to their benefits, effective July 1, 2009. The changes would affect their out-of-pocket expenses, deductibles and co-payments. As part of the state’s “Comprehensive Wellness Initiative” signed into law (Senate Bill 287) in April by Governor Beverly E. Perdue, everyone covered by the state plan must now complete an Attestation Form, stating that they, and their covered dependents, do not use tobacco products and that they have a BMI less than 40 or are participating in approved weight management and/or tobacco cessation programs. They must also agree to submit to random testing for the presence of nicotine and to be weighed and measured at their workplace. By July 2012, the BMI requirement will be lowered to less than 35.

The mailing included “the requirements for compliance and the consequences of noncompliance” to its weight management and smoking cessation policies. The consequences of noncompliance mean paying one-third higher insurance premiums, higher deductibles and out-of-pocket expenses, for themselves and all covered family members. Noncompliants will no longer be eligible for the 80/20 plan and will be automatically moved to a costlier 70/30 plan. Plus, “members will forfeit any coinsurance and deductibles already paid under the 80/20 Standard Plan.”

Translation: even if you’ve never lit a cigarette in your life and you weigh less than Mary-Kate Olsen, you’ll be penalized for not checking in with Nurse Ratched on a regular basis.

How did North Carolina turn into a health police state? Junkfood says the state, like many employers who have bought into “preventive care” as a cost-cutting measure, was sold a faddish bill of goods:

The State Health Plan’s wellness initiative mandated by the legislature and largely enacted through employers, is “wellness care” and healthy lifestyle interventions, rather than caring for sick people. It was sold to politicians and company benefit managers as saving costs and preventing aging-related diseases. These alternative beliefs, born of the new field of “lifestyle medicine,” are increasingly finding their way into popular culture, even though few are supported by the scientific and medical literature.

[Blue Cross/Blue Shield of North Carolina] tells prospective group plan managers that the key to controlling healthcare costs is prevention. Calling obesity the public health crisis of the 21st century, it blames “sedentary jobs, high-calorie diets and leisure time spend in front of the TV or on a computer” and claims that fat people in North Carolina are responsible for $83 million in medical costs that could be reduced by healthier lifestyles. It claims that expensive diseases – from heart disease, diabetes to cancers – can be prevented by regular check-ups, cancer and cholesterol screenings, cholesterol medications, diet and exercise counseling, blood pressure checks and treatment. It also blames fat people for raising everyone else’s health care premiums.

How many politicians and employer benefit managers do you know who go to the medical literature, let alone understand the research, to realize these claims are far from slam dunks and are not supported with good science? Employers and politicians also don’t weigh the health risks and safety concerns associated with wellness initiatives. Examinations of the scientific evidence behind employee wellness program recommendations; screenings; and diet, exercise and lifestyle behavioral interventions, find poor evidence for effectiveness, as well as numerous inconsistencies with U.S. Preventive Services Task Force recommendations, that they claim to be following.

In fact, there’s not even a link between degenerative diseases of aging or premature death and any of the health indices in preventive wellness programs.


Ideal health risk indices — from BMI, blood pressure, blood sugars to cholesterol — are mostly euphemisms for thin and young. Those who believe that their own good health is because they eat “right,” exercise and have perfect numbers are often young and upper-income and not old enough to experience age-related changes. Their genetic good fortune is not evidence of good behavior, either. Evidence-based research to date has shown these health indices are primarily measures of aging, genetics and social stresses, and not significantly malleable with “healthful” diets and lifestyles. With aging, the “ideal” numbers of healthy 20-year olds cannot be achieved for most workers without taking controversial and risky prescription drugs or temporarily lowered by undergoing mostly ineffective weight loss measures.

Furthermore, there is no evidence that wellness programs cut healthcare costs (indeed, they typically increase them by identifying more candidates for, say, anti-cholesterol medications). But as Junkfood Science says, “Control over the personal behavior of others is the new public health ethic. It is not to be confused with medical ethics.”