Pretty soon your mom might not be the only one nagging you to quit smoking or lose weight—and it won’t stop at nagging. As the NYT reports, workplace penalties for non-participation in wellness programs are on the rise. The ACA gave employers more freedom to offer rewards or penalties in order to make their employee pools less of an insurance risk, and apparently they’re running with it:
Among the two-thirds of large companies using such incentives to encourage participation, almost a quarter are imposing financial penalties on those who opt-out, according to a survey by the National Business Group on Health and benefits consultant Towers Watson.
For some companies, however, just signing up for a wellness program isn’t enough. They’re linking financial incentives to specific goals such as losing weight, reducing cholesterol, or keeping blood glucose under control. The number of businesses imposing such outcomes-based wellness plans is expected to double this year to 46 percent, the survey found.
The problem here is not so much that insurance companies are trying to manage their risk pools better, but that they are doing it through employers. It makes sense for an insurer to charge someone who engages in risky behavior more than someone who doesn’t: pegging risk to cost is exactly how insurance works. But when it is done through the workplace, that adds an extra layer of coercion to the process.
In general, America should be moving toward a system where everything but wages is disconnected from employment, where, for example, individuals contract directly with insurance companies for their insurance. This would not only make benefits more portable—a must in an economy in which people frequently change employers—but it would also cut out any role employers might play in forcing behavioral changes on their employees. Instead the ACA continues the tight link between employment and insurance, exactly the opposite of what we need to be doing.