Paid to Be Healthy

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Update January 29, 2016

For years, some employers have offered workplace wellness programs — voluntary programs that give employees financial incentives for engaging in healthy behaviors, such as exercising regularly or quitting smoking. For employers that provide health insurance for their employees, the reasoning behind these programs is simple: Healthy behaviors lead to lower health-care expenses, which saves both employees and the company money.

More recently, several states have tried taking a similar approach in their Medicaid programs. (Medicaid is the joint federal–state health insurance program for low-income people, and is administered separately by each state.) According to an article published earlier this week at MedPage Today, more than a dozen states have added incentives to their Medicaid programs in recent years. A big reason they’ve done so is the Affordable Care Act (“Obamacare”), which provided grants for 10 states to test incentive programs and encouraged all states to expand, and experiment with, their Medicaid programs. Connecticut, for example, pays Medicaid enrollees up to $350 a year in gift cards to quit smoking, with different amounts given out for attending smoking cessation counseling, using a telephone counseling service, and taking a breathalyzer test that shows no recent smoking. The state is comparing health-care costs between people who participate in this incentive program, and those who smoke but are not participating.

In some states, like Iowa, the incentives offered are relatively small, such as saving a $10 premium payment for filling out a detailed health-risk survey. In other states, like New Mexico, the incentives are larger and apply to many different behaviors. Medicaid enrollees in the state can earn reward points for having their eyes examined, having their teeth cleaned, getting screened for diabetes, or recording how many steps they take using a pedometer. Points can then be redeemed for gift cards, which can be used to buy health-related items like soap, toothpaste, and over-the-counter drugs and vitamins.

Some private insurance plans offer incentives similar to those offered in some Medicaid programs, but most do not. One reason for this may be that people tend to move between private plans, so the long-term savings from healthy behavior won’t necessarily be reaped by the company that incentivized it in the first place. Private insurance companies are also limited by law in certain areas — they can’t, for example, give you financial rewards or charge you a lower premium for losing weight or improving your blood pressure. A bill introduced several years ago that would have required private insurance companies to offer such incentives failed to gain support in Congress, which we noted here at Diabetes Flashpoints at the time.

What’s your take on insurance-based incentives for healthy behavior — are you glad that some states are encouraging Medicaid enrollees to improve their health? Do you think you’d be more likely to exercise, lose weight, quit smoking, etc., if your insurance plan gave you a financial reward for doing so? Is it unfair to pay people to quit smoking or lose weight, but not pay people who never started smoking or became overweight in the first place? Should incentives be offered only when they pay for themselves through lower health-care costs, or is achieving better health a good use of taxpayer dollars and/or health-insurance premiums? Leave a comment below!

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