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Incentives needed to encourage healthy lifestyles, improve access to preventive services

Too many insurance products not desgined to encourage wellness and prevention

June 9, 2009

Dear Member of Congress:

On behalf of the undersigned organizations, we want to express our support for healthcare reform proposals designed to improve access to preventive services and encourage healthy lifestyles. We support positive incentives to encourage individuals to be actively engaged in their healthcare, pursue recommended screenings and preventive services, and maintain or improve their health through physical activity, healthful diets, good nutrition, smoking cessation, and other healthy behaviors. At the same time, we are very concerned that individuals not be penalized — either financially or by exclusion from coverage or services — if they are sick or if they presently engage in specific behaviors or have certain health conditions, such as smoking or obesity.

Many insurance products are not designed to encourage wellness and prevention. Too often, out-of-pocket costs pose barriers to services that promote wellness and health maintenance. We support proposals to reduce financial barriers for recommended preventive screenings and immunizations. However, we will oppose provisions that give health plans expanded authority to alter premiums or cost sharing based on health status, “unhealthy” behaviors, non-adherence to specified life changes or treatment regimens, or failure to meet improvement targets.

These practices could put the cost of coverage beyond the reach of those who may be least able to change their health habits and yet are greatly in need of healthcare coverage and services. They may also be discriminatory, could compromise an employee’s right to privacy in the workplace, and have not been shown to be an effective long-term strategy for improving individual health or lowering overall healthcare costs.

The Health Insurance Portability and Accountability Act’s (HIPAA) nondiscrimination provisions generally prohibit a group health plan from charging individuals different premiums based on health factors. However, under current regulatory authority, plans may modify premiums co-payments or deductibles by no more than 20 percent of the cost of employee-only coverage in return for adherence to programs of health promotion and disease prevention. We see no justification for expanding this policy.

Our organizations strongly endorse multi-pronged policy approaches to help people modify behaviors that can result in poor health outcomes. We believe that greater use of evidence-based interventions that support healthy lifestyles, slow or prevent the onset of disease, and improve or maintain function can yield a generous return for a relatively modest investment. We agree that employers can play an important role in promoting better health through onsite wellness and prevention programs, as well as providing health coverage with cost-sharing structured to
encourage wellness and health maintenance. Well-designed employer-sponsored programs have been shown to improve health outcomes, increase productivity and lower healthcare costs.

We believe that all stakeholders – individuals, businesses, insurers, providers, and government – must play a role in improving the health of our population and reducing the health and economic toll of chronic disease. We strongly believe that the key to driving behavior change is creating environments that support healthy behaviors and give individuals the tools and support needed to implement change. We stand ready to work with you to find strategies and approaches that best work for employees, employers and taxpayers as we attempt to reduce the terrible physical and financial toll that disease and disability exact upon our nation.

American Association of People with Disabilities (AAPD)
American Cancer Society-Cancer Action Network
American Diabetes Association
American Federation of State, County and Municipal Employees (AFSCME)
American Heart Association/American Stroke Association
American Lung Association
American Psychological Association
Arthritis Foundation
Bazelon Center for Mental Health Law
Black Women’s Health Imperative
Campaign for Mental Health Reform
Center for Advancing Health
Center for Medical Consumers
Center for Medicare Advocacy
Childbirth Connection
Clinical Social Work Association
Consumers Union
Families USA
Family Voices
International Association of Machinists & Aeorspace Workers
International Union, United Automobile, Aerospace & Agricultural
Implement Workers of America, UAW
Leukemia and Lymphoma Society
Medicare Rights Center
Mental Health America
National Association of County Behavioral Health and Developmental Disability Directors
National Association of State Mental Health Program Directors
National Capital Area Union Retirees Club
National Coalition of Mental Health Professionals and Consumers
National Coalition for Lesbian, Gay, Bisexual and Transgender Health
National Congress of the American Indians
National Consumers League
National Council for Community Behavioral Healthcare
National Council of Jewish Women
National Council on Aging
National Disability Rights Network
National Health Law Program