Charging Healthcare Premiums

¶ … innovation: Healthcare Both the Framingham heart study and the Alameda County study, because of their size, rigor, and length, are frequently used to prescribe specific healthcare policies for the macro population. The Framingham study has been called the study which changed America's perception of disease. Before "Framingham, most physicians believed that atherosclerosis was an inevitable part of the aging process and were taught that blood pressure was supposed to increase with age enabling the heart to pump blood through an elderly person's narrowed arteries" ("Framingham heart study," 2015).

The study demonstrated that cigarette smoking, sedentary behaviors, and weight gain all exacerbated an individual's likelihood of developing heart disease. Similarly, the Alameda County study found that factors such as "drinking excessive amounts of alcohol, smoking cigarettes, being obese, sleeping fewer or more than seven to eight hours per night, being physically inactive, eating between meals, and not eating breakfast" were correlated with poor health outcomes and a higher risk of mortality ("Alameda County study," 2015).

Given the consistency of these findings, it has been proposed that offering individuals discounts on health insurance premiums (much having like a good driving record offers additional discounts on auto insurance) would incentivize healthy behaviors and keep costs down. The problem is that validating self-reporting on such factors would be challenging. Also, there are many genetic factors which can impact heart health. At present, only empirically-validated criteria such as age can be used to set different health insurance premiums.

But objectors would note that a healthy forty-year-old who does not smoke, exercises regularly, and eats unprocessed foods may have better health and thus lower healthcare costs than a sedentary twenty-year-old who is obese, smokes, and is a likely candidate for type II diabetes in the near future. Currently, workplaces are not permitted to penalize employees for unhealthy lifestyle practices.

"The Health Insurance Portability and Accountability Act (HIPAA) prevents employees in a group health insurance plan from being charged more for coverage because of a 'health factor,' which includes health status, medical condition and claims experience, among other things. Although lifestyle choices such as smoking are not named as health factors, medical opinion exists identifying nicotine addiction as a medical condition" (Frye 2014). Workplaces can offer discounts based upon participation in 'wellness' programs, however.

In other words, it is illegal to mandate that someone give specific, health-related information in exchange for insurance (such as a doctor's note validating that the person is likely a nonsmoker, based upon the state of his or her respiratory system). But rewarding nonsmokers and people who exercise and who are not obese is permitted. But even this could be potentially legally problematic as addiction to smoking or obesity could be viewed as a disability.

"Another potential legal problem arises from the Americans with Disabilities Act's (ADA) prohibition against discriminating in the form of benefits with respect to qualified individuals with disabilities. Although smoking has yet to be identified as a disability itself, it often involves attendant health issues that are disabilities, and there always is a possibility that a court would accept a claim on the theory that a smoker was 'regarded as' being disabled" (Frye 2014).

For workers who buy their own health insurance through the government or state marketplace, validating their nonsmoking or 'healthy' status would be even more problematic. Also, they would not theoretically be costing their employer more but the government more.