Fitting public policy into push for fitness

WASHINGTON —

Who could object to rewarding people who quit smoking, lose weight or start to exercise? The American Cancer Society and the American Heart Association, for starters.

Some companies charge lower insurance premiums to workers who meet benchmarks for healthful living. The Senate's health-care overhaul legislation would expand the trend.

But instead of cheering the proposal, some patient-advocacy and health groups are worried it would mean higher rates for less-fit Americans, possibly pricing them out of their employers' insurance plans.

"It is a way of cherry-picking," said Dick Woodruff, senior director of federal affairs for the American Cancer Society. "We are all for workplace wellness, but when you tie it to the insurance-pricing system, it's a real problem."

Critics of the Senate proposal also say that giving special treatment to those who meet a company's fitness standards could undercut one of the marquee promises of the Democrats' proposed overhaul: preventing employers and insurers from discriminating against people on the basis of their health status and pre-existing medical conditions.

Under current law, companies can discount insurance premiums 20 percent if employees meet benchmarks for weight, smoking or other aspects of their health. Earlier this year, two Senate committees, as part of the health-care overhaul, voted to allow such cuts to go as high as 50 percent.

Leading the charge for the idea is Safeway, the giant grocery chain, which has an incentive program that includes health-premium reductions. Last year, it began to offer a 20 percent premium discount to its nonunion workers who quit smoking, went on a diet, brought down their blood pressure and cut their cholesterol.

Jo Chiti, a Safeway employee who has lost about 30 pounds over the last year, said she has been swayed by the argument of Safeway CEO Steve Burd that health insurance should be more like car insurance. Just as good drivers should be rewarded with lower premiums than reckless drivers, Burd says, people who take responsibility for maintaining a healthful lifestyle should pay less for coverage than people who do not.

A lobbying blitz by Burd, who has traveled to Washington 11 times this year, was instrumental in the two Senate committees' decision to include the idea in their bills. Senate leaders are putting together the final version of a bill they will take to the Senate floor.

"We believe that personal responsibility and financial incentives are the path to a healthier America," Burd said in a newspaper column.

Nationwide, the program covers 25,000 nonunion employees who are part of the Safeway health-insurance plan, most of them in California. The company says 74 percent of them have signed up.

Once a year, participants submit to tests of four health-risk factors: smoking, obesity, blood pressure and cholesterol. If they pass all four, they receive a $780 annual discount, which is 20 percent of the total cost of their insurance.

If they do not pass initially but make progress — quitting smoking or losing 10 percent of their weight — they can get a premium rebate.

After making several changes in the policy offered to nonunion workers, Burd said, the company's health-care costs have "flatlined" over the last four years, while other companies' costs have gone up nearly 40 percent on average.

But it is not clear how much credit goes to the premium discounts. Those have been available only for one year, and presumably it is too soon for lifestyle changes to affect health expenses.

Critics say the incentive scheme is a backdoor way for companies to cut their costs by driving less-healthy workers out of the insurance group.

What is more, critics worry that the program will unfairly penalize people whose health status is not solely the result of behavior they can easily control, such as a genetic predisposition to obesity or the weight gain that often accompanies smoking cessation.

Either way, heavy people — portrayed as over-consumers of health care or as those who should miss out on discounts because of their size — say they have been maligned throughout the debate.

"I thought, 'Health reform? Yea!' " said Lynn McAfee, the director of medical advocacy for the Council on Size and Weight Discrimination, an advocacy group for heavy people. But McAfee said it was not long before her sentiment changed to the more sober, "Oh, no, we're being scapegoated again."

Marilyn Wann is an author and weight-diversity speaker in Northern California who has a message for anyone making judgments about her health based on her large physique.

"The only thing anyone can accurately diagnose by looking at a fat person is their own level of stereotype and prejudice about fat," said Wann, a 43-year-old San Franciscan whose motto in life is also the title of her book: "Fat! So?"

Americans are more overweight and obese than they were 10 years ago, or even one year ago, according to the Robert Wood Johnson Foundation and the Trust for America's Health, which published a state-by-state study in June. It showed that the trend is up sharply.

Two-thirds of all Americans are overweight or obese. In four states — Alabama, Mississippi, Tennessee and West Virginia — more than 30 percent of adults are obese.

Material from The New York Times is included in this report.