The income umbrella (AP photo/Charles Dharapak)

One of weird realities of reporting is the discovery that every position — every position — has an opposite somewhere in the reportable universe.

Somewhere out there, there’s an interest group that strongly opposes Santa Claus. A physician group that strongly opposes the concept of insurer provider networks sends me well-written e-mail every month or so. And now there are large, powerful, visible groups of people who are really skeptical about wellness programs.

In California, for example, the state Senate is seriously considering a bill, state Senate Bill 189, that would forbid group plans from using changes in plan premiums, deductibles, co-payments or coinsurance amounts as wellness program incentives.

One reason is because the Patient Protection and Affordable Care Act (PPACA) makes wellness programs one of the few mechanisms that an individual or small-group insurer can use to charge one individual more than it charges another individual.

Some have argued that poor people are often sick, and that wellness program financial incentives that simply pinch high-income workers may clobber low-income workers.

The California lawmaker who introduced S.B. 189 also argued that the evidence supporting the value of wellness programs is weak.

My feeling is that this issue is really a disability insurance issue.

The best way to hold down disability claims costs is to keep people healthy, so that they never have to think of filing claims.

If some kind of individual health insurer or employer health promotion program is really a sham and hurts people’s well being, then, chances are that the program will eventually hurt disability claims performance, by eating up time, energy and money that could be invested in better health promotion programs or used to buy other insurance products, such as supplemental disability insurance.

If a cost-effective, privacy-respecting, freedom-respecting health promotion program really reduces disability claims by improving people’s health, then the idea of opposing that program seems bizarre. Even if it is hard on poor people — well, find a way to minimize the effect on poor people, but make sure the poor people still have an incentive to get and stay healthy. 

Poor people certainly can benefit from low out-of-pocket premiums and low plan cost-sharing amounts, but they also can benefit from not having strokes.

Of course, the problem here doesn’t really have anything to do with ultimate goals, just with questions about whether some, any or all wellness programs do what the organizers say they do.

I think part of the solution is for disability insurers to support efforts to bring the wellness program skeptics together with the wellness program enthusiasts, and to have voluntary groups develop wellness program performance and burden measures — including measures of years of active working life saved and lost — that everyone can accept.

If wellness program providers have to meet reasonable performance goals that the providers and employers set together with the skeptics, then maybe that would be a way to allay the concerns of the skeptics while ensuring that the programs deliver the benefits that employers and providers of individual health insurance think they’re paying for. 

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