The Affordable Care Act: A Worksite Wellness Bust

How employers, employees and the worksite wellness community would all begin to benefit from enactment of the law

With much hard work, certain members of the worksite wellness community were able to get worksite health-related provisions into the Affordable Care Act (ACA) bill as it was working its way through the U.S. Congress. The provisions were aimed at benefiting worksite wellness and worksite health promotion. I can remember being at national conferences and learning about their efforts and their excitement about how the provisions were actually being received by members of Congress. I can also remember being at a national conference and the jubilation that was expressed by conference attendees when it was announced that the ACA had been passed by both houses of Congress. Speculation began as to how employers, employees and the worksite wellness community would all begin to benefit from enactment of the law.

From a worksite health promotion perspective, the ACA was designed to:
 

1. Provide grants to small employers
 

2. Codify into law the HIPPA regulations around providing up to a 30% health insurance premium discount incentive for participation in a worksite wellness program
 

3. Creating health-contingent worksite wellness programs that incorporate health insurance premium discount incentives for the achievement of particular health-related measures

So how have things turned out for employers and the worksite wellness community over the past 10 years since the ACA became a U.S. federal law?

The ACA called for funding small employer evidence-based wellness programs. This was exciting as little is known about effective small employer worksite wellness programs and even less is known about the application of evidence-based programming and interventions in a small employer setting. Unfortunately, funding for the grants was never appropriated by Congress. As a result, the grants never materialized. A significant opportunity here was lost for sure.

The law related to the use of incentives in worksite wellness programs remains in force. Related to the law though, aspects of the Equal Employment Opportunity Commission (EEOC) rules, based on the ACA law, came under legal challenge. A U.S. Federal District Court ruled against the EEOC and vacated portions of the EEOC rules, primarily those around the nature of voluntary participation in relation to the application of the 30% health insurance premium percentage incentive. This has created a significant impact and confusion for employers. As a result, we are seeing a lot less attention being paid today, in 2020, to the use of health insurance premium based incentives.  

In conjunction with the ability to offer health insurance premium discounts, the ACA allowed employers to create health-contingent wellness programs whereby the employee could receive up to a 30% health insurance premium deduction if they met certain health status or biological health marker requirements through participation in their employer’s worksite wellness program. These programs quickly caught on as employers struggled to keep up with ever-rising employee health-related costs. These type programs are also called outcome based programs. The health-contingent worksite wellness programs were unfortunate on two fronts:

1. It was unfortunate as there was no research-based evidence before the ACA became law that health-contingent worksite wellness programs made a difference. In the intervening 10 years since the ACA became law, there has been no research that proves that health-contingent worksite wellness programs improved employee health status over the long haul or for the long-term.  

So in 2020, we are seeing less excitement and less creation of health-contingent worksite wellness programs. And employers who have created them are now walking away from the model because of potential legal challenges by employees and the fact there is no research-based evidence that these programs actually make a difference in the long-term health of employees. Personally, I think this is a good thing.  

2. It is also unfortunate that I believe every worksite wellness program should be outcomes driven , irrespective of whether it offers a health insurance premium discount or not. If you don't have a program outcome in mind, why are you even doing a program? Fun, satisfaction or increased morale can each or in combination be an outcome. They can all be measured to determine if the desired outcome was achieved.

Unfortunately, we continue to see today, the significant confusion around the value created by offering an outcomes-based or focused worksite wellness program. The alternative is to simply offer a collection of randomly selected employee health or wellness-based focused activities, or what is commonly called an activities focused program. Being data-driven and outcomes-focused is the only approach to worksite wellness programs that makes sense to me.

There is no doubt in my mind that the worksite health promotion community members had good intentions and great expectations when they pushed to have worksite health promotion included in the ACA. But as I look at the 10-year results, overall, I think the impact of the ACA on worksite wellness programs has really been a bust. 

For me personally, the biggest loss is the failure to deliver on the small employer grants. Small employers need employee health and wellness programs just as much as medium and large employers. Based on my nearly 10-year focus now on small employers, small employer wellness program models cannot be the same as medium and large employer program models. Therefore, there is much we could have learned over the past10 years that could have benefited small employers if the evidence based programming grants had been issued over these intervening years.

These thoughts on the ACA are just my own thoughts and opinions. I am sure there are others in the field with differing opinions. I look forward to reading their thoughts and their opinions as we look back on the 10-year history of the ACA.

As a worksite well-being professional, William McPeck, MSW, CWWPC, WLCP, has training and experience in both worksite wellness and the emerging field of worksite well-being. His professional training includes program development, program implementation, consulting, training and coaching in wellness, mental health and substance abuse. William specializes in helping employers (especially small employers) and wellness program coordinators launch wellness programs and to enhance existing programs. William is also a Certified Worksite Wellness Program Consultant, Certified Wellness Culture Coach, Certified Work-Life Professional and Certified Holistic Stress Management Trainer.   Connect William McPeck