- The Trump administration wants to roll out a wellness program in the Affordable Care Act exchange market that will reward members for improved health outcomes or health-related behaviors. For example, participants would receive incentives, such as lower premiums, for completing an exercise program or losing weight.
- The administration is asking states to apply for the demonstration project and will accept up to 10 proposals. States have the choice of designing the wellness program or allowing commercial insurers to do it.
- The "health-contingent" wellness programs haven't been allowed in the individual market, CMS officials said Monday, but the agency contends a wellness demonstration project of this type is legal.
The project announcement generated swift rebukes from health policy experts who questioned the intent of the administration and argued wellness programs rarely work.
Such initiatives aim to improve the health of employees and reduce costs, but studies have shown they do neither. Still, wellness programs, particularly for larger employers, have ballooned into a massive industry.
"We've got loads of evidence that wellness programs do not work. They don't save money. They don't make people healthier. They're also creepy as all get-out," Nicholas Bagley, a health law expert and professor at the University of Michigan, wrote on Twitter.
In one of those studies, published in Health Affairs, researchers found the programs are built on faulty assumptions including that those with certain health risks, such as obesity, have higher health costs than other employees.
So the savings may not come from health improvements but from forcing those with health risks to pay more for their healthcare, according to the study. "We found little evidence that such programs can easily save costs through health improvement without being discriminatory," researchers said.
And that raises concerns for some health policy experts such as Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.
"Bottom line: if states take up this 'demonstration project,' insurers will be able to jack up premiums for people who can't meet insurer-determined health targets," Corlette wrote on Twitter.
The Trump administration couldn't get Congress to strip away pre-existing condition protections in the ACA, so this is the administration's "end run" via the states, she said online.
It's likely many critics will view this as another way the Trump administrations is working to undermine the ACA. The administration has already expanded the availability of short-term health plans, which threaten to siphon away healthy people who may otherwise have shopped for coverage on the exchange.
Republicans have also rescinded the penalty for the individual mandate, a key aspect of the law, and have cut funding that helped insurers defray costs to provide care to low-income enrollees.