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Measure may make unhealthy pay more

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Bill Radke: President Obama has said he does not want health insurers denying coverage to people who have pre-existing conditions. But this morning’s Washington Post quotes critics who say the health-care measure in the Senate would let employers make coverage harder to get for unhealthy people. Washington Post staff writer David Hilzenrath, good morning.

David Hilzenrath: Good morning Bill. Good to be with you.

Radke: So this legislation lets companies give their healthy workers bigger breaks on insurance premiums than they’re allowed to give now — wellness incentives. What’s wrong with that?

Hilzenrath: Well a coalition of labor unions and organizations devoted to combating serious illnesses, groups such as the American Cancer Society, the American Heart Association — they oppose these provisions. They fear that the legislation could be discriminatory, in effect, and that it could make health care unaffordable for those who need it most.

Radke: Are these penalties for people who fail medical tests or are they breaks on coverage, are they incentives for healthy habits?

Hilzenrath: They’re both. They’re two sides of the same coin. The way the law is written, there are limits on the size of the incentives that employers can offer based on the attainment of health-status targets. One person is charged less for beating those targets. Another person is charged more for failing to meet the targets. And when employers divvy up their compensation and benefits budgets, you’re either a winner or a loser.

Radke: Well the legislation does make exceptions for people who have medical reasons for not meeting these wellness targets, but they don’t think that closes the loophole?

Hilzenrath: That’s right. They’re not satisfied that that will close the loophole. For one thing, they fear that it’s hard to draw the line between weight issues, blood-cholesterol issues, blood-pressure issues that are innate and those that are within someone’s control.

Radke: We’ve become used to incentives for good behavior, basically. But it brings up, as you write, it brings up a philosophical question about whether that’s what health insurance is.

Hilzenrath: It does raise a very profound question that’s at the heart of this debate. That is, should health insurance be like car insurance in which good drivers get discounts and bad drivers pay a penalty, and everyone is encouraged to adopt more responsible habits? Or should it be a safety net in which the young and the healthy, in effect, subsidize the older and the sicker. With the understanding that health and youth are transitory.

Radke: Washington Post staff writer David Hilzenrath. Thank you.

Hilzenrath: Thank you Bill.

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