As healthcare costs continue to soar, many employers are using wellness programs as a way to help curb their costs. In addition, employees who enroll in wellness programs also enjoy the programâ€™s great health incentives and rewards, however, unbeknownst to them, the personal information collected may also be used for other undisclosed financial or discriminatory purposes.
This is important as the Americans with Disabilities Act (ADA) generally protects employees from discrimination based on health status or disability. The ADA specifically prohibits employers from generally requiring mandatory health examinations and also prohibits the disclosure of an employeeâ€™s protected health information. However, these exams are allowed if they are part of a voluntary employee health program or if classified as a â€śbusiness necessity.â€ť
The U.S. Equal Employment Opportunity Commission (EEOC), or the federal agency that enforces these federal laws also recently raised concern about wellness programs
and published a Notice of Proposed Rulemaking (NPRM) explaining how ADA applies to employer wellness programs that are also apart of group health plans. The NPRM explicitly prohibits employers from requiring employees to participate in a wellness program and also prevents the employer from disciplining or denying health coverage based on refusal. Although other federal laws prevent discrimination, the existing laws only apply to certain wellness programs under certain circumstances and as a result, some employers allow wellness program companies to share and use an employeeâ€™s information. Therefore, the proposed rule would not only help align federal laws to cover most wellness plans but would also require confidentiality and provide employees notice on how information is used and collected.
In a recent example, Houston city employees who participated in a wellness program were required to disclose their disease history, blood pressure, weight, drug and seat belt use to a wellness company. However, unknown to the employees, the contracted wellness company was also permitted to share the data with â€śthird party vendors acting on [their] behalf.â€ť Although the employees were permitted to refuse or opt out of the screening, they were subject to a $300 a year penalty for medical coverage. Therefore, the employees who â€śvoluntarilyâ€ť participated in the program in order to avoid the penalty, also unknowingly waived their privacy rights as the information shared could lead to discrimination by employers, lending institutions or even life insurance companies.
In another example, an employer required an employee to submit to medical testing and assessment in connection with a wellness program or â€śface dire consequences.â€ť When the employee refused to comply with the mandatory program, the employer shifted responsibility for the payment of her entire health insurance premium and ultimately fired the employee shortly thereafter. This initiative unfortunately has many unintended consequences and as the Regional Attorney for the EEOC in Chicago noted, â€śhaving to choose between responding to medical exams and inquiries — which are not job-related — in a wellness program, on the one hand, or being fired, on the other hand, is no choice at all.â€ť
While wellness programs have positive effects on employees and the workplace in general, these programs should not provide barriers to healthcare benefits or force penalties on those who cannot participate. Instead, these programs should also provide alternatives for employees who have disabilities and should not be implemented as a new way to determine insurance premium rates.
Another closely connected issue relates to privacy and the disclosure of employee data. Data companies such as Castlight Health, praised for their ability to help inform smarter decisions, are being hired by employers or wellness program companies to handle and process employeesâ€™ data. Whether it is being used, correctly or incorrectly, to identify which employees are likely to get sick, have surgery or get pregnant, these companies are using personal data and third party healthcare apps to monitor an employeeâ€™s personal information. However, even more concerning is how unregulated access to big data is.
Although some may think that the Health Insurance Portability and Accountability Act (HIPAA) applies, the privacy rule in HIPAA only applies or protects an individualâ€™s identifiable health information held by either a covered entity or business associate. Therefore, depending on how the wellness program is administratively structured and whether the wellness program is offered as part of a group health plan, the identifiable health information may or may not be protected under HIPAA rules.
While some employers have structured wellness program incentives to comply with some federal laws, the exceptions in others have made achieving privacy while protecting civil rights difficult. Despite the EEOCâ€™s best efforts to strike a balance between encouraging workplace wellness plans and compliance with federal laws, the â€śresults appear to please no one, as the EEOCâ€™s efforts to ensure only voluntary disclosure of private health informationâ€¦drew sharp criticism from agency stakeholders.â€ť In addition, despite legislation such as the â€śPreserving Employee Wellness Programs Actâ€ť introduced by Representative John Kline to offer clarity on incentives consistent with the ACA final rule not violating the ADA, the effect of these promulgated rules remains unknown as poorly designed wellness programs continue to have unintended consequences.
Although wellness programs offer attractive health and wellness benefits, until the various issues with discrimination, data privacy, and uniformity with all federal laws are addressed, employees may still be at risk of discrimination.
Tina Jadhav is an attorney barred in Maryland. Tina is actively involved in health law as a member of the American Health Lawyers Association as well as the American Bar Association-Health Law section. Tina recently earned her Law and Government LL.M. degree from American University Washington College of Law in 2014 and her Juris Doctor degree from Florida Coastal School of Law. Tina also served as a Health Policy Fellow for U.S. Senator John D. Rockefeller IV, Legal Intern at Inova Health System Office of General Counsel and the Office of the Attorney General for Commonwealth of Virginia.