Risky Assessments: New GINA Regulations Protect Family Medical History

Amid the ongoing health care debate, employers, providers and consumers alike agree that reducing the cost of health care should be a central goal of reform efforts. One of the most effective ways to reduce health care costs is to focus on early detection and prevention of disease.

To that end, a growing number of employers sponsor corporate wellness programs. These initiatives typically encourage exercise and healthy eating, provide resources to help employees improve their health, and include health risk assessments--surveys that assess workers' risk for various illnesses and direct them to appropriate preventive care or screening.

A very common component of employer wellness programs is a health questionnaire that assesses an individual's risk for various diseases based on factors such as lifestyle and family history of medical conditions. For instance, if an individual's parents both suffer from high blood pressure, that person has an increased risk for developing the same condition and could benefit from receiving information about prevention. Under the new regulations, health plans may still offer such questionnaires after enrollment, but an employee cannot be offered any incentive for completing it.

"Because health risk assessments (HRAs) are so effective, many plans offer a reward such as a reduction in premium or lower deductible for individuals who fill them out," says Sara Tountas, an employee benefits attorney at Miller Johnson in Grand Rapids, Mich. "Now such an incentive violates GINA."

But employers shouldn't hold their breath. Lazzarotti points to the strong reaction to the Ensign-Carper amendment to the federal health reform bill as evidence that change may be hard to achieve. The Ensign-Carper amendment would have permitted insurers to offer plan participants a discount of up to 30 percent off premiums if they practice healthy behaviors--such as quitting smoking or lowering their cholesterol. The amendment faced vehement opposition from the American Cancer Society and other groups, which argued that the amendment would make health insurance prohibitively expensive for the people in greatest need of coverage.

"People have a visceral reaction to this," Lazzarotti says. "Those that support GINA have the upper hand right now, even if there would be clear benefits to loosening the rules."

Adele Nicholas

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