Could a landmark new law aimed to prevent genetic discrimination have a chilling effect on workplace wellness programs?
Groups have wellness program concerns over GINA
That’s what employers and population health groups say will happen under interim final rules on the discrimination law released on Oct. 1.
The Genetic Information Nondiscrimination Act, known as GINA, was signed into law by President George W. Bush on May 21, 2008. The law, which had broad congressional support, is meant to quell patient fears that genetic test results could be used by employers or health insurance companies when making hiring or coverage decisions, and was expected to provide a boost to medical research (May 12, 2008, p. 6).
Three agencies: HHS, the Labor and Treasury departments, issued the final interim regulations on GINA. Under these regulations, health plans are prohibited from collecting genetic information—including family medical histories—for underwriting purposes.
The regulations also bar plans or employers from offering rewards in return for collection of genetic information as part of health-risk assessment, or HRA, forms. Employers and health plans routinely use health risk assessments to identify workers and members to target specific chronic disease or wellness programs. For instance, a person with high cholesterol and a family history of heart disease would be a prime candidate for a fitness or nutrition program. But employers have found that workers typically will not fill out the forms without cash or other reward incentive, such as lower healthcare premiums.
Only 11% of workers filled out a HRA without an incentive, compared to 45% of workers with an incentive, according to a 2008 survey by HealthFitness, a wellness firm based in Minneapolis. HRA participation among employees can go higher than 80% with incentives, other research has shown.
“They are an important tool and they are very widely used,” said Tracey Moorhead, president and CEO of the DMAA: The Care Continuum Alliance, representing the population health management industry.
Excluding family history questions from the questionnaires leaves out an important piece of the puzzle, said Steve Wojcik, vice president of public policy at the National Business Group on Health. “If you can’t ask those questions you have lost a critical piece of information that could be targeted,” he said. “It’s going to make it harder for employers to justify these programs if they can’t target where they would do the most good.”
Wojcik and Moorhead said some firms are pulling their HRAs and wellness programs from their 2010 calendar because of the GINA interim final regulations out of fear of violating the law, and little time during a busy annual open enrollment season to prepare.
The regulations are simply a reiteration of what was in the GINA law, according to agency officials. “There was no exemption in Title 1 of GINA for wellness programs,” said Peter Ashkenaz, a spokesman for the CMS. The regulations are effective Dec. 7, but are not final until a comment period ends on Jan. 5, 2010.
Meanwhile, the DMAA is asking the federal government to issue a moratorium on the regulations until these issues can be worked out. But that may be unlikely. “The departments will provide guidance and outreach to the employers and other stakeholders on compliance with GINA,” Ashkenaz said.
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