Wellness programs are an increasingly common feature of employee benefits programs, and guidance is needed to avoid violations of federal equal employment opportunity laws, a panel of experts representing business, advocacy groups and providers told the Equal Employment Opportunity Commission (EEOC) at a meeting held recently.
"We appreciate the valuable insights and diverse perspectives provided by today's panelists," said EEOC Chair Jacqueline A. Berrien. "There has been broad bipartisan support for the expanded use of wellness programs to reduce health insurance and healthcare costs, but today's meeting underscored the importance of insuring that those programs are designed and implemented in a manner that is consistent with federal equal employment opportunity laws."
A majority of employers now offer some sort of wellness program: 94 percent of employers with over 200 workers, and 63 percent of smaller ones, according to Karen Pollitz of the Kaiser Family Foundation, which researches issues relating to health care. Pollitz added that many of these programs offer some sort of financial incentive for participation, which can range from gift cards to higher employer contributions for insurance premiums, or penalties like additional surcharges to employees for health insurance.
The most common intersection of these programs and the statutes EEOC enforces occurs when the programs require medical exams or ask disability-related questions, both of which would ordinarily give rise to a violation of the Americans with Disabilities Act (ADA), EEOC Acting Associate Legal Counsel Christopher Kuczynski told the commission. He explained that, while the ADA allows employers to ask for medical information in connection with voluntary wellness programs, the meaning of "voluntary" merits further clarification by the commission.
Some panelists also argued that EEOC's regulations under the Genetic Information Nondiscrimination Act (GINA) — which prohibits acquiring genetic information including family medical history — should provide guidance on whether spouses of employees may be asked for health information in the context of wellness programs.
Speaking on behalf of the Consortium of Citizens with Disabilities (CCD), Jennifer Mathis warned against the use of penalties or monetary incentives for participation in wellness programs. Citing the high rate of unemployment for people with disabilities, Mathis told the commission that the CCD "is concerned that employer-based health programs which penalize people with disabilities for not being as 'well' as others — and for failing to disclose disability-related information the ADA permits them to keep confidential — make it even more difficult for individuals with disabilities to obtain employment on fair and equal terms."
Other panelists, including Leslie Silverman, a former EEOC commissioner now a lawyer representing large employers, urged the commission to provide guidance on the application of the ADA and GINA to wellness programs in order to facilitate employer compliance and clarify the relationship between the ADA, GINA, the Health Information Portability and Accountability Act (HIPPA) and the Affordable Care Act (ACA) provisions on incentives and penalties.
While most of the panelists discussed wellness programs in the context of ADA or GINA violations, Judith Lichtman of the National Partnership for Women & Families, warned of potential violations of Title VII of the Civil Rights Act's prohibitions on race, sex, and national origin discrimination, and the Age Discrimination in Employment Act's (ADEA) prohibitions on discrimination against people 40 and older.
Lichtman noted that women tend to have more health problems than men and older people tend to have more problems than the young. Many health conditions, such as obesity, diabetes and hypertension, disproportionately affect members of racial minorities. Punitive measures for failing to meet certain biometric markers therefore could have an unjustified disparate impact on certain groups, in violation of both Title VII and the ADEA, she told the gathering.