Based on data from Germany’s experience with wellness programs, a recent report cautions that wellness incentives under the Affordable Care Act (ACA) could lead to higher insurance premiums for low-income and chronically ill people. The Commonwealth Fund’s brief found that one quarter of the publicly insured population participated in wellness programs by 2008, double the participation in 2004. Wellness programs did reduce health costs – by $251 per person per year on average – but people in the lowest (and highest) income groups were less likely to participate than were middle-income people. Men and people with chronic conditions also were less likely to participate.

Wellness programs have grown in popularity, and more than half of all large employers in the U.S. offer health or wellness programs to their employees. Under the ACA health reform law, employers are allowed to increase the scope of wellness incentives: premium costs for those enrolled in wellness programs may be reduced by 30-50 percent, with those costs shifted to those employees who do not participate. Given their findings, the authors recommended that U.S. wellness programs be monitored diligently to ensure incentives do not create higher premiums for low-income individuals or those with health problems.

The study was based in part on a previously published evaluation of the Barmer Ersatzkasse, Germany’s largest sickness fund insuring nine percent of the population. In Germany, wellness programs are established to reach three primary goals:

  1. Improve the health of the population
  2. Reduce or curb increases in health care cost
  3. Promote competition among sickness funds