Senate Finance Gives OK to Raise Limits on Employee Healthy Behavior Rewards

Janice Simmons, for HealthLeaders Media , October 1, 2009

An amendment permitting health plans to reward healthy behaviors—one of the few bipartisan amendments introduced during the Senate Finance Committee hearings on healthcare reform—passed during late evening hours on Wednesday. The committee, which has several hundred more amendments to consider, has been working long hours to complete its reform measure in the next few days and to have legislation ready for the Senate floor by mid-October.

In a 18-4 vote, the panel agreed to a provision introduced by Sen. John Ensign (R-NV) and Sen. Thomas Carper (D-DE) that would add to a section in the updated Chairman's Mark to expand rewards that employers offer employees for improving their health. They called for increasing monetary rewards from 20% to 30% of the cost of an employee's coverage for participating in wellness programs.

"The key to achieving savings is to provide rewards for people who engage in healthy behaviors," Ensign said. The focus, though, "is on healthy behaviors and not genetics . . . we don't penalized people for any genetic problems they might have," he emphasized.

Both senators mentioned major companies—such as Safeway and Pitney-Bowes—that have used reward programs to keep their employee healthcare costs relatively stable. However, several senators, such as Sen. John Kerry (D-MA), expressed reservations that this type of provision could become a backdoor "vehicle for risk," in which individuals could be excluded from coverage because of various unhealthy behaviors.

Also getting the attention of the committee earlier in the day was an amendment that would require immigrants to present official photo identifications, such as drivers’ licenses, when signing up for public healthcare programs. Sen. Charles Grassley (R IA), who proposed the amendment, suggested that current law is too lax to prevent illegal immigrants from receiving government paid care.

At the current time, most newly arrived immigrants are ineligible for Medicaid or the state Children's Health Insurance Program (SCHIP) for five years, although they may obtain access to emergency Medicaid services. After five years, states may decide whether to cover the immigrants, but it must be verified if they legally are in the country.

"Shouldn't we care about people accessing thousands of dollars through identity theft," Grassley asked. "A stolen credit report has more than enough information."

However, several senators said much of the fraud related to Medicaid occurred from vendors or providers trying to beat the system. Sen. Robert Menendez (D-NJ) said that requiring ID would adversely impact the most vulnerable populations in the healthcare system—those who might be homeless or living in impoverished areas. The measure lost along party lines 13-10.

Sen. Orrin Hatch (R-UT) introduced two amendments pertaining to abortion. One amendment would require women to purchase a separate policy for abortion coverage under the bill; another called for stricter rules to protect those who worked at hospitals or provided other healthcare services if they declined to perform abortions for personal reasons. Both amendments failed by 13-10 votes.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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