HHS Proposes New Wellness Demonstration Projects

On September 30, 2019, the Department of Health and Human Services (HHS) released a bulletin outlining a new opportunity for 10 states to participate in a wellness demonstration project in the individual market. HHS will begin accepting applications immediately, without an opportunity for public comment on its guidance or on state applications.

To date, wellness programs have been limited to employers, but the Affordable Care Act (ACA) included a demonstration project to allow HHS and states to experiment with extending wellness programs to the individual market. States that are approved for a demonstration project could allow issuers in their individual market to vary the cost of coverage by as much as 30 percent because of, say, high blood pressure or high cholesterol. This could allow backdoor health status underwriting, which the ACA set out to prohibit.

Wellness Programs And The ACA
Wellness programs are controversial and, recent evidence suggests, ineffective. Critics raise concerns that wellness programs discriminate against people living with disabilities, penalize those in poorer health, require the disclosure of sensitive medical information, and allow employers to exert control over employees’ lives even during non-working (and unpaid) hours.

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