The Transylvania Times -

Health Care Responsibilities


Earlier this month the county commissioners passed changes that would still require county employees and their spouses to receive health screenings or pay $600 a year in premiums. Part of the discussion centered around employees’ responsibilities versus employees’ rights.

For the past decade, county employees and their spouses have been required to get a health screening. However, the Equal Employment Opportunities Commission (EEOC) has ruled that such an “involuntary” stipulation is in violation of the Affordable Care Act. (It’s just one irony that many complain, sometimes justifiably, about the ACA violating “rights,” yet in this instance it reverses previous requirements in order to protect a patient’s “rights.”)

Since such involuntary participation is no longer legal, the question facing commissioners was one that faces all employers: How do you encourage employees to take steps to improve their health in order to reduce overall health care costs while not mandating screenings or infringing on their individual, non-professional choices?

The commissioners, with some dissent, decided to address the issue by requiring employees to pay $50 a month in health insurance premiums but also giving employees a $50 discount if they participate in the screenings. This should have the same impact as the previous rules. (This leads to another irony; that by rewriting county regulations the ACA can be circumvented so that people who do not participate in the screenings will have to pay what commissioner Jason Chappell referred to as a “fine.”)

Thus, not much has changed in respect to employees being required to have health screenings. What will change in fiscal year 2015-16 is that employees also will have to meet one of four accountability standards. These standards, such as males having a waistline of less than 40 inches or blood pressure less than 140/90, seem somewhat reasonable.

But “normal” blood pressure is different for each person and it can change within a matter of minutes or even with the arm on which blood pressure is measured. It would be nearly impossible and possibly unhealthy for a man with a 48-inch waistline to drop 8 inches within a year or two. For some women who are “big-boned” but healthy, it would be much more difficult and unnatural for them to reach a 35-inch waistline than someone who is petite.

Wisely, the county has adopted rules that an employee can also just show incremental improvement of 5-10 percent in certain categories to comply with the regulations. And if there are extenuating circumstances, the employee can work with the employee health clinic to remain eligible for the discount. It seems quite reasonable to set standards for employees to attain one of four standards and grant exemptions to those who cannot achieve those standards for circumstances beyond their control.

The county also was prudent not to implement the monitoring of specific behaviors as is done in Henderson County with employees attaching an odometer to their ankles. Monitoring behavior is not only personally invasive, but may be counterproductive. A good behavior today may be considered bad tomorrow, or a particular activity done in moderation may be good but also harmful if overdone. One recent study showed, with giving a cause, that people who constantly run long distances have a shorter life span than those who do not. It’s better to stick with a wanted outcome and let the individual decide how to achieve that outcome.

As with all insurance, the more people use insurance, the more they pay for it. If people receive several speeding tickets or get in several accidents, their auto insurance rates increase. Those who do not usually receive lower insurance rates.

Health insurance is similar. Due to genetic predispositions, a weakened immune system, etc. there are some illnesses we contract that we can do nothing about. And sometimes we break bones or catch illnesses, such as influenza, even though we have taken all reasonable precautions. On the other hand, research indicates that many of our illnesses are the direct results of our lifestyles, of smoking, drinking excessively, eating high-fat and high-sugar foods with little nutritional value, and engaging in little or no vigorous exercise. These are things adults can control. Since adult employees can control these behaviors, businesses and governments, if they are paying the health care premiums, have the right to encourage employees to reduce those negative lifestyle choices.

In this case, the county commissioners made the right decision to financially encourage county employees to live healthier lifestyles.


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