Around 150 million Americans drag themselves out of bed each day and show up for work. You get your first cup of coffee, chit-chat a bit, punch in, and settle in for a long day on the job. But don’t get too settled, because you might be asked to answer a few questions about your family medical history, your sexual orientation, and your use of tobacco, drugs, and alcohol. You also might be asked to take a blood test, have your cholesterol and blood pressure recorded, and get your body mass index checked. Only a few years ago, such probing, pricking, and pinching would only occur in the privacy of a doctor’s office, but now these procedures are becoming more commonly prescribed in over half of American workplaces. And such “wellness” programs are growing rapidly.

Striking Chicago teachers are facing demands for such a program, which could tack on $600 a year in costs for individuals who don’t follow the dictates of the “wellness plan.” Their union has not agreed to the plan, which would require that workers participate in weight loss, nutrition, exercise, smoking cessation, and disease management programs, or face higher premium costs.

“We’re seeing a big move in this direction driven by employers’ concern about rising health costs and their sense that employee behavior has a lot to do with high costs,” writes Kevin Volpp, professor at the University of Pennsylvania School of Medicine.

Participate or pay

Primarily designed to bring down employers’ health insurance costs, wellness programs may use both incentives and penalties. A worker who takes a health screening interview may get $50 cash or $100 off her deductible, for example. A worker who meets certain goals set by the program, such as losing weight or lowering cholesterol, may see his share of premiums reduced.

Likewise, penalties can be imposed. A worker who doesn’t participate in the program may see her share of premiums raised.

At the Daughters of Charity Health System in northern California, for example, the recently negotiated Service Employees contract covering 3,000 workers stipulates that employees are charged 20 percent of their monthly premium if they fail to participate in “wellness assessments.”

The Health Insurance Portability and Accountability Act of 1996 allows such inducements and penalties, and they have withstood legal challenges.

But it gets worse. The nation’s largest group health care provider, Kaiser Permanente, reports that the Affordable Care Act will allow employers that participate in wellness programs “to raise the value of the perk or penalty from 20 percent of the cost of a worker’s health insurance plan, to 30 percent.”

Discounts or penalties could run more than $1,600 for individuals and $4,500 for families, according to Kaiser, based on average costs of employer-provided insurance.

Anybody against wellness?

Issues of employee privacy, discrimination, and larger premiums—all associated with growing employer control over health decisions—are a major factor in a California union election expected this fall.

Forty-five thousand workers at Kaiser Permanente will vote between their current union, Service Employees-United Healthcare Workers West, and the National Union of Healthcare Workers (NUHW), which broke away from SEIU-UHW and is challenging it for the second time. The two unions have diametrically opposed views on the wellness program included in the most recent Kaiser contract.

“The barometer of success for corporate wellness programs should not be about how much money the employer saves,” said John Borsos, NUHW secretary-treasurer. It “should not be about artificial ‘one size fits all’ standards for blood pressure, cholesterol, sugar, and weight levels, and should not be about ignoring broader socioeconomic issues and workplace safety concerns that experts tell us are crucial in determining one’s health.”

Borsos pointed to workplace stress as a key health factor sidestepped by wellness programs. He criticized SEIU-UHW “for not challenging Kaiser for inadequate staffing levels, over which management has direct control.

“Instead, SEIU is challenging their own members on health issues over which they may not have any control. How about Kaiser changing its behavior?”

Borsos also objects to the Kaiser plan because employees who decline to participate “will be subject to enormous pressure from co-workers whose bonuses are tied to everyone’s participation.”

Many details of the Kaiser program are yet to be negotiated, and Borsos says SEIU-UHW is not releasing information because “they don’t want to tell the membership how onerous these stipulations will be, before the election.”

SEIU-UHW, the largest union at Kaiser, disagrees 180 degrees. “It’s shameful that NUHW would use lies and deceptions to score political points instead of advocating for the health of workers and encouraging them to participate,” said spokesperson Steve Trossman.

Co-workers will ‘help’

SEIU-UHW applauded the Kaiser wellness program because it “defines new roles for union members as ‘health care leaders’ to help their co-workers achieve that goal” of becoming more healthy.

Trossman explained that the health care leaders will “develop programs to help their co-workers take on chronic illness and live healthier lifestyles.”

“Not so fast,” says nurse Faith Simon, an organizer of a July conference sponsored by NUHW and the California Nurses Association that explored alternatives to worksite-based wellness programs.

“It’s not the job of the boss, their appointees, or fellow employees to evaluate or to make judgments and recommendations about health,” Simon said. She is a family nurse practitioner and primary care provider in a rural California town. “That’s my job and the job of other health care providers voluntarily selected by workers.”

Former Communications Workers veteran negotiator Steve Early said he’d seen manufacturing employers try to induce smokers to quit so the company could save on its medical costs, “but management never wanted to address job-related hazards like chemical exposure or excessive noise levels that have an equal or greater impact on workers’ health.” When employers push wellness programs, Early said, unions should counter with proposals to cut forced overtime and decrease workload.