White House May Push Health Plans to Create Wellness Programs

First Lady Michelle Obama is taking on a bloated nation and health insurers may one day have to help.

Health plans are now trying voluntarily with wellness, fitness, and disease management programs, but those offerings could become mandatory as the nation searches for ways to reduce health costs. Will insurer programs help pare the pounds?

While the First Lady gets ready to launch a major anti-obesity initiative, the beer ads, and fast-food ads will be a part of the Super Bowl commercial ritual. While watching, the calories will pile on probably a lot more than tacklers taking on Peyton Manning.

America is a contradictory place.

Michelle Obama announced her crusade against obesity, particularly child obesity, last week in a news conference with Health and Human Services Secretary Kathleen Sebelius. Later next week, she is expected to finalize her specific plans and announce those proposals.

Execs who run health plans aren't exactly sure what she'll release, but nobody seems to be worried about any "requirements." Indeed, the Obama Administration's war against fat has trimmed down, reflective of the overall healthcare package, which is being sliced and diced in the Senate and House conference rooms.

When Obama and Sebelius announced their plans to combat obesity, they emphasized the importance of wellness plans, being initiated across the country by employers, various health advocacy groups, and insurance companies.

Indeed, in some respects the administration is putting its money where its mouth is: a few days after the announcement, the White House's proposed 2011 budget was released, which includes plans to reduce childhood obesity rates by budgeting $1 billion to improve children's access to healthy meals, and include $10 million in a federal employee workplace initiative to implement prototype wellness programs.

No mention was made about putting any "requirements" on insurance plans.

That wasn't the case when Sebelius spoke in July 2009 before the Centers for Disease Control and Prevention at a "Weight of the Nation" conference. At that time, Sebelius noted, "The President and First Lady have made investing in prevention and wellness one of their top priorities."

"It's why we're going to require health insurance plans to cover preventative services like the kind of counseling and care that can help people lose weight or keep the weight off in the first place," she said.

These days, as the Obama Administration rather quietly tries to salvage the healthcare reform package, nobody mentions requiring health insurance plans to cover preventative programs.

"We always have difficulties with well-intentioned but unfunded mandates," says Don Bradley, chief medical officer and senior vice president at Blue Cross Blue Shield of North Carolina. "But we are doing (wellness and other programs). The thing is we don't know what works in combating obesity. It's important to launch these projects carefully and analyze what works and what doesn't." The problem isn't simply a matter of burning calories, Bradley says. "It's the behavioral part and the environment."

Insurance has a difficult and contrary role in the nation's fight against fat. On one hand, patients complain about insurers not supporting enough conditions linked to obesity, insurers insist they are doing more than ever to prevent obesity to begin with.

"We strongly support efforts to fight the obesity epidemic—that's a top priority," says Robert Zirkelbach, spokesman for the America's Health Insurance Plans, a major lobby for insurers.

Elizabeth Sell, spokeswoman for Aetna Communications, says the government plan to combat obesity is in alignment with many initiatives currently being supported by Aetna, says Sell.

The stars aren't all aligned. There are just so many issues that tangle insurance and obesity.

"The countless number of available insurance plans and ever changing policies have made it difficult to assess the extent to which obesity treatment and preventions services are covered by third-party insurers. More data is necessary to determine the health needs of persons with obesity," according to the American Obesity Association.

So far, the government has been waging a losing battle against expanding waistlines.

From 1980 to 2004, the prevalence of obesity more than doubled among adults and tripled among children and adults, according to Sebelius' office. Currently, two-thirds of adults and nearly one in three children are overweight or obese. That totals $150 billion a year, which is more than it would cost to treat all the cancers in America, she said. Clearly we're doing something wrong.

Whatever is needed, more insurance plans are getting involved in wellness programs and trying to obtain that data about the health needs of persons with obesity, requirements or not. There are assorted programs out there. And the health plans say they are achieving results.

A study by CIGNA's Healthy Steps to Weight Loss program says its 7,500 participants have lost an average of 9.4 pounds. That's progress.

Health plans also have joined an initiative of the American Heart Association and the William J. Clinton Foundation—the Alliance Healthcare Initiative—aimed at working together to combat childhood obesity. They seek to make together to make sure children get the insurance coverage they need—and the big thing: Insurers are part of the process.

The involvement with wellness programs happens, one bite at a time. It's not all smooth. Last October, HealthLeaders Media reported that an interim final rule from the Genetic Information Nondiscrimination Act of 2008 (GNA) could cripple wellness, disease management and population health management programs, according to employer and wellness groups, health insurances and DMAA: The Care Continuum Alliance.

The law prohibits employers from using generic information for coverage and employment decisions, ranging from promoting to firing. The Wall Street Journal this week quoted some employees saying the law "is stymieing their efforts" to promote employee wellness because it bars them from offering financial incentives about family history.

But Jeremy Gruber, president of the Council for Responsible Genetics, says the Genetic Information Nondiscrimination Act (GINA) poses "only minor limitations on wellness programs and these limitations are easily overcome." As Gruber sees it, wellness programs are—well, OK.

So wellness programs are advancing, with the dollars being poured into them by the Obama Administration. When you "have to" be on a diet, it's tough.

Insurers aren't crazy about being forced by the government to help America shed pounds. The way they figure it, with the wellness programs, the more everyone loses weight, the more health plans gain.