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The Law, Policy & Ethics of Employers Use of Financial Incentives to Improve Health Kristin M. Madison, Kevin G. Vol pp & Scott D. Happen Version: June 2011 A revised version of this article was published
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In this article, we discuss the potential negative consequences associated with such financial incentives as well as the legal, policy and ethics issues. Background. The ACA requires employers to offer health insurance as a benefit to full-time workers or pay a penalty. The mandate specifically identifies the health insurance of eligible employees as an inducement to take preventive health actions. The law allows employers to take up to 20 percent of the employee's income directly to an individual health savings account (or Has) on an individual basis. These HSA dollars can be used by employees to pay for out-of-pocket health costs, such as co-pays, deductibles or other out-of-pocket expenses under a managed care plan. In addition, the law imposes significant limits on the amount an employer may contribute to an HSA each year. The employer may not contribute more than 2000 (or 5,400 in the first year) to an HSA each year. Further, employers cannot contribute an amount that is more than 4 times the current employee contribution level to an HSA. Some employers offer an Has that are partially or fully dependent upon the employer's contributions. The ACA requires the government to set up an online HSA choice tool beginning in 2014 (the tools are set to be available by April 2014). We present analysis of employer contribution levels in general as well as employer contributions to the health savings accounts of low income workers, which will be very important in the implementation of this new law. The analysis also covers contributions to Has with dependent care for adults (including both children and adults). Employers provide the funds of their HSA accounts to employees as a benefit, with the idea that this will lead to the creation of the health incentive account for employees. We focus on the potential negative impacts of financial incentives to improve health and consider potential legal, policy and ethics issues. We will use administrative and survey data on the use of employer-provided financial incentives for improving health as well as discussions with experts in health finance. Keywords: employer financial incentives, Healthy Savings Accounts, managed care Plans, Medicare, Health Savings Accounts Financial incentives to improve health are an important new tool used to promote healthy behavior.1-4 In the health incentive program mandated by the Affordable Care Act, which is known as the “Healthy California Act,” health insurance exchanges that will operate in various states of the United States allow the use of financial incentives for healthy behavior to encourage and encourage health care professionals, patients, and employers to achieve healthier behaviors.

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