title: The Affordable Care Act permits greater financial rewards for weight loss: a good idea in principle, but many practical concerns remain.
abstract: The Patient Protection and Affordable Care Act of 2010 (ACA) increased the maximum rewards that group health insurance plans (including employers who self-insure) may offer in their wellness programs, with the goal of incentivizing healthy behaviors such as weight loss among the obese and smoking cessation. In this essay, I describe the history and intention of such programs, and make the following three points: (1) In principle, incentivizing healthy behavior can reduce external costs and help people with time-inconsistent preferences stick to their resolutions; (2) there are problems with the design of this portion of the ACA that will limit its effectiveness in achieving these goals; and (3) financial rewards for healthy behaviors have a mixed record to date, and thus many practical design features need to be resolved to improve the effectiveness of such programs.
authors.affiliation: Department of Policy Analysis and Management, and the Department of Economics, and Institute for Health Economics, Health Behaviors and Disparities at Cornell University, 2312 MVR Hall, Ithaca, NY 14853, USA. JHC38@cornell.edu
authors.forename: John
authors.initials: J
authors.lastname: Cawley
mesh_terms: D015992:Body Mass Index; D005378:Financial Support; D015438:Health Behavior; D017048:Health Care Costs; D020408:Health Insurance Portability and Accountability Act; D006293:Health Promotion / Q000191:economics* / Q000266:history / Q000331:legislation & jurisprudence* / Q000379:methods; D006308:Health Systems Plans; D049674:History, 21st Century; D006801:Humans; D009042:Motivation; D009765:Obesity / Q000628:therapy*; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D015397:Program Evaluation; D012201:Reward; D014481:United States; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000191:economics* / Q000331:legislation & jurisprudence*