Sheila Kromer doesn't want any help.
She enjoys smoking and she doesn't want to quit.
Nor does she want advice on how to eat right. Or how to exercise. "I'm smart enough to take care of myself," she says.
As a chemist at 3M, she's had plenty of chances to join health and fitness programs on the job. But like many Minnesotans, she's simply chosen not to.
Now, that choice is starting to get costly.
At a growing number of workplaces, employees are paying a price for refusing to take part in wellness programs. Some face hundreds of dollars a year in higher costs for health insurance. Some are missing out on cash and gifts used to reward their colleagues -- not for their work, but for the way they eat, exercise and conduct their lives.
Once, on-site gyms and Weight Watchers classes were viewed as perks. But now, many employers see wellness programs as their best weapon in the war on health costs.
"I think everyone is collectively beginning to understand that the 400-pound gorilla in the room is health and wellness," said Dr. Ted Loftness, a vice president at Medica Health Plans. "We can't dance around it anymore. We have to do something about it."
Experts say that upwards of 40 percent of U.S. medical costs are linked to obesity, smoking and other lifestyle factors -- a statistic not lost on the nation's employers. As a result, more than half of large corporations now use incentives to get employees to shape up, a 2008 survey found.
But in the process, employers are pushing the boundary between work life and private life.
At 3M, General Mills and many other Twin Cities worksites, employees can earn up to $100 in cash or shave hundreds of dollars off their health insurance if they (and sometimes their spouses) take a "health risk assessment" -- a detailed survey of their personal health habits.
Some companies are tying payments to medical test results. This year, Blue Cross and Blue Shield of Minnesota is offering $200 insurance rebates to its own employees who can maintain "healthy levels" of blood pressure, cholesterol and other risk factors -- or show they're making an effort to improve them.
In other parts of the country, employers have gotten even tougher. Alabama announced plans to charge what some call a "fat tax," a $25 monthly surcharge on insurance for state employees who are clinically obese.
This can be troubling news to people who simply want to do their jobs and be left alone.
"I really think it's an encroachment on our freedoms and our choices in life," said Kromer, 50, of White Bear Lake. "They should not be able to tell me what I can and cannot do off of work time."
Last month, she turned down the $100 incentive at 3M to fill out a health survey.
Like many companies nationwide, 3M is promoting the health risk assessments as a tool to encourage people to modify their behavior.
"I would never fill one out," says Kromer, who admits she's a contrarian. (She cochairs a committee to repeal the state's smoking ban.) As a smoker, she worries that the information might be used against her. "If I ever had to fill one out, I'm going to be real honest with you," she confesses. "I would lie."
David Bornus, who works for the Minnesota Department of Corrections, also refused to take a health assessment last year. He said he found the questions silly and patronizing: Do you have a smoke detector? Exercise? Eat vegetables? Drink to excess? Own a gun and keep it locked? He drew the line, he said, when he learned that his wife also would have to fill it out to get the incentive: $5 off copays for doctor visits.
"At this point, I decided that I did not like the incremental intrusion into my and my family's private matters," he said. "It's not worth it."
This year he changed his mind after the spousal requirement was dropped and some questions became optional. Still, he says, "the whole approach is a bad idea."
To some, employers are crossing the line in their zeal to contain health costs.
"When you have your employer kind of dictating how to live your life, it's kind of a scary thing," said Shawn Gertken, 35, a government worker in Wabasha County. "Where does it all end? Pretty soon they're going to be after you if you choose to ride a motorcycle after work."
Good reason to worry
But health and wellness experts say businesses have good reason to worry about what employees do in their off hours -- if it jeopardizes their health. "That's because employers are paying about $10,000 a year [per person] for employee health care costs," says Don Powell, president of the American Institute for Preventive Medicine in Michigan. "Companies are clearly tired of paying increases [of up to 10 percent] each year."
The drive to change behavior has been fueled by some alarming trends: Nearly two-thirds of Americans are overweight or obese, according to federal statistics. Diabetes has soared at the same time. While smoking rates have dropped, they're still one of the biggest factors in heart disease, strokes and, of course, lung cancer.
"The cost trend is not sustainable. We all know that," said Loftness of Medica. "We're going to bankrupt the country on the backs of diabetes, obesity and tobacco.''
It's no surprise, then, that, many businesses are losing patience footing the bill for preventable diseases, says Susan Relland, a Washington, D.C., attorney who specializes in health law. "Just running the math, they realize that the health of their employees is having a very direct financial impact on the company."
"They've offered wellness programs for a long time, but they're having a hard time getting employees engaged," Relland added. Now "they've gotten a lot more serious about it."
General Mills at forefront
Few have pushed employee health more vigorously than General Mills, with its state-of-the-art fitness center, outdoor running paths and even a medical clinic at its Golden Valley headquarters. But after 20 years of wellness programs, it's still an uphill battle to draw in every employee, says Dr. Timothy Crimmins, the company's medical director.
So the company has added financial incentives to the mix as it tries to overcome people's natural affinity for donuts and a sedentary life. "We've had to work harder to fight the tide of American culture," says Crimmins.
Today, employees can eat at a "gently subsidized" salad bar, while burgers are full price, and collect $10 monthly nonsmoking bonuses. At sales meetings, staffers can meet with health coaches and get free blood pressure and cholesterol tests. There's a $50 bonus for filling out a health risk assessment (double if a spouse fills one out, too). In January, a $60 exercise credit makes its debut.
To Pamela Matovich, a systems analyst at General Mills, the payoff was more personal. She lost 75 pounds through the company's fitness and weight-loss programs, which she was able to fit into her workday.
"It's made a huge lifestyle difference for me," says Matovich, a Cottage Grove mother of two small children. Before, she was on insulin for diabetes and faced surgery for back pain. The weight loss made both unnecessary. "I think companies have the right to be able to say we'd like you to be healthier," she said. No one forced her to change, she adds; when she was ready, the company gave her the help to do it.
Crimmins wouldn't say how much General Mills spends on wellness, but he's confident it's worth it. Company surveys show that the rate of obesity has dropped from 23 percent to 12 percent among its sales force since 2005. In general, experts estimate that every $1 spent on health and wellness saves $3 in medical costs.
At some point, even supporters say companies may tire of paying people to help themselves, especially in a tightening economy.
Behind the scenes, there's growing talk of a tough love approach -- making some health programs mandatory. "It is a controversy right now," says Dr. David Plocher, chief medical officer at Blue Cross and Blue Shield of Minnesota. "No one has really agreed on the direction."
But some predict that will never fly, for legal and practical reasons.
"The coercion thing just doesn't work," says Crimmins, of General Mills.
Loftness of Medica agrees. "People don't change their behavior when they're threatened," he said. "I really believe you have to help them."
Maura Lerner • 612-673-7384
