College Students’ Perceptions Regarding Medical Waivers for Wellness Incentives Under the Affordable Care Act

Abstract

Background and Purpose: The use of health-contingent financial incentives in promoting employee wellness is controversial because of potential discrimination against those who could not reach certain health goals due to health factors. To protect consumers from such discrimination, the Affordable Care Act (ACA) requests protective mechanisms; however clear and detailed guidelines for the medical waivers have yet to be developed. This study aimed to identify college students’ opinions about employee wellness programs where monetary incentives are given for those whose Body Mass Index falls into the normal range with particular attention to medical waivers. Methods: A cross-sectional survey study was conducted with participants consisting of a convenience sample of 58 college students in California. Results: Some scenarios were considered more legitimate for waivers than others (pregnancy, 67.3%; chronic back pain; 43.1%; broken leg, 38%; and steroid use; 34.5%). The non-medical reason of "trying to lose weight" was also considered legitimate by 21% of respondents. Responses varied by participants’ gender and their own weight status. Conclusion: College students did not view all scenarios as legitimate reasons for medical waivers. These findings call for physicians to develop a list of legitimate reasons for medical waivers, and for physician preparedness in discussing these issues with patients.