Serving Clients Nationwide. Call us at 608-579-1267

Blog

What the Wellness Industry Needs to Know about the AARP v. EEOC Decision

Posted by Barbara J. Zabawa | Aug 23, 2017 | 2 Comments

In October last year, the AARP filed a complaint against the Equal Employment Opportunity Commission (EEOC) about the EEOC's wellness rules under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).  Specifically, the AARP complained that the EEOC went against Congress' intent by allowing a 30% incentive maximum under the ADA and GINA for purposes of gathering employee or family health information through workplace wellness programs.  The AARP argued that the EEOC's incentive maximum was arbitrary and unjustified. 

Yesterday, the U.S. District Court in the District of Columbia issued an order agreeing with the AARP's argument.  The court refused to defer to the EEOC's judgment in interpreting what is meant by a “voluntary” wellness program that seeks health or genetic information from employees or their family members.  Instead, the court questioned whether the EEOC had truly evaluated the incentive limit in light of the purposes of the ADA and GINA, which are to prevent discrimination against employees on the basis of a disability or genetic precondition.  The court noted that the EEOC failed to provide a convincing rationale for its incentive limit and seemed to ignore the data and concerns provided by other stakeholders.  The court highlighted a significant concern expressed by some stakeholders that a 30% incentive level “was likely to be far more coercive for employees with lower incomes, and was likely to disproportionately affect people with disabilities specifically, who on average have lower incomes than those without disabilities.”  Opinion at 26. 

As a result, the court ordered the EEOC to go back to the drawing board, evaluate the evidence about what incentive limit constitutes the dividing line between voluntariness and coercion, evaluate the impact of its decision on various groups, and then adequately explain its decision on what a “voluntary” incentive limit may be.  Importantly, the court did not vacate the current incentive limits under the ADA and GINA rules – the 30% maximum incentives are still intact.  However, those who work in the workplace wellness industry may be wondering what to expect in light of this court decision.  Here are a few insights:

  1. The current ADA and GINA incentive limits of 30% of the total cost of self-only coverage are still intact. The court deliberately considered the disruption it would cause if it struck down the current EEOC rules.  So, it left the current incentive limits in place while it asked the EEOC to reconsider its decision about making 30% the incentive maximum. 
  1. The EEOC may appeal the decision. The court's decision was a “final” decision in the case, granting summary judgment in favor of the AARP and denying the EEOC's summary judgment motion.  This means the court's decision is ripe for appeal.  It will be up to the EEOC to decide whether to appeal the decision to the District of Columbia Court of Appeals.  
  1. An EEOC appeal may face an uphill battle. Although I was surprised that the court did not defer to the EEOC's judgment, like so many courts do when a federal agency is charged with interpreting laws (a legal doctrine called “Chevron deference”), the tide may be turning on a court's willingness to “trust the judgment” of the federal agency.  This court in the AARP case spent a lot of time discussing the evidence and comments brought forth by various stakeholders about the validity of a 30% incentive maximum under the ADA and GINA.  In a way, the court was showing the EEOC all of the comments and data that it failed to consider when writing the ADA and GINA final rules last May.  The court criticized the EEOC's rationale for settling on a 30% maximum incentive, which the EEOC explained was to “harmonize” the ADA and GINA rules with the HIPAA/Affordable Care Act incentive rules.  Upon a closer look, the court concluded that the ADA and GINA incentive maximum did not harmonize with the HIPAA/ACA rules, but in fact made the incentive limits more confusing.  The court's willingness to closely examine the EEOC's rule making process and rationale may reflect a new view of the judiciary's role in evaluating agency rules.  The newest appointee to the U.S. Supreme Court, Justice Neil Gorsuch, appointed just this year by President Trump, has been openly critical of judicial deference to agency rules.  In a past opinion, Judge Gorsuch denounced agency deference as “a judge-made doctrine for the abdication of the judicial duty.”  See this article for an interesting take on Justice Gorsuch's stance on this issue.  Justice Gorsuch's view may be setting the tone for the lower courts when reviewing federal agency rules.
  1. The EEOC may end up lowering the incentive maximum under the ADA and GINA. The court in the AARP case gave the EEOC until September 21, 2017 to come up with a timeline during which it would review the ADA and GINA wellness incentive rules.  If the EEOC decides against appealing the decision, it must start reviewing its rules in light of all the comments and data pointed out by the court.  Using this information, the EEOC must decide whether the 30% maximum incentive makes sense.  The court was certainly not persuaded that a 30% maximum made sense because that is what the HIPAA/ACA rules use.  As a result, the EEOC may end up lowering the incentive maximum incentive, perhaps below 20%.  An incentive maximum below 20% may be possible because the court pointed out in its opinion that a RAND study found that “high powered” incentives of 20% or more might place a disproportionate burden on lower-paid workers.  Opinion at 26.

What Should You Do Now?

Until the EEOC changes its rules, you should continue to abide by the ADA and GINA wellness incentive rules as currently written.  By September 21st, we should have a better idea of when the EEOC might change its rules.  We may also know whether it intends to appeal the court's decision.  The Center for Health and Wellness Law will continue to monitor any developments in wellness law.  As always, if you need compliance assistance with workplace wellness program development or implementation, contact us.  We are here to help you.

About the Author

Barbara J. Zabawa

Barbara is lead author of the book Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. She is a frequent writer and speaker on health and wellness law topics, having presented for national organizations such as WELCOA, National Wellness Institute, HPLive, Healthstat University and HERO. Barbara J. Zabawa is a Clinical Assistant Professor for the University of Wisconsin Milwaukee College of Health Sciences, Department of Health Services Administration where she teaches graduate and undergraduate courses in health law and compliance, US health care delivery and health professions career development. Barbara also owns the Center for Health and Wellness Law, LLC a law firm dedicated to improving legal access and compliance for the health and wellness industries.  Before graduating with honors from the University of Wisconsin Law School, she obtained an MPH degree from the University of Michigan. Immediately prior to starting her own firm, she was Associate General Counsel and HIPAA Privacy Officer for a large health insurer where she advised on Affordable Care Act matters. She was also a shareholder and Health Law Team Leader at a large Wisconsin law firm. Barbara serves health and wellness professionals and organizations across the country as an advocate, a transactional lawyer and a compliance resource. Her commitment to improving health and wellness also shows through her community service. Barbara founded the Wellness Compliance Institute, a nonprofit organization that seeks to improve wellness program and activity compliance. She also is a Board Member for the Rogers Memorial Hospital Foundation, a health care organization that specializes in treating mental illness and she chairs the State Bar of Wisconsin Health Law Section. Barbara is licensed to practice law in both Wisconsin and New York.

Comments

JC Reply

Posted Sep 19, 2017 at 20:06:35

This is BS, 30% of a typical individual health plan of $10k or more is a lot for somebody making even 100k /year, let alone people who make less. There needs to be a lot more laws in the wellness area, like requiring disclosure so employees know exactly how much opting in versus opting out will cost up front before the biometrics testing. There needs to be easy, clear method to opt out. My company hides the fact that you are signing up for wellness and gives no option to opt out, which I thought was illegal since it is supposed to be voluntary. How many companies did EEOC sue concerning wellness and lost every case, then AARP sued and EEOC loses again. Why are employees subjected daily to illegal workplace laws, with little recourse?

JC Reply

Posted Sep 19, 2017 at 20:22:48

My company required biometric testing to avoid $1500 smoking surcharge and$500 biometric surcharge but said nothing about signing up for wellness. Then you receive Biometric results and they thank you for signing up for wellness. So basically they con you into signing up for wellness and say it is part of your insurance with no opt out provision (wellness is supposed to be voluntary). 30% penalty is a lot. Hope the judge requires 5% or less and basically makes wellness plans obsolete. I think people have had it with corporate intrusion of their health information and daily lives.

Leave a Comment

Make Compliance a Selling Point

You work hard to differentiate yourself from the pack. The Center can help. The Center offers compliance evaluations and support to give you and your clients confidence in the services you provide. Backing up your health or wellness services with the Center's expertise in health and wellness compliance can enhance the credibility and effectiveness of your health or wellness service. Contact us today. We would love to be your legal partner!

Contact Us

Fill out the form on this page or call us at 608.579.1267

Menu