The Affordable Care Act and Health Promotion: The Role of Insurance in Defining Responsibility for Health Risks and Costs

This article examines whether insurance is an appropriate mechanism for improving individual health or reducing the cost of health care for payers. The Affordable Care Act contains implicit standards for allocating responsibility for health, especially in provisions encouraging health promotion and wellness programs. A summary of the accumulating evidence of the effects of such programs suggests that wellness programs have been somewhat more effective in making people feel better than in reducing costs. Health promotion should be encouraged, because health is valuable for its own sake. Insurance is not well suited to improve health or manage behavioral risks to health; its tools are too crude to address the complex causes of chronic diseases.Insurance functions better as a means of financing access to preventive care. The ACA\u27s use of insurance to encourage individual responsibility for risk prevention may influence social attitudes and policies about conditions of employment, housing and social relationships.Wellness programs that characterize ill health as the produce of individual choice are likely to shape public perceptions of individual social worth and justify abusive practices.If such programs are to avoid marginalizing a growing population, they should be offered independently of health insurance