President Obama, members of Congress and dozens of interest groups have pledged to find new ways to provide Americans with better access to health care while regaining control of health care spending. With public and private health spending predicted to reach $2.5 trillion in 2009 -- a 17.6% share of the U.S. gross domestic product-many policymakers are arguing that effective, evidence-based, preventive services such as smoking cessation programs not only promote health, but also offer high economic value.

Employers have a huge financial stake in the success of these efforts. Effective employer-based wellness programs can reduce absenteeism, increase productivity and lower health care costs by helping workers avoid or postpone serious diseases. A comprehensive nationwide survey of 583 workers conducted in late March, demonstrates that preventive health services in the workplace is and will be an important issue in the upcoming health care reform debate.

"Healthy at Work?", a report from Rutgers University's John J. Heldrich Center for Workforce Development, found that nearly four in ten workers say their employer provides some kind of wellness program, ranging from classes in nutrition to a newsletter to a fitness center.

Nearly one third of those respondents think wellness programs have a major impact on the health of people in their workplace. And 70% of working adults think employers should offer wellness programs that address important health issues such as diet, exercise, stress reduction, and how to manage chronic illnesses, such as diabetes.

Not every worker enjoys access to these programs. Workers who are less affluent and less educated are less likely to have access to employer-provided preventive health services. Nearly half of college-graduates (46%) report an employer wellness program, compared to just one-quarter of employees with a high school education or less (25%). About four-in-ten workers (44%) with incomes of $70,000 or more say they have access to a wellness program, compared to just two in ten (21%) of those making $35,000 or less.

Workers are also divided over the incentives and penalties employers might use to encourage healthier behavior among employees. Most workers surveyed do not feel it is appropriate to provide increased salaries or extra time off to those who participate in wellness programs. Instead, three-quarters of workers (74%) say employers should lower health care premiums to employees who participate in wellness programs.

Many of the workers also feel it is unfair for workers to pay higher premiums because of existing health conditions:

• Just half (47%) of workers say employers should be allowed to charge smokers more for health insurance.
• Barely 4 in 10 workers (43%) support higher rates for people who drink too much alcohol.
• Only one-quarter of workers (26%) think people who are very overweight should pay more.

Finally, workers express strong concern for the privacy of their health care records if the trend toward using electronic records continues as expected.

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