Capstone, Final Submission, Dylan Sosa, '17

Table of Contents • Cover Letter • Submission Five • Submission Four • Submission Three • Submission Two • Submission One

Cover Letter Dear Reader, Welcome to my final capstone submission. As you may know by the time you read this letter, I took an unusual approach to both my civic engagement and final submission. I did this because I felt the most important element required to solve the social problem of miscommunication between legislators, employers, and employees would be to get information directly into the hands of employees and others who need to know how employers can potentially affect their health insurance.

My capstone is on the recently proposed bill, “The Preserving Employee Wellness Programs Act," also know as H.R.1313 (house bill 1313). My submissions one through five act primarily as documentation of my capstone process and they served to inform me of how best to construct a mobile application designed to bring information about H.R.1313 to those who want it. Therefore submissions one through five do not form a cohesive narrative, rather what they do is illustrate my process of gathering information about H.R.1313, preparing accessible documents to disseminate information on my topic, and the ultimate construction of a mobile application that brings everything one should know about H.R.1313 into one, convenient place.

The submissions also serve as documentation used to inform my choice of civic engagement, which took form as my iOS app. My final submission is the product of complex and labor intensive effort, and I believe that it perfectly encapsulates civic engagement because it brings critical information about a bill affecting the health of workers and their families to a place that is always near.

I would like to use the space following this letter to provide images of my app. The first is an image of the app’s icon, which is the university seal as this app can be considered an alpha version not ready for commercial release. The next is a screenshot of the framework of the app which shows each possible pages that can be navigated to and their interactions. I’ll conclude the images with two examples of pages in the app: the first is information about H.R.1313 and the second shows biographies of my interview subjects.

I thank you for taking the time to review my finished capstone project, my previous submissions will follow this letter.

With regard,

Dylan Sosa, ‘17

Submission Five 12 April 2017 St. Edward’s University 3001 S. Congress Ave. Austin, TX 78704

To Beth, Having completed the research component of my Capstone project, I am in the process of creating the final submission. My topic is on H.R.1313, The Preserving Employee Wellness Programs Act, and my conclusion is that the bill would infringe upon employee genetic privacy. I have decided that the most effective way to present the information collected as well as utilize my skillset it to write an iOS application. This letter will defend my choice of modes and media in light of audience, purpose, and occasion, and will document my progress and plan of work for the final weeks of the course.

Overview This is a wide-angle view of the semester up to this point. For my Capstone project, I originally chose to analyze and write about the 2015 moratorium on biomedical research concerned with introducing human pluripotent stem cells into non-human embryos introduced by the National Institutes of Health. This was not a good policy for the me to study for this capstone project because the conflict and debate surrounding the ban were exceedingly hypothetical and without significant evidence from either side of the debate. The project in its current form involved planning, research, composing, and revising. A list of all of the required tasks follows.

1 Choose topic 2 Analyse topic 3 Conduct library research 4 Conduct original research (interviews) 5 Conduct immersive research (civic engagement) 6 Choose appropriate modes and media for presentation of final project 7 Create preliminary version of final submission 8 Revise final submission 9 Finish!

Work Completed I have completed the following tasks: I.

Topic Analysis and Annotated Bibliography A. Fully completed topic selection and analysis as well as completed annotated bibliography.

II. Preliminary Narrative, Translation of Components A. Initial attempt lacked evidence for either sides’ argument—this is primarily why I made the decision to change my capstone topic. Following that transition my component translation and preliminary narrative have been completed. These have greatly informed my stance on the debate surrounding H.R.1313.

III. Ethical and Argument Analysis Infographic A. Still needs to be translated to infographic form following my topic change. This will be a part of my final submission in some capacity.

IV. Expert Interviews, Civic Engagement Narrative A. Completed three interviews: my two anchor interviews plus one additional interview that supports my position. I have not yet completed my civic engagement. The plan is to use my final submission to fulfill this requirement by sharing it with stakeholders that support my position.

V. Final Submission Proposal A. In which I propose an iOS application to be the best medium to reach my capstone project’s intended audience.

Work Remaining To complete the entire capstone project I still need to create the ethical analysis infographic, civic engagement, and my final submission product—the iOS application that will house the results of my analysis and investigations into H.R.1313. With three weeks remaining I don’t anticipate any scheduling difficulties with the conception and implementation of the iOS app.

My submission five timeline is separated into seven distinct phases: learning Swift, designing an initial layout and structure of the app, implementing the design, incorporating capstone components (will finish any incomplete capstone components here), complete a rough draft of the app, revision, and finally submission. So, with three weeks remaining the majority will be spent on the conception and implementation of the app, most likely one week. One week will be used to learn Swift and design the structure of the app. The final week will be used to both populate the app with my capstone components and other information pertinent to my topic as well as revise the product for final submission.

Discussion The idea behind the app, if it were actually a final version to be publicly released, is that it would provide information to employees about The Preserving Employee Wellness Programs Act, related governmental agencies, and contact information for the congresspeople who introduced the bill. I don’t anticipate this being too terribly difficult as I have had coursework and experience in three different programming languages. Moreover, upon cursory online searches it seems as though Swift (Apple’s programming language) has a lot of publicly available resources to support this endeavor. I believe I am currently on schedule—this project has been dynamic and as such once my final submission is completed, all of the necessary capstone components as required for this course will be complete as well because they are all necessary for my final

product. Resources I currently anticipate utilizing include: Apple’s Swift documentation, Xcode (the development environment I will work in), online tutorials and communities, computer science faculty (specifically those that teach mobile app development), and any literature on design that is pertinent to my work. The remaining time in this semester should be ample for me to complete this goal.

With regard, Dylan Sosa

Submission Four Dylan Sosa BethStone 10 April 2017 Sub 4 (Notes) My two anchor interviews were with Mr. James P. Gelfand from the ERISA Industry Committee (ERIC) and Dr. Nancy J. Cox from the American Society of Human Genetics.

Mr. Gelfand is Senior Vice President, Health Policy at ERIC. He works with ERIC members to develop and advance public policies including legislative and regulatory advocacy at the federal, state, and local levels. The ERISA Industry Committee is the only national association that advocates exclusively for large employers on health, retirement, and compensation public policies at the federal, state, and local levels. Since 1976, ERIC has been the influential voice of large employers in the United States, successfully advocating on key employee benefits issues. ERIC is recognized by Congress, the White House, federal agencies, state governments, the media, and the courts as the go-to source for information, advice and counsel on employee benefit public policies impacting large employers.

Transcription from Gelfand interview VI. What is ERIC’s opinion on H.R.1313 A. Companies that are members of the IRS Committee have been offering wellness programs for years and have increased individual health status and have lowered premiums for millions of people. Prior to The Affordable Care Act (ACA) premiums could have been reduced by participation in a wellness program by up to 20 percent. By ACA it was increased by 30% and could go up by 50% up to the discretion of the secretary of labor. When ACA was passed into law, regulations were passed into law by [The Departments of] Labor, Health and Human Services, and the Treasury to lay out how this new rule [The Tri-Agency Rule] 30-50% would go into effect. What happened was, employers came into compliance and moved on with their understanding of the law.

Years later the Equal Employment Opportunity Commission (EEOC) began suing businesses that offered these wellness programs. They didn’t like the Tri-Agency rule because they thought it gave too much power to employers. The EEOC is losing over and over in court. So the EEOC went to make a new rule in the ACA. This rule directly countermands things in the Tri-Agency rule. HR1313 would overturn the EEOC rule and bring back Tri-Agency rule.

VII.What do you think of the other side’s opinion on H.R.1313?

A. I think there are a lot of people who’s herts are in the right place who have been whipped into a frenzy by a combo of fake news who and people who do not like wellness programs. So the section of ACA that made this change to premium variation based on

wellness programs changed the public health service act. The EEOC has no authority has to regulated programs under the health act, they said they had authority under The Genetic Information Nondiscrimination act (GINA) and The Americans with Disabilities Act (ADA). Neither acts were amended by the ACA. Meaning the ACA did not give the EEOC any new authority. The EEOC just invented this authority, but the EEOC draws power from this. To prevent EEOC from writing their own rules about wellness programs H.R.1313 has to clarify that the EEOC does not have authority under GINA and ADA to attack those wellness programs. What happens next is that reporters and advocates look at these and say people are taking away GINA protections. There are no changes happening to GINA, jut reeling the EEOC back in. The EEOC used GINA as justification. If H.R.1313 passed into law, no Americans would lose protections under GINA and the EEOC. The EEOC would just not be able to do what they want.

VIII.Your opponents have accused this bill of proposing compulsory participation or coercion, how would you respond?

A. The compulsion question is that if you don’t get a big discount, does that mean you have to do what needs to be done to get a discount? Here’s an analogy, say you’re at a grocery in line before a couponer. They buy $1000 worth of food for $5. Now if you only have $1000 and no coupons is the grocery compelling you to go home and cut coupons?

Several courts have said no. Even if you don’t do the thing that gets you what you want, that’s not compulsory. Here’s the controversy, the advocates are saying, “think about the health insurance.” It’s not cheap, a family plan could cost $10,000. Let’s say that an employer offers a thirty percent incentive for participating in a wellness program. That’s real money and could make a lot of difference to people. People are saying that because it’s a lot of money it’s compulsory. Even a child knows that you still have a choice even if it is a lot of money. It’s worth knowing that there are groups that have always been groups against programs like this. They think it discriminates against elderly and sick people. Those people have motives to demonize the programs. From our perspective they are being silly.

IX. What do you think should happen in the future of this policy and why? What would the consequences be?

A. It’s unfortunate that there’s been so much scaremonging, it has the potential to save families thousands of dollars. Not discriminating, stealing DNA, or making hiring and firing decisions. It’s causing people not to participate, so it is causing people to lose money that could make a real difference. My hope is that if this passes we can move past scaremongering and just tell the truth. Some people don’t want to do stuff. From a business perspective it saves employees money. Going forward we hope to do more and better not less and worse.

X. What do you see as the obligation of your organization to this bill?

A. ERIC has endorsed this legislation which lets congress let people know it is important. It also lets Americans know that the fear mongering coming from advocacy groups and universities and such that they don’t have to be afraid and are protected by The Health Insurance Portability and Accountability Act of 1996 (HIPPAA). Those who do this coercion are subject to jail time. There are laws that are protecting them and have been

protecting them for a long time. We want to get back to one that was a consensus between three reasonable government agencies. [this is a reference to the tai-agency rule] XI. What do you see as potential consequences from this bill?

A. I think there will be an avalanche of miscommunication that will go along with it. The senate takes a measures approach to legislation, I would be surprised if the senate didn’t take some time to amend it Ina way that would make people worry less. The most basic consequence that employers will have certainty to offer robust wellness programs to save lots of money on their insurance costs.

Nancy J. Cox, PhD is Director of The American Society of Human Genetics, Professor of Medicine and Director of the Division of Genetic Medicine in the Department of Medicine at Vanderbilt University. The American Society of Human Genetics (ASHG), founded in 1948, is the primary professional membership organization for human genetics specialists worldwide.

Transcription from Cox interview I.

What is ASHG’s position on the bill?

A. The genetics community worked hard to get GINA passed so this has caused great consternation and has basically gutted GINA. II. What do you think of the other side A. I would like to understand better why anybody thought this was a good idea. The ostensible purpose was to promote genetic testing to improve healthcare. The bill basically gutted GINA. III. What is your opinion on the argument that H.R.1313 will force employees to participate in wellness programs?

A. It’s very straightforward, wellness programs can be required by employers. In the past with respect to wellness programs, if a company had a mandatory wellness program that included genetic testing and an employee did not want to undergo genetic testing, there could be no financial penalty to the employee if they refused the genetic testing. Under the new bill if the testing was to be considered to be mandatory, they could be charged up to half of the cost of the entire insurance covered by both the employee and the employer, about 9k dollars. Previously without this bill, no employee could incur any financial penalty for refusing to undergo genetic testing. With this bill they could have been fined. In the past if they had chosen to undergo testing that info was private and shared only with their healthcare professionals. Under this bill the information could have been shared with employers and sold on the third party market. They can say they didn’t intend it to be coercive, they were asked to change the wording so it wouldn’t seem like that. I presume somebody wanted it to be coercive and wanted access to people’s genetic information. If the wellness program is mandatory, and if an employee refuses to participate they could pay a a large fee.

IV. What do you think should happen in the future of this policy and why? What would that do or what would the consequences be.

A. So the bill has been withdrawn *not true*, I think that bills that are genuinely focused on encouraging improved healthcare through genetic testing would be greatly welcomed by

the scientific community, but not at the cost of employers losing their privacy and their right to decline to participate.

V. What do you see as the obligation of your organization regarding this bill?

A. The genetics community in general really wants to insure that genetic testing is done the right way. That the American public can trust that their results will remain private and used in an appropriate way for their healthcare and not distributed to those who have no business.

VI. Her last thoughts A. Its fair to note that when comments are raised by the genetics community and others about this bill, very very small changes would have satisfied the bill. The people putting the bill together were unwilling to make those changes. It would have not been hard to make this bill not coercive. It would not have been hard to make this bill consistent with ADA and GINA. The fact that it was not and that they were not willing to make it not coercive and congruent with those things, I presume that there were people who wanted those things and pushed for them. I am pleased that the bill has been withdrawn *not true* and I hope not to see it in this form again.

Civic Engagement As I have just changed my paper’s topic, I have yet to complete my civic engagement component. My working idea is based on class discussion. The idea is to create a brief, accessible (i.e. bilingual) infographic describing what H.R.1313 is, does, and how it can affect employees. With this infographic in my mind, I plan to distribute it to the EEOC office in Austin and from there share it with any other body the EEOC recommends. Even though I will write the infographic in an objective way, my position on the opposing side of the bill is illustrated by giving this resource to the EEOC, who also oppose the bill. This civic engagement will effectively make a contribution to public understanding of the potential danger that could come from H.R.1313 is passed into law. By sharing a short, easy-to-understand infographic the probability that somebody will become the slightest bit more informed will be a great contribution to the opposition. Moreover, by putting this issue back on the EEOC’s radar both locally and hopefully nationally, there will be more influential people than myself working toward opposing this bill. Ultimately, I hope my infographic will help someone protect themselves from genetic discrimination.

Submission Three BETHSTONE SUB 3 Normative Question Should should H.R. 1313 be enacted in order to facilitate improved employee health?

Social Problem Proponents claim that in order to provide more favorable treatment of individuals with adverse health factors, rules regarding wellness programs need to be clarified.

Policy Information H.R. 1313 Preserving Employee Wellness Programs Act Introduced by Representative Virginia Foxx, a Republican from North Carolina and the chairwoman of the House Committee on Education and the Workforce.

Its stated goal is to, “clarify rules relating to nondiscriminatory workplace wellness programs.”

Proponents Insurance companies Employers Legislators Conservatives Religious people/groups They claim the bill will: Protect employee wellness programs Reassert congressional intent Encourage lower health care costs Promote a healthy workforce

Opponents Employees Scientists Physicians Health Care Workers Civil rights Activists Argue that the bill will: Financially force employee participation Give way to genetic discrimination Will not improve health care

Issue One The bill will force employees to participate Proponents Opponents Supporters argue that the bill will not make wellness programs mandatory.

In the article “Opposition grows to bill that would let employers demand genetic test results” from STATnews, proponents claimed that, “Supporters of the bill insist that this financial consequence does not make a workplace wellness program involuntary, and that it addresses employers’ confusion about what is and isn’t allowed.”

Mr. James P. Gelfand, Vice-President of ERIC, claimed that despite there being some financial motivations to participate in wellness programs, employees still have a choice, “Even a child knows that you still have a choice even if it is a lot of money.”

Critics argue that workers are essentially being coerced into giving up private medical information.

According to Snopes and STATnews this could be done if the H.R.1313 passes because it would allow employers to penalize employees. “Employees facing forfeitures of thousands of dollars for non-compliance will find such a demand [to participate in wellness programs] to be financially coercive,” Dr. Nancy Cox, Directory of the American Society of Human Genetics said in our interview that employees could be “charged up to half of the cost of the entire insurance covered by both the employee and the employer, about $9,000.”

Ethical & Logical Analyses H.R. 1313 removes genetic privacy protections. By allowing employers to financially penalize employees that refuse to participate or disclose information effectively forces workers who can’t afford the penalties to compromise their privacy rights. Moreover, this bill would let employers access employees' family health as well.

It is unethical to force employees to surrender genetic information as well as deny them civil protections under the GINA and ADA because it burdens employees with the decision to forego their rights or endure intense penalties.

Issue Two The bill will engender genetic discrimination Proponents Opponents

Issue Three The bill will not help improve employee health Proponents Opponents

Proponents argue that no privacy protections will be lost if H.R.1313 passes.

Representative Virginia Foxx claims that employee wellness programs can improve the health and well-being of America’s workers, and as a result, strengthen the nation’s economy. This claim is without evidence.

Mr. Gelfand claimed that “If 1313 passed into law, no Americans would lose protections under GINA.” In a NYT article, Bethany Aronhalt, a spokeswoman for the House committee, said the bill's goal was to address employers’ concerns rather than to drastically change the laws protecting workers.

“We want to ensure working families can continue to benefit from these voluntary programs, and so did the Obama administration”

Opponents argue that the bill undermines GINA and ADA, and will create a precedent for employers to make firing and hiring decisions based on health data obtained.

Dr. Aronson, physician and writer who wrote an opinion piece about H.R.1313 in the NYT argues that employers “could terminate or not hire someone based on this information. It’s really difficult to prove to this, but that doesn’t mean it doesn’t enter in to the equation. If Congress passes this law, it will be opening the door to statesanctioned health discrimination.”

Ethical & Logical Analyses Proponents are arguing that there would be no privacy changes if H.R.1313 were to be passed. However, there is language in the bill that would allow employers to demand private health information about employees and their families, thus effectively curtailing GINA and ADA. This is unethical because it takes away employees' civil rights and gives employers the power and impunity to fire people based on the health data collected.

A house committee spokeswoman told CNBC that those opposed to the bill “are spreading false information in a desperate attempt to deny employees the choice to participate in a voluntary program that can reduce health insurance costs and encourage healthy lifestyle choices.”

Rigorous studies by researchers not tied to the $8 billion wellness industry have shown that the programs improve employee health little if at all. An industry group recently concluded that they save so little on medical costs that, on average, the programs lose money. But employers continue to embrace them, partly as a way to shift more health care costs to workers, including by penalizing them financially. (from STATnews) In a 2016 Chicago Tribune article Al Lewis, a Boston attorney and former Harvard University economics lecturer,. said wellness industry vendors boast of "mathematically impossible results" of 3to-1 returns on investment and health care cost savings through studies that seldom withstand real scientific rigor and are later discredited.

Ethical & Logical Analyses The ultimate goal of the bill is to make health information and care more effective and affordable for employees.

H.R.1313 has no evidence to support its claim that wellness programs are effective, no evidence to support its collection of private health data, and no evidence to discredit opponents.

This bill is unethical because its purpose is to support the health of employees, but it is not doing anything to reach this goal all while undermining employee's civil rights.

Submission Two This capstone project will investigate the recently proposed H.R.1313, “The Preserving Employee Wellness Programs Acts” and the controversy surrounding the language within it. I question whether or not this legislation should pass the house without amendment as well as analyze the ethics of the bill. Throughout this capstone project I will analyze the ethical and moral reasons for the uproar, retaliation, and fear engendered by the language contained within H.R.1313 which has the potential to allow employers to heavily penalize any employee that doesn't not volunteer to participate in wellness programs hosted by the employer. The relevance of this topic is clear by its recent proposal and controversial status among many different groups.

At the end of this project I hope to provide a way to address the social problem of miscommunication between legislators, employers, and employees as defined by the proponents of the bill.

• Wellness Programs • A program intended to improve and promote health and fitness that's usually offered through the work place, although insurance plans can offer them directly to their enrollees. The program allows your employer or plan to offer you premium discounts, cash rewards, gym memberships, and other incentives to participate. Some examples of wellness programs include programs to help you stop smoking, diabetes management programs, weight loss programs, and preventative health screenings.

• GINA • A 2008 act that made it illegal to discriminate against employees or applicants because of genetic information.

• ADA • a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public This work will not be covering in-depth economics regarding health insurance or the inner workings of various health plans provided by employers.

Those who support H.R.1313 claim that the bill “is trying to streamline the regulatory scheme.” This is a quote from Kathryn Wilber, a senior official at the American Benefits Council, which represents employers’ interests. As of this writing, there several courses of action proponents have taken: they have lobbied for more support of H.R.1313, they have had any interviews arguing that this bill will not give employers the power to penalize employees, and they have been working to get the bill past the House. Proponents include employers from all sizes of business, but most especially large companies, lobbyists, conservatives, and conservative politicians.

Those against H.R.1313 typically includes liberals, civil rights activists, health care professionals, physicians, and scientists. Generally this group is against the bill because it oversteps and undermines GINA and ADA.

Works Cited 1. 110th US Congress. “Genetic Information Nondiscrimination Act of 2008.” (2008): 881– 922. Web. 2. Abelson, Reed. “Employee Wellness Programs Use Carrots And, Increasingly, Sticks - The New York Times.” The New York Times (2016): 2–6. Web. 3. Against, Discriminate et al. “Don ’ T Discriminate Against Mutants Like Me.” (2017): 2–5.

Print.

4. Agencies, Federal et al. “U . S . Equal Employment Opportunity Commission Definition of ‘ Genetic Information ’ Discrimination Because of Genetic Information.” 1–4. Print.

5. Begley, Sharon. “House Republicans Would Let Employers Demand Workers ’ Genetic Test Results.” (2017): 4–7. Print.

6. Employees, Require, and Genetic Testing. “Does House Bill 1313 Require Employees to Submit to Genetic Testing ?” 3–7. Print.

7. Flambeau, E E O C et al. “E.E.O.C. v. FLAMBEAU, INC.” 849 (2015): 1–6. Print.

8. Foxx, Virginia. “H.R.1313 - Preserving Employee Wellness Programs Act.” 115th Congress (2017): 16–17. Web. 9. Healthy, How et al. “How Healthy Are You ? G . O . P . Bill Would.” (2017): 28–31. Print.

10. “Group Opposition Letter” (2017): n. pag. Print.

11. March, D C. “Press Releases Committee Advances Reforms to Expand Affordable Health Care Coverage for Working Families.” 202 (2017): 2–3. Print 12. Pictures, Brand X. “U . S . Rep . Virginia Foxx Defends Her Wellness Programs Bill.” (2017): 3–5. Print.

13. Pollitz, Karen, and Matthew Rae. “Workplace Wellness Programs Characteristics and Requirements.” May 2016 (2015): n. pag. Print.

14. Preserving, The, Employee Wellness, and Programs Act. “Our View : House Should Shoot down Wrongheaded Bill Pushing Employees to Hand over Genetic Info.” (2017): 6–7. Print.

Submission One VII.Topic Question: (“Should”) A. Should H.R.1313 be enacted in order to facilitated improved employee health?

VIII.Underlying Social Problem: A. Proponents claim that in order to provide more favorable treatment of individuals with adverse health factors, rules regarding wellness programs need to be clarified. This argument implies that there is a social problem between inadequate communication of rules between the government, employers, and employees. From the proposition of this act several issues arise.

IX. Proponent Stakeholders A. In favor of enacting H.R 1313 B. General pro stakeholders 1. Large companies 2. Employers 3. Conservative Politicians 4. Conservative Lobbyists C. Specific pro stakeholders 1. Congresswoman Virginia Foxx 2. The ERISA Industry Committee X. Proponents’ Issues, Arguments, Evidence, and Plans/Actions A. Issue 1, Unclear rules 1. Proponents argue the bill is trying to streamline the regulatory scheme and make clear the rules and limitations set forth by GINA with regard to wellness programs.

B. Issue 2, Ensure working families benefit from wellness programs 1. Proponents argue that in order to serve employees the best employers can, employer concerns need to be address through this bill and other legislation that will reaffirm existing law and provide clarity.

C. Issue 3, No financial consequences will befall employees.

1. Supporters of the bill insist that this financial consequence does not make a workplace wellness program involuntary, and that it addresses employers’ confusion about what is and isn’t allowed.

D. Examples of pro plans/actions 1. Propose legislation 2. Amend H.R.1313 3. Share goals for H.R.1313 with constituents and media XI. Examples of Proponents’ Values (i.e. self-reliance, security, equality, liberty) A. Health B. Clarified rules C. Employee and employer financial security XII.Opponent Stakeholders A. Against H.R. 1313 in its current form B. General opponent stakeholders 1. Employees 2. Physicians 3. Health Care Workers

4. Civil rights activists C. Specific opponent stakeholders 1. The American Society of Human Genetics 2. Dr. Louise Aronson XIII.Opponents’ Issues, Arguments, Evidence, and Plans/Actions A. Issue 1, The bill will force employees to participate 1. They argue that the bill uses coercive language and punishes employees’ freedom that choose not to participate in wellness programs.

B. Issue 2, The bill will engender genetic discrimination 1. Opponents argue that the bill undermines the Genetic Information Nondiscrimination Act as well as the Americans with Disabilities Act. C. Issue 3, The bill will not improve employee health 1. Employers continue to embrace wellness programs despite no statistical evidence showing that they contribute to improved employee health. Opponents argue that this it is a way for employers to shift health care costs to workers.

D. Examples of opponents’ plans/actions 1. Writing letters 2. Addressing academic societies 3. Voting to have the bill amended XIV.Examples of Opponents’ Values (i.e. self-reliance, security, equality, liberty) A. Civil rights B. Genetic privacy C. Fair health insurance costs XV.Definitions/Explanations: (what specialized or technical terms or bureaucratic processes do your readers need in order to understand the topic?)

A. Genetic discrimination B. Health insurance C. Wellness programs XVI.Limits: (what related topics or questions will you exclude for reasons of space and focus?)

A. In-depth examinations of GINA and ADA B. Economics of health insurance