If you enter Yale Law School and make a left up the stairs, you’ll notice the stained-glass window portraits—a lawyer with a quilled pen, a judge clutching a case, the scales of justice—guiding you as you ascend. Rosanna Gonsiewski, a senior administrative assistant, climbs past those windows to her third-floor office every day, but she has yet to reach the promise of justice they hold. We meet on a quiet Friday afternoon inside her office, which we’re both relieved is empty. Her coworker is taking a sick day. Gonsiewski, I learn, holds onto those tightly. Especially after she used up twelve to satisfy Yale’s Health Expectations Program, or HEP.
Gonsiewski spent all of her sick days getting colonoscopies—not because her doctor mandated them, but because Yale, her employer, forced them.
After her fiftieth birthday, Gonsiewski received a notification that HEP, a mandatory health screening and “coaching” system for many of Yale’s unionized employees, was requiring her to get a colonoscopy. “Some of this is really disgusting,” she warns me. She laughs and puts her hands to her face, her brown curly hair bounces in front of her eyes. Gonsiewski had been previously diagnosed with an irritable bowel, so she knew that cleaning out her system for a colonoscopy wasn’t going to be an easy process. But if she didn’t complete the exam six months after her birthday, her paycheck would start to drop $25 a week—a cost she couldn’t afford. So she scheduled the colonoscopy for a month after her birthday. Then the complications began.
At first, she only planned to take three days off of work: one day for a clearing of the system before the procedure, one day for the colonoscopy, and one day for recovery. But during the first procedure her prescription medicine counteracted the anesthesia, and she was screaming “Ow!” on the operating table. They had to redo the procedure. Another three days off work. This time, her system wasn’t cleared and she would have to do two days of prep. Four more days off work. Ten sick days used.
Gonsiewski was irritated. After working so hard to accumulate her sick days, HEP was eating away at them. “This was not something I deemed an emergency,” she tells me. If it had been her choice, she would have waited to complete the colonoscopy during a break. Yet under HEP, the medical decision wasn’t hers to make. It was Yale’s. And the threat of losing $25 a week, Gonsiewski tells me, “instill[ed] so much fear” that she had to get the test done. Twenty-five dollars a week is $100 a month. One thousand three hundred dollars a year. It’s groceries for five weeks in New Haven. A month’s rent. Childcare. Money towards a mortgage. Part of her daughter’s tuition.
Last spring when Gonsiewski got the flu, she was too dizzy and feverish to come to work for four days. When she returned, she learned two of the days she was out sick were going to come out of her paycheck. Gonsiewski couldn’t believe it. She always left herself a cushion of sick days for medical emergencies like this. But after the colonoscopies required by HEP, she had none left until July 1. With a chronically ill husband and daughter in college, Gonsiewski couldn’t afford to miss even the days of pay that were already gone. She wouldn’t be able to take a sick or vacation day between March and July.
Gonsiewski is one of around 5,400 clerical, technical, cafeteria, maintenance, and power plant workers at Yale, who, belonging to unions Local 34 and 35, have been required to enroll in Yale’s Health Expectations Program since January 2017. HEP also applies to those employees’ spouses and dependents who use Yale Health or Aetna insurance. If employees (and dependents) don’t comply or choose to opt out, they suffer a fine of $25 per week.
Yale rolled out the workplace wellness program of HEP with the hope of keeping employees healthy—and also with the hope of reducing the money it spends on healthcare. In theory, if Yale could identify an employee’s health problem early, they could act early and avoid serious healthcare costs. Local 34 and 35 provide employees with affordable health care plans— with a $0 premium option if employees elect the Yale Health insurance. Yale was threatening to increase healthcare costs substantially, so HEP was negotiated as an alternative, lower cost option.
But when employees enroll in HEP, they are shepherded through a long list of invasive screenings and tests, like the colonoscopy Gonsiewski underwent. Christine Turcek, a first line cook at JE, who had a double mastectomy after battling breast cancer, was forced to get a mammogram under HEP. Even though she medically couldn’t complete the breast exam, she was still threatened with the fine. It took repeated long explanations to HEP representatives— which forced her to relive her experience with cancer each time—in order for them to grant her an exemption for the test. If an employee doesn’t complete HEP’s requirements by a certain deadline, the $25 per week pay dock begins. The weekly deductions continue for at least three months, regardless of whether the requirement is fulfilled before that period ends.
Although it’s not unheard of for companies to charge penalties for opting out of wellness programs, Yale’s non-compliance fee is among the highest in the country, according to the American Association of Retired Persons (AARP), meaning HEP is among the nation’s most punitive wellness programs.
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Jason Schwartz, a locksmith at Yale, refuses to comply with HEP on principle. He takes the $25 a week pay cut, his version of a silent protest. “For some people that work at Yale, $25 is a lot more money than it is for me,” he tells me when we meet at Blue State on Wall Street. Some people in his union earn only $16.92 per hour, and it’s often harder for them to accept the cut.
He leans across the table to whisper. “But I had to cut down on non-necessities,” he says. He used to visit his in-laws in the Philippines every year. The trip was something that he always looked forward to, but with the pay cut he’s suffered from not complying with HEP, he says he can no longer afford to go. His wife and daughter will go without him this year.
Schwartz is right: For many of Yale’s lowest-paid employees, like Gonsiewski, the choice to opt out isn’t financially feasible. That’s why Gonsiewski joined leading plaintiff Lisa Kwesell, a part-time service assistant at Yale, to sue Yale and to make HEP participation voluntary. The plaintiffs assert that HEP is “coercive.”
Under the American Disabilities Act and Genetic Information Nondiscrimination Act, employers can collect medical and genetic information from their employees only if they provide the information voluntarily. Since this law was enacted, there have been disputes over what “voluntarily” means. In 2016, it was deemed that employers could charge employees up to 30 percent of their insurance premium as a penalty for not participating in wellness programs—and still call the program “voluntary.” But in 2018, the AARP, which is known for fighting for employee rights in workplace wellness lawsuits, won a lawsuit that got rid of this clause in the law. Nothing was left in its place. With no new guidelines, just an absence of old ones, the question of what makes a program “voluntary” is now entirely up for interpretation. Yale declined to comment on the case due to the ongoing litigation, but the University’s legal stance is that HEP qualifies as voluntary. Many required to participate in the program disagree. Their legal battle with Yale has been proceeding for two years—with no clear end in sight.
HEP’s testing isn’t just problematic for those who have experienced certain medical conditions. Over-screening can cause “people to feel more vulnerable, to be terrorized by false alarms, and to be overdiagnosed and overtreated,” says Gilbert Welch a professor at Dartmouth College’s Geisel School of Medicine.
Some employees are particularly concerned with how HEP affects the privacy of their medical records. HEP is implemented not through Yale, but through a third-party company known as a wellness vendor, called HealthMine. Gonsiewski was shocked to learn she had to send her private information to a company she had never heard of. She had no idea a different company was administering the program until she received the link to register.
HealthMine gathers HEP members’ test results and insurance claims and sorts through the data. The company flags employees with high weight or blood pressure, diabetes or heart disease. It gathers their health records. And it reveals their information to yet another third-party company, TrestleTree. TrestleTree then connects the employees with mandatory health wellness coaches—nurses or dieticians who focus on providing strategies for managing stress and weight.
Yale calls TrestleTree a “health transformation organization” on the HEP website. But TrestleTree is not a covered entity under the Health Insurance Portability and Accountability Act, or HIPAA, a law that protects patients’ privacy. When enrolling in HEP, employees sign a contract that states, “I also understand that information disclosed under this authorization may no longer be subject to the HIPAA privacy rules.” Yale employee’s health information is then accessible to TrestleTree—and to the organization’s wellness coaches.
Noah felt like his coach was in his face even through the phone: “When did you weigh yourself this week? How much did you weigh?”
Yale claims that these health care coaches are “highly trained.” In fact, the only training required of TrestleTree coaches is a three-week program in Fayetteville, Arkansas. Yet these coaches are supposed to provide in-depth health counseling sessions, much longer and more intimate than one might have even with their own doctor.
In flyers sent to employee homes, Yale writes that TrestleTree’s health care coaches will “be a trusted guide and advisor for you and your health.” What Yale doesn’t say is that the health care coaches might pester you with phone calls until you complete a mandatory three-hour session with them. They might send you a tape measure in the mail if you’re overweight, as they did to plaintiff Mary Brassil. Or call and email multiple times a day, until you answer, as they did to Noah, a law enforcement official and a spouse of a Yale employee.
Noah, whose name has been changed in this story to protect his privacy, has a hard time talking about TrestleTree without raising his voice. “I’m a private person,” he said, “so right off the bat, the concept of talking to someone on the telephone who I’ve never met, who’s not a doctor, who’s not my doctor, who’s really not a stakeholder in my health felt totally invasive, over the top, and unnecessary.” Noah was recently hospitalized after Sudafed mixed badly with the diuretic pills he takes for his blood pressure. After this incident, HEP required him to see a health coach. Noah had sorted out what went wrong with his doctor, and he was soon feeling well again.
Yet when Noah was released from the hospital, he still had to meet with a TrestleTree health coach. “Right off the bat, a gun was put to my head,” he tells me. The coach called him at work, and when he didn’t pick up, she would call again. And then email him. And email again. He explains that the whole experience was “invasive, condescending and bordering on harassment.”
Noah felt like his coach was in his face even through the phone: “When did you weigh yourself this week? How much did you weigh?” He received calls multiple times throughout his work day and would have to complete his sessions during his free time. His coach, he said, obviously seemed to be reading from a script. Even though he explained to her he had to do one hundred sit-ups and one hundred push-ups a day for law enforcement training, she kept calling him to ask if he completed the core workout she recommended. Then she would email him the link to it. Again.
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For a company that seems to have so much information about its clients, Trestletree publicizes very little information about itself. None of the Yale employees I spoke to could tell me the name of their assigned coach, how the company got their health information, where TrestleTree is located.
I decided to investigate. Next door to Yale Human Resources on 221 Whitney is a brick building with what looks like an abandoned construction project blocking the front entrance. 205 Whitney Avenue. The sign in front advertises a construction company, Yale’s Women Faculty Forum, a nonprofit. There’s no mention of TrestleTree.
If you walk inside and turn left at the stairs, there’s a printed paper sign leaning against the wall, reading “TrestleTree Health Coaching (Office on the 2nd floor).” I take a picture. My first proof that the company’s real. I walk upstairs and the office seems abandoned. Each room has a scale. There’s a BMI chart. It seems more like a weight loss coach’s office than a health one.
A woman with a short blonde haircut, one of the coaches, is in her office. She tells me she really can’t say anything when I approach her. She seems nervous. She stands up immediately when I introduce myself and starts to usher me out. She tells me everything said has to be approved by her manager. I keep pressing but I’m met by silence. She brings me to her manager, a slightly younger woman with a similar blonde short haircut, and they share a look of rolled eyes and tight smiles before looking towards me. I can tell their lips are going to stay pressed together. I’m directed to check out the National Board for Health and Wellness Coaching for any more information. I leave carrying a post-it note with the URL.
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Barbara, an employee at Yale who requested that her name be changed in this article due to a fear of retribution, was flagged as someone who needed coaching, she suspects, because of her clinical anxiety. But her whole experience with the coaches, she tells me, stressed her out more. “I’m so pissed off honey, I can’t even tell you,” she’s smiling, and she says this through her teeth. We’re sitting so close together that I can feel her breath on my face. She tells me she has bronchitis, a polite warning I suppose, and I try to subtly shift away without offending. But, really, I’m not that worried. As a student at Yale, my healthcare is simple. Yes, sometimes the walk to Yale Health is cold and long, and sometimes there’s a wait. But beyond that, I never really worry that much when I feel sick. I just go to the clinic. I lean back in, deciding, slightly guiltily, that hearing her was worth the risk of sickness.
Barbara whispers, “You have to be careful here.” Her eyes are wide as they scan the room. Blue State on York Street is brimming with students— finishing their morning Hindi homework, eating a croissant after morning lift, trying to fit a Constitutional Law textbook and coffee on the small table. There’s no maintenance staff in the cafe. Or technical staff. Or clerks. No Union 34 or 35 workers. Nobody here would quite know what we’re talking about. But Barbara already feels targeted, surveilled, and she’s worried. So, we whisper.
“It’s such an intrusion,” she says of her coaching experience. “I said to [the coach] ‘Do you want know about my bills at home too? My mortgage?’ Seriously.” Barbara said she would rather give the health coach her financial information than her health history. “Medical records are so personal.”
A few minutes after Barbara leaves our interview, she returns and sits down next to me again, a little flushed from the cold, a little flustered by her thoughts. She’s speaking quickly and louder. “I just want to let you know I’m not against this university. I’m grateful for my job.” I assure her I understand. She pauses for a moment. “There’s just some bad stuff that goes on here,” she says.
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In the four colonoscopies that ate up Rosanna Gonsiewski’s sick days, the doctor found some polyps. They were precancerous and had to be removed. That finding, in some ways, explains why HEP exists, why it mandates rigorous testing: to find health issues before an employee gets truly sick, and before hospital visits and surgeries become too expensive for Yale.
Gonsiewski is glad the doctor found the polyps, but she didn’t want them found at that time, at the expense of her limited number of days off work. For her, their removal wasn’t “do or die.” If she had been in control of her healthcare, she would have waited until the operation worked better with her schedule, when she had a cushion of sick days. Over the phone her husband, Glenn, crystalised that feeling. He tells me he called up HEP saying, “If I want to drop dead, it’s up to me to drop dead.” Well, he says he learned, it’s actually up to the union.
Not every union at Yale has HEP in its contract. The Yale Police Benevolent Association, the police’s union, has a similar version of it, but union members that don’t participate in the program don’t have to pay a $25 fee. Managerial staff and faculty members aren’t subject to HEP. Neither are Yale students. A representative from the Local 34 and 35 unions who wished to remain anonymous maintained that since those unions— the maintenance workers, the technical workers— negotiated down to a a very low premium for employees (even $0 on Yale Health insurance), they had to give Yale something to promise that they would work to stay healthy and keep down healthcare costs.
Yet, as it turns out, the lowest paid employees at Yale are paying one of the highest fees for noncompliance in the country. Stanford University implements a wellness program with procedures similar to Yale, including screening and health coaching. But its program is incentive-based, rather than punitive: if employees participate in an advising appointment, a preventative screening, and make a plan for wellness goals, they can earn $200. If they take a wellness class, they can make $260.
“I’m a grown adult man. I’m going to be 47 next month. I’ve been in charge of my own medical care for my whole life,” Jason Schwartz tells me. He perceives that Yale doesn’t trust him to keep track of his own health—and this message feels personal. To Schwartz, Yale seems to be saying that those who do the most menial work on campus aren’t responsible enough to take care of their own health, but that those in higher positions at the university are.
In Yale’s view, the people who work more physically intensive, riskier jobs—such as a power plant mechanic or fire inspector—are more expensive to cover with health insurance. But HEP’s rigorous testing, coaching, and punitive fees make these workers vulnerable, too, just in a different way. HEP strips away your sense of choice over your own body, Schwartz explains to me.
Gonsiewski is surprised that more people aren’t talking about this issue. So is Barbara. And Noah. And Schwarz. HEP is affecting thousands of employees but many seem to think they’re alone in their sense of violation and victimization. Each of the employees I spoke with asked me if I had heard similar stories or complaints—unsure if they were the only ones. The silence around HEP is pervasive. But those who work in Yale’s kitchens, dining halls, and facilities are paying attention to their health—and their message is loud and clear.
– Elena DeBre is a sophomore in Pierson College. She is the executive editor of The New Journal