It is a smart bet. A recent Milken Institute report puts the chronic-disease price tag of lost productivity at $1.1 trillion, with additional estimated treatment costs of $277 billion. Hewitt estimates that a typical 10,000-employee company spends $18 million to $22 million on direct medical care just for its diabetic employees.

Employers are clearly fed up with waiting for the federal government and insurers to get a grip on healthcare costs and are taking things into their own hands, especially because they are footing a majority of the bill. About 60 percent of Americans got their health insurance through their employer in 2006.

The payback varies, and sometimes it takes a while to recoup it. But a 2005 American Journal of Health Promotion analysis of studies of return on investment for workplace health promotion found an average of $5.81 per $1 invested in programs. The American Heart Association (AHA) claims $16 savings for every $1 invested. The return includes improved employee health, reduced medical expenses and absenteeism.

Wellness programs typically include employee health assessments and interventions aimed at minimizing health risk factors, such as smoking, excess weight, high blood pressure and high cholesterol. Fitness classes, subsidized gym memberships and tobacco cessation counseling are popular.

These efforts can take the edge off the economic downturn’s impact on health. A March AHA survey showed 57 percent have altered health behavior by dropping gym memberships, eating fewer fruits and vegetables, skipping doctor appointments and forgoing medications.

But employers get the biggest payback when they target chronic conditions, ensuring employees are monitored properly to avoid complications from heart disease and diabetes. An estimated 30 percent of workers have an undiagnosed chronic condition, and another 25 percent are considered at risk of developing one. Heart disease and diabetes can comprise an estimated 90 percent of hospital and physician payments for a typical company.

This is all well and good, but companies offering to help are not feeling the love.

Employee participation in these services is only about 15 percent, according to a PricewaterhouseCoopers survey. However, they are significantly more likely to participate if they receive incentives such as gift cards or insurance premium reductions.

An encumbrance historically, the federal government is finally catching on that the private sector is taking the initiative to attack health costs and that it needs to get out of the way. Federal law limits the amount of financial incentives companies can give employees for losing weight or kicking a smoking habit. It also treats subsidized gym memberships as taxable income.

Health reformers want to remove the handcuffs. One of President Barack Obama’s eight goals for health legislation is investment in wellness and prevention. There is a flurry of legislation from both sides of the aisle. Democratic Sens. Tom Harkin of Iowa and Max Baucus of Montana want to grant tax credits for corporate wellness programs. Sen. John Cornyn, R-Texas, is sponsoring the Workforce Health Improvement Program Act of 2009 to allow employers to subsidize health-club memberships up to $900 annually.

State Sen. Jane Nelson, R-Flower Mound, has expressed a desire to give tax credits for corporate wellness efforts but has not been able to gain any legislative traction.

But critics have emerged because some companies are also making employees financially responsible for unhealthy behavior. They may charge more for health insurance to those who fail to take corrective action after they have been counseled about their condition and advised of a course of action. For example, employees who have high cholesterol ethically cannot be penalized for the condition because it may be genetically influenced. But they can be penalized for not taking cholesterol-lowering medicine or attending a pertinent class.

Companies — and many of their healthy fellow employees — argue that workers who are unhealthy by their own actions are harming everyone by driving up the firms’ cost of health insurance. For that, they say, there should be a price.

Worker-rights groups and unions argue employees should be judged on job performance, not health habits, and companies have no right to intrude on private lives. Such corporate paternalism has a long history. Nearly a century ago, Ford Motor Co. investigators visited workers’ homes to check on their sex lives and drinking habits.

The National Institutes of Health (NIH) has established guidelines to ensure workplace wellness programs are being ethically administered. The NIH warns employers not to create standards that are unnecessarily difficult to achieve or potentially harmful. And the financial penalties should be designed to provide an incentive to change behavior instead of attempting to recoup costs.

The workplace is an ideal venue for prevention and wellness. Motivated companies can, in turn, motivate employees, and everyone wins. Congress needs to deliver on this pillar of health reform and do its part to allow it to continue to flourish.