Obesity Surcharge

[maleficent]

[FONT=arial, helvetica]
[FONT=verdana,arial]September 3, 2008
[/FONT]
[FONT=Times New Roman, serif]Obesity surcharge amply justified[/FONT]
Alabama provides state employees with excellent health insurance coverage and is well justified in doing so. It is a sensible investment of the taxpayers' money in the people who make state government work for all of us.

But the state also is amply justified in its decision to impose an insurance surcharge for employees who are obese or who have any of three common health problems that contribute greatly to health care costs. Because state workers currently pay nothing for individual coverage -- a great deal that is all but unheard of in the private sector -- the decision by the State Employees' Insurance Board has drawn some complaints.

Such measures, however, are not without precedent. Four years ago, the state began charging state employees who smoke a surcharge for coverage that will reach $25 per month in the fiscal year that begins Oct. 1. Given the undeniable impact on health care costs created by smoking, a known contributor to cancer, heart disease, lung disease and other problems, this made a lot of sense.
One consequence of the decision has been a significant reduction in the percentage of state employees who smoke, down from 22 percent when the surcharge began to 19 percent today.
The latest surcharge related to obesity and the other common health problems is still a long way from taking effect. Beginning in January 2010, employees will face a $25 per month surcharge if they do not undergo health screenings -- conducted at no cost to them.

If the screenings detect serious problems with obesity, blood pressure, cholesterol or glucose, employees will have time to address the problems. If follow-up screenings do not indicate improvement, the $25 surcharge will begin in January 2011.

Problems with blood pressure, cholesterol and blood sugar can be treated with medication or lifestyle changes, or a combination of the two. A blood pressure medication, for example, is far less expensive than treatment for a stroke or heart attack or kidney failure, all of which can result from hypertension.
Obesity, which often has these problems as components of its threat to health, can be more difficult to address. The prospect of a surcharge may serve as further incentive for state employees to make healthier lifestyle choices.

Health insurance for state employees is a major expense for Alabama's taxpayers. It is hardly unreasonable to expect state employees to help keep costs manageable, especially when they benefit not only from good coverage, but also from improved health.
[/FONT]

 

[maleficent]

Alabama 'Obesity Penalty' Stirs Debate
Alabama 'Obesity Penalty' Stirs Debate
Plan Calls for State Employees to Pay More for Health Insurance if They Don't Lose Weight
By Don Fernandez
WebMD Health News
Reviewed by Louise Chang, MD
Aug. 25, 2008 -- Obese Alabama state workers may soon pay a health insurance penalty for their excess pounds.

Beginning in January 2009, state employees will be required to receive medical screenings for several conditions, including body mass index (BMI). Those who are considered obese -- along with exhibiting other negative health factors -- will have a year to get in shape.

The penalty for failure? A $25 increase in their monthly insurance costs.

Although critics view the penalty as a "fat tax," Alabama officials believe the new policies will result in fitter, healthier, and happier employees -- as well as help reduce the state's mounting health care costs.

"Our goal was to make our members aware of those risk factors," Deborah Unger, RN, clinical director for the Alabama State Employees Insurance Board in Montgomery, tells WebMD. "As long as you are aware and are doing something to correct it, there won't be a fee. We either do something to control claims costs or you pay the premium anyway."

Alabama now ranks as the second most obese state in the U.S., according to the CDC -- perhaps a clear sign that change is needed. In addition to BMI, the state will screen three additional criteria: cholesterol, blood pressure, and glucose levels. These four risk factors have consistently resulted in costly treatments for the state.

Opponents of the Obesity Penalty
While the plan might seem practical, some experts question whether paying a fee for being obese is the best motivator for overweight people.

"We certainly wouldn't support these kinds of punitive measures," says Jeffrey Levi, PhD, executive director of Trust for America's Health and associate professor of health policy at George Washington University School of Public Health. "The successful measures by health plans focus on incentives rather than punishment."

The Alabama requirements, Levi tells WebMD, could be interpreted as a genetic penalty for those who are predisposed to having extra weight or high cholesterol. Some people also require a variety of treatments or medications before finding one that is effective. Making those who fail pay from their pockets also places more economic pressure on them, he says, which could lead them to turn to cheaper, calorie-dense food.

"We need to recognize the complexity of these things," Levi says. "Just addressing this through the health care system is insufficient. What are we doing about the workplace environment? What's served in state cafeterias and hospitals? We need to do the voluntary things first for people to be able to make healthy choices before forcing punitive measures."

Alabama employees at risk will receive some help in their quest. The state is arranging programs with Weight Watchers and offering employees YMCA discounts. Information will also be available at behealthy.com, a Blue Cross-Blue Shield web site that provides online wellness tools and news.

But the prime motivator for this policy is hefty health care costs. And the attitudes of employers and employees may reflect an ambition to help remove obesity from the equation.

Employees and Employers: Seeking Obesity Solutions
A recent survey conducted by the National Opinion Research Center (NORC) at the University of Chicago, partnered on the research with the George Washington University School of Public Health and Health Services, showed that:

80% of employees, regardless of weight, believe healthy lifestyles/weight management programs belong in the workplace.
67% of employers are concerned about obesity's effect on medical claims expenses.
93% of employers see obesity as a preventable condition and due to poor lifestyle choices.
Fewer than half of employers believe their company has given enough attention to the problem of obesity.

Christy Ferguson, director of the STOP Obesity Alliance in Washington, D.C., which commissioned the survey, tells WebMD that while employers are eager to promote weight loss, only about a quarter of those surveyed believe financial penalties should be placed on those who have difficulty succeeding.

"While employers and employees favor positive financial incentives, they oppose negative financial penalties," she says. "There's a strong support for the carrot, so to speak, and not-so-strong support for the stick."

Key in all of these programs and findings is that shedding excess pounds is intrinsic to good health. But does thin and trim always equal fit and healthy?

A report released this month by The Archives of Internal Medicine, which weighed cardiometabolic risk factors vs. weight, revealed that among the 5,440 participants -- U.S. adults 20 years old and older -- 23.5% of "normal weight" adults were metabolically abnormal. Conversely, 51.3% of adults deemed overweight and 31.7% classified as obese were declared "metabolically healthy."

Lifestyle and activity levels certainly vary between individuals, but the link between weight and health doesn't appear to be absolute. And unlike many conditions which remain discrete, obesity is on full display.

"I don't think we can arbitrarily pick out one specific set of people with health risks," San Francisco internist Ann Haiden, MD, tells WebMD. "There is evidence that fit people with a little excess weight can actually be healthier than unhealthy normal-weight people. What we don't need is for a policy like this to turn into yet another reason to exclude as many people as possible from the insurance pool."

Even with a $25 monthly bill, Alabama state workers boast a plum health care plan. Single state employees pay no insurance fees, Unger says, while family plans -- which can include a spouse and several children -- only cost $180 per month. Spouses and children of state workers will not be subject to the wellness screenings.

Legally, these new protocols could face few serious threats.

Myra Creighton, an Atlanta labor and employment attorney who specializes in health-related issues, says many people are unsympathetic to obese individuals, which could make civil liberties organizations reluctant to pursue opposition. Michigan, she says, is the only state where weight is categorized as a protected class for workers.

Ethical Issues of Penalty Proposal
Still, she does question certain ethical aspects of these actions.

"Do I have any privacy interests in my body weight?" Creighton says. "I'm just glad my firm doesn't require me to hop on a scale."

While the converted are often the most zealous agents for change, one Alabama resident who triumphed against the scale finds the state requirements somewhat troubling.

Enterprise, Ala.-resident Roger Shultz, this year's runner-up on the NBC TV show The Biggest Loser, nearly cut his formerly obese physique in half while appearing on the show. Shultz, who lost 164 pounds, has kept his 6-foot-3-inch frame at a lean 222 pounds since the show ended. He's now a spokesman for Scale Back Alabama, a state-sponsored campaign that promotes weight loss and exercise.

Keeping trim in Alabama is sometimes challenging: "We deep-fry everything," he tells WebMD. But instituting fines for failing doesn't seem like the right step to him.

"I worked for a state institution and I'd hate to see something monetarily taken away from me," says, Shultz, who was employed at two Alabama colleges. "We have to be healthy, but I don't think you should penalize people for being heavy."

 

[maleficent]

I almost want to move to Alabama just so I would only have to pay 25 bucks a month for insurance... I'd kill for insurance that cheap...

What really stands out for me thoug with this -is that at my heaviest weight - my blood sugar was perfectly normal, my cholesterol, perfectly normal, my blood pressure slightly elevated but not considered hugely high... I have not taken a sick day in the past 15 years -I am never sick - my weight never impacted health care costs - skinnier people I worked with could absolutely not say the same thing...

 

[angel98]

I have a friend who has insurance like this. It is doing physicals though as well. If you smoke or are overweight you get the surcharge BUT if you can show evidence that you are working on these things, they won't charge it. My friend is overweight and has a gym membership. That is enough to avoid the surcharge. Even if she stays overweight, I guess they figure the membership at least means she's active. *shrug*

 

[maleficent]

Alabama employees at risk will receive some help in their quest. The state is arranging programs with Weight Watchers and offering employees YMCA discounts.

though that perk isnt bad

Smoker's already get charged a surcharge -It doesn't seem to make people smoke any less... so it's nice to see that they're trying to educate a little instead of just penalizing people...

What's next -surcharges for people who drive too fast, don't wear their seatbelt, don't wear helmets when they drive, don't practice safe sex, cheat on their spouses, drink?

 

[txsqlchick]

I have a friend who has insurance like this. It is doing physicals though as well. If you smoke or are overweight you get the surcharge BUT if you can show evidence that you are working on these things, they won't charge it. My friend is overweight and has a gym membership. That is enough to avoid the surcharge. Even if she stays overweight, I guess they figure the membership at least means she's active. *shrug*

My gym membership costs more than a $25 surcharge.

In a way I can see the potential benefits of this; if people can actually see the increased cost of insuring them flying out of their pockets, they may make the necessary changes. OTOH, they might simply resent the "intrusion".

As someone who is still obese, I see the looks I get. I hear the lectures from my doctor. I'm constantly bombarded by ads on TV, in print, and on the net to LOSE WEIGHT! GET THIN! BE SEXY! Even my own family tells me I'll never get married again unless I lose weight. I've been hearing it for years. It's not as if I don't "get" it.

I can't even explain where the motivation came from this time; I think it was a combination of things: the breakup of my relationship, the constant pestering from my doctor and the realization that I was doing serious harm to my body, the getting older and realizing I didn't want to spend the rest of my life fat...I dunno.

If $25 a month is a kick up the ass to enough people, I think it's worth offending a few other people. I like how it doesn't single out obese people either; everybody has to undergo the screenings or face the charge, and you can have hypertension or high cholesterol...or even diabetes...and be a perfectly normal weight.

It'll be interesting to see how this plays out as time goes on.

 

[edco76]

One thing that can,t be overlooked in this is that despite being one of the poorest states year after year Alabama state employees have some of the best benefit programs in the country. Our government is pretty corrupt. We have the same irony in our education system. We have on of the worse systems in the US but our teachers union is one of the best. Go figure.

As far as the policy goes, I am fine with it so long as it is monitored by screening based rather than formulaic. As mal said just because you are overweight doesnt mean you are unhealthy. And vice versa.

We have the same deal in all other insurance. Higher risk = higher premiums. I have a damn chronic disease and still don't need half as much care as some of the people at my work. I still pay my 450 a month though.

 

[maleficent]

it's any "high risk" behavior that has a potential cost down the road... people who get regular sunburns run the risk of skin cancer

Just because a person is thin, doesn't mean that they eat healthy or are healthy...

I don't object to surcharges -I object to surcharges on a group..

 

[txsqlchick]

I'm one of the lucky ones...I work in the private sector and my insurance is outstanding. It also costs me $0 a month. The trip that my doc DEMANDED that I make to the ER a few months ago cost me $53 in co-pays. I was actually kind of pissed because all the docs did was take my blood pressure. Twice. I wonder what the actual bill was. I bet with another plan my portion would have been much higher.

Right now we have no "wellness plan" at work aside from discounted gym memberships at Bally's. I use 24 Hour Fitness instead because even with the discount, Bally's is more expensive than 24 Hour. One thing I've noticed about my company is that there are far fewer overweight/obese people than could be expected in a company this large. I'm not saying that we discriminate, but it certainly does appear to be the case on the surface. Most people who work here appear to be a normal weight. In a country where over 65% of adults are overweight/obese, it's startling to be in the minority in that respect at work.

 

[LowFatMilk]

My healthy weighted mother with her thin stomach, and and hour glassed shape eats her chips, her doughnuts, her garbage (She eats the healthy food too. She eats it all) and her sit down all day office job-- is going to be charged less than me who is making the effort to get healthier in all aspects, but who is still at 250lbs.

Hm.


Glad I live in Canada.

 

[ABBAgirl]

I, too, am glad to live in Canada for the sake of our affordable health care. Just so our Southern neighbors know, it is not free - just not debilitatingly expensive.

I work at a hospital, and am VERY concerned by the ill health of my coworkers! Smoking and obesity are the first issues that come to mind. I am pushing for a fitness room as our facility expands, but don't expect to get anywhere with it. It blows my mind when health care workers are dangerously unhealthy!

JM2C
ABBA

 

[txsqlchick]

I, too, am glad to live in Canada for the sake of our affordable health care. Just so our Southern neighbors know, it is not free - just not debilitatingly expensive.

I work at a hospital, and am VERY concerned by the ill health of my coworkers! Smoking and obesity are the first issues that come to mind. I am pushing for a fitness room as our facility expands, but don't expect to get anywhere with it. It blows my mind when health care workers are dangerously unhealthy!

JM2C
ABBA

When I lived in the UK there seemed to be a lot of "not caring" from people about what they did to their bodies because no matter what they did to themselves, they'd get free healthcare. Then again, there was also a lot of irritating nannying from the government because of the increased costs to the NHS from smoking, binge drinking, and obesity. 6 of one, half a dozen of the other I guess.

 

[Ted2]

I guess something like an obesity tax would make money and be simple to set up.

I just wonder why governments don't think of doing things like subsidizing gyms, or healthy food. I guess the cost would be a lot, but in a country like Canada with natinal health care, it would probably save money in the long run.