On Thursday, Republican Gov. Jan Brewer of Arizona proposed that some enrollees in the state’s Medicaid program—including smokers and those who are obese who don’t follow a regimen under a physician’s supervision—should pay a $50 fee. According to the Wall Street Journal, such a plan “would mark the first time the state-federal health-care program for the poor has charged people for engaging in behavior deemed unhealthy.” Advocates for individuals with disabilities—who may be obese because they are physically unable to exercise—and others have issued an outcry.
Gov. Brewer offered the plan as one way to raise funds for Arizona’s Medicaid program, whose budget she recently, and drastically, cut. According to the Centers for Disease Control and Prevention, 25.5% of Arizona’s residents were obese as of 2009, ranking it about in the middle among states. A 2006 survey by the state’s Medicaid agency says that about 46% of Arizona’s Medicaid enrollees smoke daily.
If ratified, the measure would revive coverage of organ transplants, which Arizona limited last year as a way to save money. It would also reduce the number of childless adults disqualified from Medicaid to 135,000, compared with the original proposal of 250,000.
“If you want to smoke, go for it,” said Monica Coury, spokeswoman for Arizona’s Medicaid program. “But understand you’re going to have to contribute something for the cost of the care of your smoking.”
She said the proposal is a way to reward good behavior and raise awareness that certain conditions, including obesity, raise costs throughout the system.
Ms. Brewer’s surcharge would apply only to only certain childless adults: Those who are obese or chronically ill, and those who smoke. They would need to work with a primary-care physician to develop a plan to help them lose weight and otherwise improve their health. Patients who don’t meet specified goals would be required to pay the $50, under terms of the proposal.
Coury said that Arizona officials have not yet determined how they will decided if a person is obese or if he or she is not following a wellness plan.
Should the measure pass, it still faces scrutiny by the Centers for Medicare and Medicaid Services in Washington. Federal rules could prevent Arizona from enacting the levy which no state has ever been approved for. Unlike private insurers, Medicaid must enroll all those who meet its eligibility requirements. As states have struggled to balance their budgets, Medicaid—which, along with education, is one of states’ top two expenditures–has become one of their biggest problems.
State Sen. Kyrsten Sinema, a Democrat, said “such a fee would unfairly penalize those who can’t control their weight” and I believe she is accurate. Gov. Brewer’s proposal implies that losing weight is just a matter of changing bad habits and that, if you are not able to, you are not exhibiting good behavior and should be penalized. Of course people should be encouraged to have healthy lifestyles and eating habits. But the proposal stigmatizes those who are obese by requiring them to pay more and in effect singling them out as those who don’t have ‘good behavior’—as those who are, well, bad.
Photo by mrd00dman.
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