AZ Governor Proposes ‘Fat Fee’ & ‘Smokers’ Fee’ For Medicaid

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.


LMj Sunshine

Thank you.

LMj Sunshine

Thank you.

LMj Sunshine

Thank you.

Norma V.
Norma Villarreal5 years ago

Obesity and smoking....not easy to overcome. Why is it applying to certain childless adults?

Ann G.
Ann G.5 years ago

I don't agree with the idea of forcing people to pay for being overweight, for reasons already stated here. I do, however, think that people should have to pay for smoking. People shouldn't smoke, plain and simple, and this might make some people think more seriously about quitting. As has been already pointed out, $50 is a lot of money for many people, but since the bill already contains a provision that you have one chance if you are a smoker to change your ways before getting the fine, there is no way to be unfairly "jumped" and not given time. I think that this bill needs work- how long after the first warning should the fine be applicable, and how exactly do you determine what is "has a plan" to quit smoking?- and I think that the bill should be reviewed by a team of doctors and lawmakers together before the final draft is introduced, but I think that overall it is a good idea. I never thought I'd see the day when I agreed with Jan Brewer, of all people, but it has arrived.

Petra Luna
Petra Luna5 years ago

Rather than an all or nothing attitude, why not accept people who need the help, and mandate that they go on a smoking cessation or weight loss program before denying coverage. If they don't comply, and some of them will sneak, while others will try and fail, make a decision based off of that. That makes more sense.

Jennifer W.
Jennifer W.5 years ago

I watched my mother deteriorate over twenty years and then spend weeks drowning in her own fluids due to cigarettes. I think free/subsidised medical aid should be denied to smokers until they stop. You've got to be cruel to be kind in this case.

Emanuel v.
Emanuel v.5 years ago

It is not their fault.that many people are obese The government encourages the refining and processing of most staple foods. It's the fault of corporates, Governments and doctors that make it difficult and even impossible to get hold nutritiously potent food. What is worse is that the FDA attempts to suppress supplements that are designed to compensate for all the vitamins and mineral complexes that are missing from our chemicalised and over heated diets It's making people chronically ill.
Don't be surpirised that all that denaturation of food, water and air is a deliberate plan by the WHO { World Homocide Organisation} to make a killing while they are at it. Healthy people don't need doctors and live too long. and that is counter productive.when a depopulation at the heart of their culling policies.

Lika S.
Lika S.5 years ago

Nanny state republicans at it again. While on one hand I do totally encourage to not smoke, and if you can afford cigarettes, you can afford to at least pay the $50 sign up fee.

As for over weight people, it's not always about not following a doctor's regimen. Had this particular doctor not gotten fired, I'd be one to be denied because I refused to go on the Atkins diet. Because I wanted something more reasonable, say a well balanced 1500 calorie diet, he refused to help with ANYTHING because I refused his Atkins diet. Not even a referral to another professional... like say a nutritionist or dietitian or what have you.

Jeannie Miner
Jeannie Fuchs5 years ago

Yet another time when the government is hurting the poeple instead of helping, another sad day for Americans