Home News Feed Arizona Governor Proposes “Fat Fee” For Medicaid Enrollees

Arizona Governor Proposes “Fat Fee” For Medicaid Enrollees

by Erika Nicole Kendall

Presented without comment:

Arizona’s governor on Thursday proposed levying a $50 fee on some enrollees in the state’s cash-starved Medicaid program, including obese people who don’t follow a doctor-supervised slimming regimen and smokers.

The plan, if approved by the Republican-dominated legislature, would mark the first time the state-federal health-care program for the poor has charged people for engaging in behavior deemed unhealthy.

[…]”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.

In Arizona, 25.5% of residents were obese as of 2009, according to figures from the federal Centers for Disease Control and Prevention, ranking it about in the middle among states. About 46% of Arizona’s Medicaid enrollees smoke daily, according to a 2006 survey by the state’s Medicaid agency.

State Sen. Kyrsten Sinema, a Democrat, said such a fee would unfairly penalize those who can’t control their weight. “If someone is obese because they’re severely disabled or can’t exercise, we shouldn’t be punishing them,” she said. “I mean, it’s not their fault.” Ms. Sinema said she would vote against the plan—mostly because of the enrollment cuts—and said such changes would require approval by voters rather than lawmakers.

Such a Medicaid fee typically would need authorization from the Centers for Medicare and Medicaid Services in Washington, and federal rules could prevent Arizona from enacting it. Mary Kahn, a spokeswoman for the agency, said no such levy has ever been approved.

Ms. Coury suggested federal rules may not apply to those affected by the proposal, because Arizona extends coverage to them beyond what Washington requires.

Unlike private insurers, which often charge different premiums based on customers’ health status, Medicaid must enroll all those who meet its eligibility requirements.

Medicaid’s rising cost has become one of the biggest problems for states struggling to balance their budgets. It is one of states’ top two expenditures, along with education, and has ballooned in recent years as more people lose jobs and otherwise fall on hard times.

Ms. Coury said Arizona officials hadn’t yet finalized how they would determine whether a person was obese or had sufficiently followed a wellness plan, but that measures such as body-mass index could provide some guidance. All childless adults enrolled in Medicare who smoke would be required to pay the annual $50 fee.

If approved as is, the provision would take effect Oct. 1. [source]

So, BGG2WL, let me ask you a question. What do you think the “weight loss plan” their primary care physician will create would consist of? If it’s more of the same thing we’ve been fed for the past few decades, it’s likely that more people who already struggle with health care… will be paying more money to get it.

I’m pretty saddened by this. What do you think?

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Nichole April 1, 2011 - 2:05 PM

This article saddens me as well. It adds to the myth that people choose to be overweight. It puts the blame solely on the individual who is merely displaying symptoms of a broken system that supports bad eating and unclean food. It also supports the misconception that fat=unhealthy and skinny=healthy. There are plenty of people who don’t fall into the “overweight” category and continue to eat the same junk that leads to health problems. Another issue that I take is that the people who qualify to be on Medicare may be struggling to afford healthy food. Many times the inexpensive options that are readily available are the same ones that are causing them to be overweight. If the government really wants to “reward” good behavior then there would be more incentives targeted at the root of the problem and to support healthy eating. I’m not saying that there shouldn’t be individual responsibility for what you choose to put in your body but I am saying that this type of action will not address what the problem truly is.

Ben Hyrman April 1, 2011 - 2:46 PM

Having grown up poor, I disagree about your statement that the poor often don’t have access to healthy food. We were so poor that we couldn’t afford the unhealthy food! Dried beans and rice go a lot further than McDonald’s and Doritos.

But, I agree with absolutely everything else 1000%. While overweight may be an indicator of an unhealthy diet/lifestyle… slim is absolutely no indicator of a healthy lifestyle.

Plus, where does this stop? Raise health premiums for people that drive versus take the bus? (if, for example, you’re statistically more likely to be involved in an accident while driving)

Erika Nicole Kendall April 1, 2011 - 3:11 PM

I have to tell you, Ben… I don’t know that I like this contention – it’s kind of argument by anecdote. “We were so poor we couldn’t affrd the unhealty food, either!” My own personal story counters yours – “Well, WE were so poor theonly thing we had within reach were convenient stores that sold soda and $0.25 bags of chips and penny candy!” While I can understand your point, it’s not about just having access. It’s access plus knowing WHAT healthy food consists of and how to take advantage of it. People come to this blog every day looking for help with that, regardless of how much money they have. I think we all can agree that there’s more than a little confusion.

All I’m saying, is that I don’t know that your story disproves her overarching point about price points preventing people from better options, and AZ focusing in on the wrong things, here.

Ben Hyrman April 1, 2011 - 3:17 PM

and since I agreed with her overall point (plus, my question of where would one choose to draw the line on penalizing people), I’m not sure what the contention is.

Erika Nicole Kendall April 1, 2011 - 3:24 PM

Simple. It’s here: “Having grown up poor, I disagree about your statement that the poor often don’t have access to healthy food. ”

Just because one person’s family “made a way,” doesn’t mean that everyone else can or knows how.

Ben Hyrman April 1, 2011 - 5:42 PM

“knows how” is different altogether. I didn’t ever claim that one automatically knows carrots are better for them than cheetos. After all, that’s why you have a blog, I assume, because not everyone knows how.

I was simply disagreeing with her statement that poor people can’t afford or have access to healthy food. While it may be true that access is an issue for some people, it’s also true that access isn’t an issue for other people. And, Erika, since you and I both grew up poor (or our approximation of what that is) and we both have different stories then truly that must be the case.

However, access and cost shouldn’t be conflated (although it can definitely contribute… I know I wouldn’t want to take two transfers both ways and come back with a 20 lb bag of beans if I didn’t live close to any sort of food store).

Anyway, I think I’m participating on the wrong blog… so I’ll stop bothering you now.

Erika Nicole Kendall April 1, 2011 - 6:57 PM

I just.. I’m not understanding why because it’s not an issue for ALL of the poor, it shouldn’t be considered an issue. I’m confused by that. It isn’t everyone’s issue, but it is an issue that needs to be tended to because it is a road block for some when it comes to healthy eating.

I’m also confused by the idea that you’re bothering anyone, or that you’re participating on the wrong blog. We simply disagree, here. I disagree with lots of people here every day and that doesn’t make them any less welcome, Ben.

Danielle April 1, 2011 - 4:15 PM

Erika, this is what your repsonse to Ben sounds like to me…

“It’s not like there is any type of nutrition education in public schools these days, and even if there are -we have parents who don’t know how to be responsible for their kids nutrition. It’s the not the kids fault because their parents didn’t know any better, and it’s not the parents fault because they’re just passing on what THEY were taught as kids, and of course we have a limited budget to think about. ”

Here’s the thing- at what point does personal responsibility come in to play? Im not even talking about ‘blacks’ here, I’m talking about the American masses .

Erika Nicole Kendall April 1, 2011 - 4:23 PM

I’ve always believed that food was a personal responsibility issue… I’ve written about that countless times on this very site. It’s part of the reason why I HAVE this site. Because even though it IS a personal responsibility issue, if enough generations of food knowledge and basic cooking skill have been wiped away by the convenience of processed foods, how many untainted resources are there out there?

That doesn’t change the fact that government involvement implies an element of benevolence and an “Of course I have the answer and my answer is the RIGHT answer – I’m the government, for crying out loud.” at play, here. So if the government is going to come in and do it, then they need to do it RIGHT. That means not penalizing people for doing things the government’s way – the wrong way, as we’re pretty much assuming, here – and still failing, when it’s a failing path to begin with.

Carmel April 1, 2011 - 2:35 PM

Ahhhhh. It’s more of the same kind of condescending views that plague the Republican party’s way of doing business. Fining people for their lifestyle will cause a significant number of people to not show up to the doctor. This will result in treatable diseases becoming fatal. They have no real plan on how to foster the weight loss they demand work but they can definitely penalize. Will they provide programs to help people learn about better food choices, work out plans? Initiatives to get the community to get healthier, enforce fines on companies that make foods that are helping in the maintaining this health crisis?
It just feels wrong.

Rooo July 23, 2011 - 5:45 PM

“They have no real plan on how to foster the weight loss they demand work but they can definitely penalize.”

This. Absolutely this. Because it’s easier to blame the individual than address the corporations that directly contribute to the problem, as you talk about below.

“…enforce fines on companies that make foods that are helping in the maintaining this health crisis?”

This is what they should do, but I think we all know if the Big Ag lobbyists continue to have their way, that will never happen — unless there’s tireless work to expose what they’re doing.

Eva April 1, 2011 - 3:42 PM

I don’t like this; just because a person is thin doesn’t mean they’re not eating junk that might make them sick years later.

However, I don’t get what you mean by “teach them how to eat.” My mother and I both learned how to eat in school, when they taught you to eat protein, a vegetable and a small portion of starch (rice, potato, etc). I think the issue is today that so many people learn how to eat from watching TV and they take everything they see on TV as fact. I saw that video of Jamie Oliver teaching children what was in chicken mcnuggets and the kids STILL wanted it, even after learning it was nothing but crap. That’s because they’ve been brainwashed by TV.

Erika Nicole Kendall April 1, 2011 - 3:53 PM

First, I think the answer – when it comes to kids – is to look to the adults controlling the situation. Kids don’t make decisions. Adults make them for them. Kids follow suit.

That being said, you teach people the same way one could infer that this blog “teaches” people. I didn’t “learn how to eat in school.” I suspect that many others didn’t, either.

That doesn’t take away from your point about being brainwashed by marketing, though – lots of people have wasted money on ridiculous purchases because a commercial gave them the indication that it was the right move… and that relates to food, clothes, cars, voting, medication and beyond. I suppose people have to “learn” how to deal with those, as well.

milaxx April 1, 2011 - 4:07 PM

I’d like to see what the state recommended weight reduction program consisted of first. My own personal experience is that one size fits all programs not only don’t work, they often cause more problems. I can agree that there should be more education on health and nutrition, but this bill sounds like it’s penalizing people who often already have very few resources.

In my own search for better health, I went to 2 different nutritionist. The first one insisted that I eat chicken and I would lose weight. (I’ve been a vegetarian for 15 years). The second recommended I join Wight Watcher’s. I have nothing against WW’s in fact I think it’s one of the more nutritionally sound weight loss programs out there. The thing is I wanted to eat more cleanly and WW recommends a lot of “sugar free” and “low calorie” foods with additives that I don’t want in my diet. Additonally I’d rather use my limited funds on a gym membership rather than paying WW’s meeting fees.

Finally a friend took me to a naturapath. She looked at me as a person. Things like the endocrine issues that run in my family and how that effects how my body processes foods. She also talked about the nutrients my body may be lacking as a cancer survivor. More importantly she discussed with me how to eat nutritionally as a vegetarian. How to get adequate protein. How my sleep patterns, and life style would all play a part in my endeavor to lose weight. We discussed sample diets and advised me on what foods might not work with my body chemistry. She helped me look at this as a lifestyle change, not a diet.

My concern is a bill like this would send someone like to one of the nutritionist I saw at first. That’s a set up for failure.

Sadly we live in a nation where people still don’t understand the importance of eating breakfast. As a social worker I cannot begin to tell you how many parent I saw putting hugs in children’s baby bottles. I won’t even go into the crap we serve children in cafeteria’s. IMO the issue is that we as a nation are more concern with bottom line dollars than actual nutrition. This bill just feels like it’s penalizing the people who can afford it the least.

Daphne April 1, 2011 - 10:33 PM

So instead of addressing the larger, systemic issues, the state is proposing to penalize the individual (likely underprivileged) person? Gotta love capitalism.

This is really sad, and classism at its finest. I’m gonna assume that obesity will be measured by the BMI scale, which is very disturbing.

I’m all for personal responsibility, but commercially processed foods, especially the “healthy” ones, are now part of the American food culture. Saying “educate yourself” without changing the culture doesn’t incite mass change. The rugged individualism of the United States only goes so far.

malpha April 1, 2011 - 11:38 PM

You can be skinny and unhealthy as crap on Medicaid, but if you’re overweight but in perfect health, you have to pay a premium? Sounds exactly like the reason insurance charges my mother $100 extra a month even though she’s perfectly healthy…now she wants Medicaid wants to do the same?

Also, I’m confused about the children issue. If you’re a smoker with kids, it’s totally cool to smoke around your kids without paying the $50 premium to contribute to their future lung cancer fund, but if you’re childless, you have to pay for yours? You don’t have to pay a premium if you’re overweight and (by their reasoning) at risk of a load of factors that may kill you before your children reach the age of majority whereupon they’ll probably get some government assistance but the single people gotta pay? What? Nonsense.

Deedee April 3, 2011 - 12:11 AM

I’m not really into the politics of it, but if it is true as stated in the article that Medicaid costs are expanding so disproportionately then I think $50 a year is not excessive to ask of those who end up costing the program more than the average user. Hopefully even just seeing the surcharge will those being levied identify the need for change. I also hope the PCP will have a variety of programs to offer them as both weight loss and smoking are not a one size fits all type of thing.

rikyrah April 3, 2011 - 8:08 PM

if you’re on Medicaid, you’re already LOW INCOME. I see this as another penalization against the poor. I doubt highly that Medicaid is assisting these people in helping them to try and lose weight by doing it comprehensively. I find the Governor absolutely repugnant.

Lincoln April 4, 2011 - 12:18 PM

*smh* Just another wrong-headed government levy on the poor and disenfranchised. I’m on state disability in WA, and it was cut from $339/mo to $260 something because we have such a “horrible budget problem”. Apparently it’s not so bad that we’ll tax businesses to help make up the difference though. http://bit.ly/f44lH9

In looking at the weight issue, I almost missed the other thing:
“would apply only to only certain childless adults:…or chronically ill”

Yeah…let’s charge people for having chronic illnesses. Cause chronic illnesses aren’t one of the main reasons a lot of people end up on Medicaid or anything. And it’s not like we’d suddenly get well and you’d have to stop charging us. That’s sort of the definition of chronic.

And even further, some of the medications people take for chronic illnesses can cause weight gain. Would that mean they’d get to charge you twice?

There’s so much wrong with this we could talk about it for years.

Thermidor July 25, 2011 - 6:21 PM

I,ugh…no words.

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