Arizona Medicaid Subscribers Paying for Unhealthy Choices

From Washington all the way down healthcare reform is definitely one of the hot topic of politics today.  News reports are rife with reports criticizing or lauding each new change or proposal.  This month Arizona has proposed to charge Medicaid subscribers a fee for bad health choices. This proposal has gained a lot of protest, but from the state’s perspective it makes a lot of sense.  Medicaid is state funded health insurance for people who can’t afford private insurance.  The proposed changes would add a $50 charge per year for each subscriber who continued to smoke or made no attempt to follow diet and exercise prescribed by a doctor following a diabetes or obesity diagnosis. The government contends that these illnesses or complications are avoidable by people’s own choices.

Smokers and obese people incur greater health care costs for the state than do non-smokers and people of normal weight.  Since people can quit smoking or lose weight, albeit with difficulty, their decision not to accept these medical suggestions would cost them fifty dollars annually.   This seems fair to me. It already exists in many private insurance plans, but has never been implemented under federal or state insurance plans. If people are making unhealthy choices, and are thus more likely to need future medical attention, they should have to pay more for their health coverage. Additionally, this measure is being added to revive coverage for organ transplants which was cut last year for budget reasons.

This measure has been seen as an attack on people’s personal freedom despite the fact that it makes economic sense. It’s also ambiguous about what it requires for obese people to be considered following a doctor’s diet and exercise regimen.  It would be considered discriminatory to set deadlines for losing certain amounts of weight.  Obesity is complicated by many other factors and other health issues such as thyroid problems may keep obese people from losing weight despite diet and exercise.  As an idea for budget control, this seems like it would be effective and is in line with the federal campaign against obesity. It will probably be thrown out because it isn’t quite politically correct, but I think as both a budget control measure and as a way to make patients take responsibility for their role in their own health it is a step forward.