Employment: AL hits obese workers with fee

Alabama “Computer technician Tim Colley already pays $24 a month for being a smoker and doesn’t like the idea of another charge.”

Alabama to Start Charging Overweight State Workers $25 More a Month for Health Insurance

February 08, 2009
by: David Gutierrez, staff writer
(NaturalNews) In an effort to rein in rising health-care costs, Alabama will start charging a fee to overweight workers who do not take part in free wellness programs.
“We are trying to get individuals to become more aware of their health,”
said Robert Wagstaff of the state insurance board.
An estimated 30.3 percent Alabama residents are considered to be obese, more than any other state but Mississippi.
Currently, health insurance is free for all Alabama state employees except for smokers. Starting in January 2010, however, all employees will be required to take a free yearly health screening. Workers who refuse to participate will be charged $25 per month for their health insurance, on top of any smoking fees.
Workers who are diagnosed with serious weight, blood pressure, cholesterol or blood sugar problems will be screened again in one year to see if their health has improved. Those who have not shown any improvement will also be charged $25 per month.
In the year between the initial screening and the follow-up, employees will be entitled to see a doctor or enroll in a wellness program at no cost. They can also take any other measures they wish to improve their health.
For the purposes of the program, anyone with a body mass index of 35 or more will be classified as having a weight problem. Health professionals typically consider anyone with a body mass index of 30 or higher to be obese.
Walter Lindstrom, founder of the Obesity Law and Advocacy Center, warned that the program will not be fair if overweight employees are just offered vague advice about eating better and exercising more.
“The state will feel good about itself for offering something,” he said, “and the person of size will end up paying $300 a year for the bad luck of having a chronic disease his/her state-sponsored insurance program failed to cover in an appropriate and meaningful fashion.”
While some states offer one-time incentives for employees to lose weight, no others penalize overweight workers.

Alabama Plans to Tax Fat Employees to Recoup Insurance Costs
Tuesday, September 02, 2008
Alabama is rolling out a creative but controversial program that will subject its 37,527 state employees to possibly humiliating at-work weigh-ins and fat tests. If they tip the scales, they’ll be given a choice: slim down or pay up.
The state is trying to solve two of its biggest problems — health insurance costs and obesity — in one fell swoop.
Beginning in 2010, Alabama, which has the second highest obesity rate in the country, will start charging all of its employees an extra $25 per month for health insurance. (Currently, single workers pay nothing; family plans cost $180 a month.)
But there’s a way to avoid the fee: Get a check-up at an in-office “wellness center,” where nurses will check for diabetes and hypertension and measure blood pressure, cholesterol, glucose levels and Body Mass Index (BMI).
The idea is to encourage employees to act responsibly, lose weight and lower their health care needs. But critics say it will humiliate and stigmatize obese employees and amounts to nothing short of a “fat tax.”
A BMI test uses height and weight measurements to calculate the percentage of body fat in adult males and females. Alabama is using a BMI threshold of 35 — 30 is considered obese, by most medical standards — to determine who doesn’t have to pay the automatic $25 deduction.
Health practitioners often factor in skinfold (fat) and waist circumference measurements while calculating a patient’s BMI.
Does Alabama think you’re fat? Take this humiliation-free BMI test online.
If you’re deemed fit, you’re exempt. But if you flunk the BMI exam, it’s shape up or pay up. Obese workers will be required to see a doctor and will have to show proof of their attempt to lose weight.
The program is optional … sort of. If you don’t take the tests, you’ll have to pay the $25 charge.
The $25-per-month fee is not the only way Alabama hopes to discourage bad health decisions by state employees, said the program’s creator, William Ashmore, executive director of the Alabama State Employees’
Insurance Board. Alabama already charges smokers a monthly $25 insurance fee.
“There are folks walking around with diabetes and hypertension that don’t even know it, and it’s just a matter of time before something catastrophic happens to them,” Ashmore said. “If we can get people to manage their health, we’ll have healthier employees and less healthcare costs.”
He said employees with a BMI of 35 or higher cost the state 40 percent more than those with a BMI under 35, and the program will help in many ways. “This is not a fat tax,” Ashmore said. “It’s not punitive.”
But that’s exactly what critics are calling it: a punitive “fat tax”
designed to stigmatize the obese by inappropriately — and possibly illegally — bringing weight into the workplace.
“This is a dreadful, dreadful policy,” said Judith S. Stern, an obesity expert and nutrition professor at University of California at Davis.
“Overweight and obese people, especially women, feel that their weight is private, and being weighed at work is like having a prostate exam in the hall. It’s not appropriate.”
Critics also say Alabama’s program borders on discrimination by using obesity, which is medically categorized as a disease, as its benchmark.
“I think it discriminates against people with a disease — obesity is a disease,” Stern said. “Would you charge more money if they had breast cancer?”
Alabama’s program is a dangerous step on a very slippery slope, says Mark V. Pauly, professor of health care systems at the University of Pennsylvania’s Wharton School of Business. “The unanswered question is, ‘How much you want to do this?'” he said. “If you got lung cancer because you smoked, do we charge you a penalty there? What about couch potatoes? Do we put all the employees on treadmills?”
Medical and social considerations aside, other critics say it’s just not going to work. “There’s the thought that obese people are weak-willed, and if we charge them more they won’t be as fat,” Stern said. “This assumes they have control over what’s involved, and often they don’t.”
And there’s the cost factor. In its efforts to reduce heath care costs Alabama will spend an extra $1.6 million for health screenings and programs next year.
“From the viewpoint of the employer who provides health care and pension, this kind of cancels out,” Pauly said. “What you lost on health care you get back in pension plan, because now these people are living longer.”
Whatever the plan, a company’s success in lowering health care costs and curbing obesity could depend entirely on how it’s framed. Rewards tend to work better than punishment.
“It’s possible to set these things up to look like more like carrots than sticks,” Pauly said. “And people tend to respond better to carrots.”
Alabama isn’t alone in its struggle to cut costs and curb obesity.
Two-thirds of American adults are overweight or obese, according to a recent report from Trust for America’s Health, a nonprofit organization based in Washington, D.C.
Clarian Health Partners, a hospital chain in Indiana, has taken a different approach. In 2009, they will start deducting money from the paychecks of workers who do not meet — and don’t show efforts to meet — various health criteria. Smoking without trying to quit will cost $5; high glucose, high blood pressure and high cholesterol levels will cost $5 each; a high Body Mass Index will cost $10.
This is also happening abroad. Japan is monitoring the waist measurements of its policyholders, according to official government websites. Citizens receive jury duty-like summonses to appear for measurements — and if they’re too fat, their employer will be slapped with a hefty fine. The maximum waist size allowed for men is 33.5 inches and 35.4 inches for women.
It’s unlikely that Japan’s program will catch on stateside, but that doesn’t mean Americans are off the hook. Alabama’s so-called “fat tax” could just be the beginning of a trend.
“A lot of employers are talking about this,” Pauly said. “There’s the feeling that you have to do something. What you do then is a matter of design and discretion.”
As for Alabama, Ashmore is sure that those who have their doubts will soon come around. He encourages workers to swing by his Montgomery office to pick up pamphlets about the program and to learn more about reducing their Body Mass Index.
But to get to his second-floor office they’ll first have to make it past the Chick-Fil-A downstairs (average meal: 1,000 calories).

Alabama hits obese workers with fee
Employees of this American state who don’t try to lose weight will have to pay part of their health insurance premiums. It may sound heavy-handed, but the workers’ lobbying group is not complaining.

By The Associated Press
August 26, 2008
The state of Alabama has given its 37,527 employees until 2010 to start getting fit — or they’ll pay $25 a month for insurance that otherwise is free.

Alabama will be the first state to charge its overweight workers who don’t try to slim down, while a handful of other states reward employees who adopt healthful behaviours.

Alabama already charges workers who smoke — and has seen some success in getting them to quit — but now has turned its attention to a problem that plagues many people in the Deep South: obesity.

* Sympatico Health & Fitness: Tools to help you lose weight

The State Employees’ Insurance Board earlier this month approved a plan to charge state workers starting in January 2010 if they don’t get free health screenings.

If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enrol in a wellness program or take steps on their own to improve their health. If they show progress in a follow-up screening, they won’t be charged. But if they don’t, they must pay starting in January 2011.

“We are trying to get individuals to become more aware of their health,” said state worker Robert Wagstaff, who serves on the insurance board.

Not all state employees see it that way.

“It’s terrible,” said health department employee Chequla Motley. “Some people come into this world big.”

Computer technician Tim Colley already pays $24 a month for being a smoker and doesn’t like the idea of another charge.

“It’s too Big Brotherish,” he said.

The board will apply the obesity charge to anyone with a body mass index of 35 or higher who is not making progress. A person 5 feet 6 inches tall weighing 220 pounds, for example, would have a BMI of 35.5. A BMI of 30 is considered the threshold for obesity.

The board has not yet determined how much progress a person would have to show and is uncertain how many people might be affected, because everyone could avoid the charge by working to lose weight.

But that’s unlikely. Government statistics show Alabamans have a big weight problem. According to the Centers for Disease Control and Prevention, 30.3% are now obese, ranking the state behind only Mississippi.

E.K. Daufin of Montgomery, a college professor and founder of Love Your Body, Love Yourself, which holds body acceptance workshops, said the new policy will be stressful for people like her.

“I’m big and beautiful and doing my best to keep my stress levels down so I can stay healthy,” Daufin said. “That’s big, not lazy, not a glutton and certainly not deserving of the pompous, poisonous disrespect served up daily to those of us with more bounce to the ounce.”

A recent study suggested that about half of overweight people and nearly a third of obese people have normal blood pressure and cholesterol levels, while about a quarter of people considered to be of normal weight suffer from the ills associated with obesity.

No intent to punish
Walter Lindstrom, founder of the Obesity Law and Advocacy Center in California, is concerned that all overweight Alabama employees will get is advice to walk more and to broil their chicken.

“The state will feel good about itself for offering something, and the person of size will end up paying $300 a year for the bad luck of having a chronic disease his/her state-sponsored insurance program failed to cover in an appropriate and meaningful fashion,” he said.

William Ashmore, executive director of the State Employees’ Insurance Board, said the state will spend an extra $1.6 million next year on screenings and wellness programs but should see significant long-term savings.

Ashmore said research shows someone with a body mass index of 35 to 39 generates $1,748 more in annual medical expenses than someone with a BMI of less than 25, which is considered normal.

According to the U.S. National Conference of State Legislatures, a few states offer one-time financial incentives for people pursuing healthy lifestyles. Ohio workers, for instance, get $50 for having health assessments and another $50 for following through with the advice.

Arkansas and Missouri go a step further, offering monthly discounts on premiums for employees who take health risk assessments and participate in wellness programs to reduce obesity, stress and other health problems.

Alabama’s new policy is drawing no objection from the lobbying group representing state workers.

Mac McArthur, the executive director of the Alabama State Employees Association, said the plan is not designed to punish employees.

“It’s a positive,” he said.

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