Punitive Fees for “Unhealthy Behaviors” (Like Diabetes)

Punishing people for being unhealthy is not a new idea. Everything from societal peer pressure and limitations on things like where it is possible to smoke, to calorie counts at fast food restaurants and financial strikes through insurance have tried to convince folks to simply be fitter. And for some folks, it may have worked.

However, now the country of Arizona would like to have a similar “health initiative” and turn it into a money maker. Arizona’s Medicaid application is cash-strapped, so today they want to tack on a fee to all those unhealthy people that are apparently sucking the system dry. Arizona is going so far as to single out groups of individuals whom they believe are the greatest drain: individuals who smoke or are obese. PWDs and others with chronic illnesses are also being included in this “fat fee,” in which they’ll be required to cover the fee if they don’t follow their doctor’s directions to lose weight (there is no indication that A1c or other measures of health could be included).

Some personal insurance and state governments have already implemented a simple fine for those that are overweight or smoke, but Arizona’s fee would be the initial state-federal good to get low-income individuals.

There are so many issues with this initiative which it is difficult to know where to start, but consider… why is it OK for its rich Arizonians to stay obese?! If it were so important for the state to use punishment to motivate behavior change, why wouldn’t they charge the wealthy-unhealthy proportionately?

Since this is concentrated solely on low-carb households on Medicaid, let us consider how much money goes into weight loss attempts: buying healthy, refreshing, or possibly organic food (if you can get it where you live); exercise gear and/or gym membership; clothes and appropriate shoes for workout; and co-pays for medications and services (that are small compared with private insurance co-pays, however they still exist).   Not to mention time off work time meeting with doctors and nutritionists, time forcing time waiting in line at the drugstore, and the comprehensive lack of time with the doctor that you are required by the law (in case this AZ fee passes) to view.

Not to mention all the other variables you may not have control over, such as handicap, race and genetic factors that contribute to prevalence in obesity (and diabetes). Talk about adding insult to injury!

A spokesperson for Arizona’s Medicaid, Monica Coury, states “We want to stretch our dollars as much as we can. Part of this is engaging individuals to take better care of themselves.”

Wha? Since when has punishment from the lack of benefits been proven an effective wellness engagement plan?   Since when does charging a $50 penalty do anything other than annoy people? Unless of course you’re a 2-person household earning less than $15,000 per year, and possibly struggling to cover your diabetes meds — in which case the fee becomes a large financial hardship.

We certainly agree that this nation needs to address obesity and unhealthy lifestyle and eating behaviors. We’re not advocating our shoulders at that. But there are far better and more productive ways to encourage wholesome living which don’t demand a good! My suggestion: rather than charging individuals a minimal fee for not following directions, why not actually help prevent the reasons why 25 percent of Arizona’s population is obese and 46% of those smoke? Perhaps gym memberships must be reimbursed? Perhaps there ought to be vouchers for healthier food?

Implementing programs which make it simpler for individuals to become healthy is what would engage and encourage individuals, instead of sending them a “You’re still too fat” invoice each year. For diabetes particularly, some health insurance companies are attempting incentive programs, like the one from UnitedHealthCare which offers discounted prices and no-cost office visits, lab tests, generic medications, insulin, pen needles, syringes and lancets, in addition to insulin pumps and supplies provided that members take certain proactive steps. They need to “comply with diabetes and preventative care evidence-based guidelines” provided by the ADA. A monitoring site collects information concerning the services members use, and has an automated reminder system to prompt them to acquire their evaluations and lab tests frequently. Not a terrible idea, it sounds.

Meanwhile, we PWDs that are pretty engaged have been contending with personal insurance for many years to cover upfront for the expenses of staying healthy today, instead of waiting until severe complications put in that are significantly more expensive. Maybe rather than cutting gym class at colleges or making quick food so appealing to kids (Happy Meal toys anyone?) , Arizona must cough up money for Weight Watchers applications and diabetes education, to name a few.

A “sin tax” does not count as helping!

I truly liked the MSNBC op-ed in which contributor Dr. Art Caplan, professor of bioethics at University of Pennsylvania, writes: “And just to be honest, the Senate can add the same taxation to water-skiing, jet ski, horseback riding, mountain biking, possessing a swimming pool, paragliding, rock climbing, failing to wear a helmet when riding a bike (Arizona has a very weak law) or opting to operate in roofing, mining or structure — or another activity that carries a risk. Actually, if the governor really wants to make money, how about a youth tax for people who bask in the Arizona sun and hike their risk of skin cancer”

Along with passing the Republican state legislature, this new bill would also require federal approval, since Medicaid is a federal program, so there is a fantastic chance it will not pass. Still, if you live in Arizona, this is a superb time to put in your Diabetes Advocate hat.

In the end, if this about a state budget crisis than the usual wellness initiative (as seems to be the case), I am convinced we can all figure out ways to get the greatest bang for the dollar that will actually alleviate the budget and help people be healthier. Right?

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is made for Diabetes Mine, a customer health blog concentrated on the diabetes community. The content is not medically reviewed and doesn’t stick to Healthline’s editorial guidelines. To learn more regarding Healthline’s venture with Diabetes Mine, please click here.

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