Obese State Workers to Pay Higher Insurance Costs in NC

North Carolina is set to become the second state in the country to raise insurance costs for obese state employees; and smokers in both Carolinas will pay higher costs in the coming years.

Smoker Freddy Hall lives in Morganton, North Carolina, and he believes he should pay for it. "In all eventuality, a man who does things to harm himself is going to be discriminated against eventually when it comes to health care," but he hates to see state workers be penalized, saying they have already been hit hard by budget cuts. Smokers will pay more starting in July 2010.
The extremely obese will pay more in July 2011.

Here are the details, non-smokers or workers with a body mass index (BMI) of less than 40, can take advantage of the 80/20 Standard Plan, verses smokers, or those with a BMI over 40, who will pay thirty percent out of pocket expenses.

The State Employees Association of North Carolina taking a stand against it. SEANC Communications Specialist Mary Adelaide Bell told News Channel 7, via phone, "We feel like the plans are discriminatory. They are invasive. They are unnecessary."

North Carolina State Employees’ Health Plan administrators were not available to speak with us Wednesday, but on their website, they say the idea is to encourage individuals to adopt healthy lifestyles. State worker Dori Wallace believes it could backfire. "If everything is more expensive then you may end up having less treatment and wind up, with more serious diseases that end up costing us more in the long run," says Wallace. Employees will be subject to random wellness testing at work, and Wallace worries costs could be a hardship on many workers. Wallace says, "I think some people their weight is an issue due to other health concerns, and it's not fair to penalize them for something that's beyond their control."

Hall believes it's fair for him to pay, but he just wants to know where you draw the line.
He says, "It will be skinny people next."

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About BMI for Children and Teens: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Children's BMI Tool for Schools: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/tool_for_schools.html

Adult: BMI Calculator: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

Child BMI Calculator: http://apps.nccd.cdc.gov/dnpabmi/

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BMI Chart - http://statehealthplan.state.nc.us/oversight-committee/February%202009/bmi_tbl.pdf

State by state: http://statehealthplan.state.nc.us/oversight-committee/February%202009/state-by-state-benefit-summary.pdf

Overview of Initiative: http://www.shpnc.org/comp-wellness.html

Frequently Asked Questions: http://www.shpnc.org/cwi-faqs.html

Tobacco Cessation Component: http://www.shpnc.org/comp-wellness-tobacco.html

Weight Management Component: http://www.shpnc.org/comp-wellness-wt-mgmt.html

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N.C. to penalize obese workers

From Charlotte Observer:

State employees who are overweight, or who smoke, will pay more for health insurance. North Carolina is poised to become only the second state to penalize state employees by placing them in a more expensive health insurance plan if they're obese.

Smokers will feel the drag of higher costs, too, as North Carolina and South Carolina state employees who use tobacco are slated to pay more for health insurance next year.

N.C. officials, coping with a steady uptick in health care costs for state employees each year, are aiming to improve state workers' health, which saves money in medical expenses.

"Tobacco use and poor nutrition and inactivity are the leading causes of preventable deaths in our state," said Anne Rogers, director of integrated health management with the N.C. State Employees Health Plan. "We need a healthy workforce in this state. We're trying to encourage individuals to adopt healthy lifestyles."

State workers who don't cut out the Marlboros and Big Macs will end up paying more for health insurance. Tobacco users get placed in a more expensive insurance plan starting in July and, for those who qualify as obese, in July 2011.

Some state employees, though, are criticizing the planned changes. The State Employees Association of North Carolina opposes the tobacco and obesity differentials as invasive steps that could have been avoided if the legislature had fixed the plan.

"It's my understanding they're talking about testing (for tobacco use) in the workplace which, to me, would create a hostile environment," said Kim Martin, a sergeant at Piedmont Correctional Institution in Salisbury. "And it's an invasion of privacy. This is America, the land of the free. I don't think (body mass index is) a very good measure. I know some folks who would have a high body mass index because they're muscular."

The health plan covers more than 600,000 state employees, retirees and teachers at a total cost last year of $2.6 billion. Last spring, the legislature bailed out the plan with an infusion of $250 million to pay the bills after rising costs and inaccurate projections left little money for claims. Over the next two years, the state general fund will pump about $408 million into the health plan.

While officials have not yet estimated any potential savings from the obesity requirement, the higher costs for smokers could save $13 million in the 2010-2011 budget year, Rogers said, emphasizing that the plan's priority is to improve health and save money in the process.

The idea of penalizing unhealthy lifestyles and rewarding healthy conduct is hardly new among insurance plans. Public health insurance plans in other states already penalize smokers or reward nonsmokers in insurance costs. South Carolina's state employees health plan is scheduled to add a $25-per-month surcharge on smokers in January. Elsewhere in the southeast, Kentucky and Georgia impose surcharges, and Alabama gives nonsmokers a discount.

Alabama was out front on weight testing. Starting in January, state workers will have their blood pressure, cholesterol, glucose and body mass index checked by a nurse. If they're in a risk category, such as a body mass index of 35 or greater or a blood pressure of 160/100 or greater, they are charged an extra $25 per month on their insurance premium. If they go to a health screening, either offered by the state or by their personal physician, then the $25 is subtracted, according to Gary Matthews, chief operating officer for the Alabama State Employees Insurance Board.

North Carolina will allow state workers with a BMI of up to 40 to keep the discount, although a BMI of 30 is considered obese by some experts.

Private sector employers appear to have been targeting tobacco and weight in their insurance pricing ahead of state health plans.

"We're beginning to see a lot of employers extremely interested in this," said Tim Smith, president of BioSignia, in Durham, which provides for private employers a system of measuring employees' risk factors for the onset of chronic disease. The company presents only aggregate data to the employers and does not disclose information about individuals, Smith said.

Tobacco and obesity are leading risk factors for ailments such as heart disease, stroke, Type 2 diabetes and chronic breathing disorders. BioSignia is not under contract with the state health plan, but Smith said that employers like the state are trying to catch employees who are in pre-disease stages to save both lives and money.

Only a fraction of employers, though, offer financial incentives for healthy behavior or wellness programs, such as gym memberships or smoking cessation, according to a Kaiser Family Foundation study last year. Differences in employees' education, health literacy and access to basic health care could affect the usefulness of financial incentives in reducing health-care costs over time, the study said.

The results are not yet in. The higher costs for smokers and the obese don't appear to have been in place long enough for any state to boast a healthier workforce yet, according to officials in several states.

"I don't know that any states have a lot of hard data on this," Rogers said.

The policies have generated a backlash among at least some state workers. Some workers are anxious about the idea of tests for smoking. The tests involve examining a saliva sample for cotinine, a derivative of nicotine found in the system of tobacco users. Health plan officials recognize those concerns and are getting ready to take bids from companies that will perform the tests.

The state plan has not yet developed a procedure to monitor members for the obesity standard due to take effect in 2011.

"We're going to have to work out those logistics," Rogers said.

South Carolina and Tennessee rely on self-reporting instead of tests for illicit tobacco use, and Tennessee found the percentage of smokers in voluntary reports match public surveys.

Martin, the prison sergeant in Salisbury, doesn't smoke but considers herself overweight. Instead of financial penalties, she would like to see financial subsidies.

"If they're going to hold us accountable," Martin said, "pay for a gym membership or part of a membership. Give us an incentive, a way to combat it."

http://www.charlotteobserver.com/topstories/story/988655.html

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