Alabama board approves plan to charge state employees for obesity, health problems

The Alabama State Employees' Insurance Board last week approved a plan that will require state employees who are obese or have health problems to make progress to address those issues or pay a monthly charge for health insurance, the AP/Philadelphia Inquirer reports.

Under the plan, state employees must undergo a health screening at no cost by January 2010 or pay a $25 monthly charge for health insurance, which all workers currently receive at no cost. In the event that the screenings find serious problems with blood pressure, cholesterol, glucose or obesity, state employees will have one year to visit a physician at no cost, enroll in a wellness program or take steps on their own to improve their health. In the event that follow-up screenings do not indicate progress, state employees will have to begin to pay the monthly charge in January 2011. The board will consider state employees with a BMI of at least 35 obese. The board has not determined the amount of progress that state employees will have to make to avoid the monthly charge.

According to William Ashmore, executive director of the insurance board, the plan will cost an estimated $1.6 million next year for screenings and wellness programs but likely will result in significant savings over the long term. Ashmore said that individuals with a body mass index of 35 to 39 account for $1,748 more in annual health care costs than those with a normal BMI of less than 25.

Board member Robert Wagstaff said, "We are trying to get individuals to become more aware of their health." Mac McArthur -- executive director of the Alabama State Employees Association, the union that represents state employees -- called the plan "positive," but workers criticized the plan as unfair (Rawls, AP/Philadelphia Inquirer, 8/24).

Editorial

Summaries of two editorials about the plan appear below.

• Miami Herald: The plan is a "bad approach to an admittedly worrisome problem," a Herald editorial states. "Yes, it is a good idea to encourage employees to improve their health, get in shape, be fit," the editorial states, adding, "However, being overweight -- even obese -- is not necessarily linked to one's diet" and often is "more about genes. The editorial states, "This is a situation where the carrot is better than the stick" because a plan that offers rewards for "improvement creates positive incentives and good karma," adding, "Assessing a cash penalty for lack of improvement ... can work, but there may not be full buy-in of the concept." In addition, "many people who are of 'average' weight are afflicted with the kind of medical issues ... typically associated with obesity," the editorial states. "If the concern is about poor health, why not focus on health issues instead of weight?" the editorial states (Miami Herald, 8/25).
• Rochester Democrat and Chronicle: The plan is "extreme," but "is anyone really surprised?" a Democrat and Chronicle editorial states. The editorial adds, "With health care costs continuing to spiral, it was just a matter of time before employers took out the hammer to achieve savings." According to the editorial, "this page would rather see incentives that reward healthy behaviors" because some "people are genetically predisposed" to obesity. However, the editorial concludes, "there is no denying that, when Alabama has a population that ranks only second to Mississippi in obesity, exceptional measures are necessary" (Rochester Democrat and Chronicle, 8/26).