Alabama to Penalize State Employees Deemed Obese

Published November 1, 2008

The state of Alabama will begin charging the obese among its 37,000 employees if they do not take advantage of their health care benefits to undergo screenings and improve their health in accord with yet-to-be-determined criteria.

The Alabama State Employees’ Insurance Board has approved a plan to charge workers who do not comply with the new policy $25 a month starting in January 2011, making Alabama the first state to penalize overweight employees.

The fee will go toward their health insurance premiums, which are currently paid entirely by the state. Alabama already charges its state employees who smoke $24 per month, again to offset the alleged higher cost of those workers’ health care.

A Year to Improve

More than 30 percent of Alabamans are obese, according to the Centers for Disease Control and Prevention, the second highest percentage in the nation, behind only Mississippi.

The new policy requires workers to undergo free health screenings by January 2010. If those screenings reveal blood pressure or cholesterol problems or show patients to be obese based on the Body Mass Index (BMI), those employees will have a year to seek treatment for those conditions.

A refusal to do so—or a lack of progress in improving the conditions even with regular doctor visits—will result in the $25 fee being charged beginning in January 2011. The insurance board has not yet decided on specific criteria for “improvement.”

“We are trying to get individuals to become more aware of their health,” said insurance board member Robert Wagstaff at a press conference.

BMI Index Flawed

The state expects to spend $1.6 million more in 2009 than in 2008 on screenings and wellness programs, but with obese patients costing nearly $2,000 more in annual medical expenses than their non-overweight counterparts, according to the Centers for Disease Control and Prevention, some health care analysts expect the state’s taxpayers to reap savings far above that initial cost.

Others say the preventive advice and treatment employees receive will greatly influence the program’s effectiveness in bringing down costs.

Not all agree the program is a good idea, however. “The increasing use of health insurance surcharges for certain physical conditions affecting medical costs should make all of us afraid,” said Maureen Martin, senior fellow for legal affairs at The Heartland Institute.

“Take obesity as an example,” Martin continued. “First, BMI as an obesity barometer is flawed. Doctors and public health officials say a patient’s score alone does not diagnose obesity because it does not take age, gender, and muscle mass into account. Under this policy, Michael Jordan in his championship basketball days would have been classified as obese and forced to pay a surcharge, even though he was in prime physical condition.”

Unfair Focus on Fat

Martin says the focus on a limited number of health factors is inherently unfair.

“Anyone who engages in any risky personal habit should have to pay a surcharge” if states are going to charge people for such behaviors, Martin said. “To single out only the obese and smokers is illegal and unconstitutional, in my view. Anyone who engages in unprotected sex, particularly with multiple partners, should automatically be forced to pay a surcharge, because they are much more likely to catch the HIV virus and other sexually transmitted diseases, costing the medical system more money. Do we really want the state in our bedrooms?

“By the same reasoning,” Martin concluded, “pregnant women should also pay a surcharge because their condition—largely preventable through birth control—will result in increased costs to the health care system.”

The Alabama State Employees Association, the lobbying group that represents state employees, is not opposing the plan. They say the plan is not designed to punish employees, but to benefit them by encouraging them to improve their lifestyles and decrease the burden health care imposes on the state’s taxpayers.

Katie Flanigan ([email protected]) writes from Georgia.