(Colorado baby denied health care coverage for being "too fat".)
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(NC State employees fume over the implementation of a "Fat Tax". This appears to be another effort that will legally allow NC Health Care Insurance companies to deny coverage or deny paying eligible claims. Just because its legal (in NC) doesn't mean its still not discriminatory or unconstitutional.)
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Rocky Mountain Health Plans, Colorado Insurer, Changes Policy On Obese Infants After Critical Headlines
A Colorado insurance company is changing its attitude about fat babies.
Rocky Mountain Health Plans said Monday it will no longer consider obesity a "pre-existing condition" barring coverage for hefty infants.
The change comes after the insurer turned down a Grand Junction 4-month-old who weighs about 17 pounds. The insurer deemed Alex Lange – called by his parents a "happy little chunky monkey" – obese and said the infant didn't qualify for coverage.
The infant's father works at a local NBC affiliate, KKCO-TV, and news accounts about the boy's rejection made national headlines.
The insurer said Monday it would change its policy for babies who are healthy but fat. The company attributed the boy's rejection for health coverage to a "flaw in our underwriting system."
"We have changed our policy, corrected our underwriting guidelines and are working to notify the parents of the infant who we earlier denied," Rocky Mountain Health Plans said in a statement.
The company is the same insurer praised by President Barack Obama and ruling Democrats for having one of the nation's lowest Medicare reimbursement rates. The Grand Junction-based insurer grew out of an agreement by area doctors that all would accept patients using government health insurance, lowering costs.
Alex Lange's parents said they wanted to switch insurers because of rising rates but were surprised to find their youngest boy was too fat to get covered. Father Bernie Lange joked to The Denver Post that the breast-feeding infant wasn't about to start a diet or hop on a treadmill to shed pounds.
"There is just something absurd about denying an infant," Bernie Lange said.
Born at just over 8 pounds, the boy's current weight puts him in the 99th percentile for babies his age. The company says it's an industry standard to reject new patients, including babies, above the 95th percentile for weight. But it says it has never before rejected a fat baby.
The boy's mother, Kelli Lange, said her baby has had nothing but breast milk and that his brief insurance rejection didn't change how she fed him.
"I'm not going to withhold food to get him down below that number of 95," she told The Denver Post.
N.C. to penalize obese workers, those who smoke
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."
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Sources: Huffington Post, MSNBC, McClatchy Newspapers, Charlotte Observer, NY Daily News, Google Maps
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