(July 15th, 2009: SEANC organized a protest in front of the Blue Cross Blue Shield North Carolina headquarters in Chapel Hill. Attended by over 60 members of SEANC, HCAN, Acorn, AFL-CIO and other progressive groups, the event highlighted Blue Cross' use of taxpayers and customer money to fight against affordable health care for all.)
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."
Gov Bev Perdue says missing Health Care Reform signature not a sign
Gov. Beverly Perdue says there's a good reason why she didn't join most of the nation's other Democratic governors in signing a letter supporting health care reform.
Perdue says she was too busy with an economic development trip to consider the letter.
The letter was assembled by the Senate Majority Leader and the Democratic Governors Association, Talking Points Memo reports.
It's a standard letter addressed to Senate Majority Leader Harry Reid, Senate Minority Leader Mitch McConnell, Speaker [Nancy] Pelosi and Minority Leader Boehner, telling them states "will only achieve the health care security and stability they need if we succeed in working together with the Congress and the President to achieve health care reform."
Perdue was one of six Democratic governors who did not sign the letter. Talking Points Memo and some bloggers have read the missing signatures as a sign of how tough the health care battle is.
In North Carolina's case, that may be overstating things. Perdue was given a copy of the letter Wednesday between meetings, Perdue spokeswoman Chrissy Pearson said.
"She didn't feel she had enough time to give it due consideration," Pearson said. "Her focus that day was the trip to New York City. It was a very grueling schedule."
Pearson said Perdue agrees with the points made in the letter.
"She did not sign it but wants to make it clear that she remains committed to working with the Obama administration on health care reform," Pearson said. "She has continued the dialogue that began a few months ago whenever the White House asked North Carolina to host one of their forums on health care reform and she continues to remain concerned about the fact that while she believes reform is needed, such reform should not place an undue financial burden on the state."
Here is the text of the letter:
Dear Speaker Pelosi, Majority Leader Reid, Minority Leader McConnell and Minority Leader Boehner:
We are writing to express our support for your efforts to reform our nation’s health care system. As the chief executives of our states and territories, we realize that the status quo is no longer an option and we support getting health reform done this year.
Sky-rocketing health care costs hurt families, force businesses to cut or drop health benefits and cause already strained state budget deficits to significantly grow. We believe reform can relieve these burdens by reining in costs and making coverage more affordable, both for our citizens and our state budgets.
Efforts at the federal level, like the recent and critical investments through the Recovery Act that support states’ HIT and prevention initiatives, are beginning to work to lower health care costs. Our citizens and our states, however, will only achieve the health care security and stability they need if we succeed in working together with the Congress and the President to achieve health care reform.
We commend you and your colleagues for provisions included in your bills that will help states and territories. Many of the provisions will allow states and territories to achieve long term savings and help cover those who currently go without coverage. We recognize that health reform is a shared responsibility and everyone, including state governments, needs to partner to reform our broken health care system.
We thank you for your leadership in this historic effort and look forward to continuing to work together to get health reform passed this year.
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Sources: McClatchy Newspapers, Charlotte Observer, News & Observer, Democratic Governors Association, WCNC, Talking Points Memo, Think Progress, Google Maps
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