I’m not saying I’m advocating this, but I’m also not terribly upset by one Republican effort which I’m sure someone somewhere in the liberal blogosphere sees as another effort to take money from the poor. Arizona Governor Jan Brewer has proposed a $50 per year charge for Medicaid recipients who engage in unhealthy life styles such as cigarette smoking. ABC News reports:
Childless adults who are obese or suffer from a chronic condition and who fail to work with their doctor to meet specific goals would be charged $50 annually. The $50 annual fee also would apply to all childless adult smokers.
“If you’re not going to manage those things and take some personal responsibility, and in turn that costs the state more money, then you need to have some skin in the game,” said Monica Coury, assistant director of Arizona’s Medicaid program.
Obviously seeing the details of such a plan would be important. There is no question that tobacco smoking leads to far greater medical expenses and it is reasonable for an insurer to want people it is covering to discontinue this habit. Medicare pays for tobacco cessation counseling during an office appointment on top of the usual payment for the office call. Many private insurers also base their rates upon habits. The policy which covers my employees has a lower rate for those who participate in a wellness program.
I would be more cautious about using a government program to try to regulate personal behavior. However a $50 charge for cigarette smoking hardly sounds like a draconian act by Big Brother (although I’m sure Republicans would be claiming this if it was part of “Obamacare.”) I would also have concerns about charges which Medicaid recipients might have difficulty paying, but if someone is buying cigarettes regularly they certainly are spending far more than $50 per year on items beyond true necessities.
I am just speculating, but I assume that the limitation in the proposal to childless adults is to make sure that the $50 doesn’t come from money which might otherwise be spent on children who have little control over the habits of their parents. (Or maybe not limiting to the childless would occasionally work. I can imagine the nagging: “Daddy, quite smoking already so we can buy a Wii.”)
