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.”)
RT @RonChusid: Arizona Governor Proposes Fining Medicaid Smokers #p2 #p21 #topprog http://is.gd/Iqko7y
RT @RonChusid Arizona Governor Proposes Fining Medicaid Smokers #p2 #p21 #topprog http://is.gd/Iqko7y // I don't have a problem with this.
The only thing that bothers me about this is: Being an ex-smoker myself, I can’t begin to explain to a life-long non-smoker the extreme difficulty people can have when quitting. It’s been shown that nicotine addiction is more difficult to quit than cocaine, and I believe that fully (although I’ve never been addicted to cocaine, so …) Anyway, I also have problems with it in that nicotine is a legal substance, and ADDICTIVE one, and now people are going to be penalized for it … I would prefer to see the tobacco companies pay a tax on their own product, as penalty … Tax the poor/working class? You’re bound to piss off some people who are already pretty damned pissed off … Just my opinion …
The fact that nicotine is legal is irrelevant. Using nicotine is still harmful and does increase health care costs tremendously, making it valid for insurers to have an interest in changing behavior here.
The fact that it is addictive would be a reason not to make the penalties too draconian, but it is also possible that penalties might give extra incentive to try to beat the addiction. It is possible, even if difficult to quit. I have had a tremdous number of patients quit, while others continue to smoke.
It would be interesting to see if there is any good data as to whether similar programs by private insurance companies have shown any improvement or been cost effective. Being addictive, another consideration would be to require participation in a tobacco cessation program but not to penalize based upon whether this is successful. As a ball park figure, if someone is interested in tobacco cessation there is around a one in three chance of success (with a number of them later relapsing).
I would have qualms taxing the poor too much, but I figure that if someone is spending the money to buy cigarettes on a regular basis they can spend $50. (This probably wouldn’t affect the working class very much as working class people without children are unlikely to be on Medicaid.) The tobacco companies are already paying penalties for their actions, as they should.
& "childless adults" WTF // “@RonChusid: Arizona Governor Proposes Fining Medicaid Smokers #p2 #p21 #topprog http://t.co/w1VvM2d "
RT @mlnga: RT @RonChusid Arizona Governor Proposes Fining Medicaid Smokers #p2 #p21 #topprog http://is.gd/Iqko7y // I don't have a probl …
Arizona Governor Proposes Fining Medicaid Smokers Liberal Values: “If you're not going to manage those things an… http://bit.ly/dSOZJc
Medicaid News Update Arizona Governor Proposes Fining Medicaid Smokers Liberal Values http://ow.ly/1c0WHv