Sunday, April 17, 2011

The Proposed Arizona “Obesity Fine” Focuses on Overweight Medicaid Recipients

The Fat, as They Say, is in the Fire

Arizona is rapidly overtaking Florida and Texas in the race to generate news items that make late-night talk show gag writers dance with joy. Latest example: Governor Janet Brewer, who has firmly established the fact that illegal immigrants are not on her Good People list, is apparently looking to add the very overweight to the tally.

In specific, she has proposed levying a surcharge of $50 on obese Arizonans who are enrolled in Medicaid unless they adopt a supervised weight-loss program prescribed by their doctor. A similar fee would apply to enrollees who are smokers. As Jay Leno might (and perhaps will) observe, “Evidently if you’re a hopeless alcoholic or a heroin addict, you’re not a health problem.”

This is a story tailor-made for America’s chat rooms. Among the aspects of interest:

  • Most of Brewer’s political moves thus far have brought cheers of support from the Tea Party folk, but how will they react to the notion of state government fining people for unhealthy behavior? According to a spokesperson for Arizona’s Medicaid program, that was one express goal of the surcharge, along with driving home the point that obesity is a drain on health care resources. How will Brewer respond to charges that she’s engaging in that anathema to conservatives, “social engineering”?
  • This is would be the first such “irresponsibility” fee (or fine, or surcharge) in Medicaid history, and more than a few state governments, absolutely desperate for revenues, will seriously consider following Arizona’s lead, if it becomes law. Given that over 25 percent of Arizonans were obese as of 2009, and roughly 45 percent of the state’s Medicaid enrollees are smokers, at $50 a head, we’re talking some serious change. Imagine how much revenue a “fat fee” could generate in Mississippi, Alabama or Arkansas.
  • On the one hand, as liberal opponents of the proposal point out, the fee could unfairly penalize those whose weight is, for whatever reasons, genuinely beyond their control. On the other hand, obesity carries with it very definite and significant health care costs above the norm, and in most cases is due to lifestyle behavior, not genetics or biochemistry.
  • Ultimately, the proposed fee will wind up in court, first because such tinkering with Medicaid rules generally requires permission from Washington, which is already unhappy with Governor Brewer’s infringing on the federal government’s immigration turf, and second because such details as the definition of “obesity,” and who decides whether a weight-loss program is being adequately followed, have yet to be hashed out.

Our advice to the Governor and her Medicaid administrators: Don’t start counting the fee revenues just yet.

(By Robert S. Wieder for CalorieLab Calorie Counter News):


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