Sweet Home Alabama Will Charge State Employees for Being Obese

Personal responsibility for healthy behaviors is a hot topic, and a core issue in healthcare reform. A key question is how should the health habits be reflected in employee's cost of insurance.

Until recently many of these questions remained mostly academic, as employers have generally been hesitant to differentiate health benefit levels and costs. However, the skyrocketing cost of care is starting to push them to allocate costs to people who cause them.

The State of Alabama broke the new ground by introducing a $25 per month health insurance charge for "overweight state workers who don’t work on slimming down" (with one-year grace period). If you are not obese your insurance remains free. The program follows up on the earlier-implemented initiative that charges employees who smoke. Of course, accoring to report there is already a controversy:

“We are trying to get individuals to become more aware of their health,” said state worker Robert Wagstaff, who serves on the insurance board.

Not all state employees see it that way.

“It’s terrible,” said health department employee Chequla Motley. “Some people come into this world big.”

Computer technician Tim Colley already pays $24 a month for being a smoker and doesn’t like the idea of another charge.

“It’s too Big Brotherish,” he said.

In my view, $25 a month may be just the right surcharge amount - from psychological point of view. Not too much to cause true economic hardship, yet enough to get people thinking about getting in shape. What remains unknown (or just unreported?) is whether the number actually reflects the extra cost of care for obese employees. The State has yet to set the guidelines for obesity and wellness behaviors, so there could be multiple ways to answer this question.

While differential benefits, that are determined based on wellness compliance look inevitable, I wonder if the State of Alabama went off track by announcing the program as a "surcharge" and setting themselves up for criticism. In my view it is important to emphasize that it is the taxpayers and employees taking good care of themselves who get overcharged right now. So the program in fact restores the fairness and equity, based on personal responsibilty.

A better way to launch such programs may be by emphasizing the rising cost baseline (due to preventable conditions) and then passing the cost savings and rewards (due to successful prevention programs) onto the people who do their part.

Differentiation of benefits need not be controversial. This concept might be one of the few effective ways to get costs under control.