Arizona Gov Proposes Fat Tax For Welfare Recipients

[Dreadnaught]

Latest from Arizona, incubator of boundary-pushing ideas...

POLITICS APRIL 1, 2011

Arizona Proposes Medicaid Fat Fee
By JANET ADAMY

Arizona's governor on Thursday proposed levying a $50 fee on some enrollees in the state's cash-starved Medicaid program, including obese people who don't follow a doctor-supervised slimming regimen and smokers.

The plan, if approved by the Republican-dominated legislature, would mark the first time the state-federal health-care program for the poor has charged people for engaging in behavior deemed unhealthy.

Some companies have insurance surcharges for employees who smoke, but they aren't a staple of government-administered health programs.

Republican Gov. Jan Brewer proposed the idea as part of a broader plan to raise money that would allow the state to offset recent cuts she engineered to its Medicaid program. If ratified, the measure would revive coverage of organ transplants, which Arizona limited last year as a way to save money. It would also reduce the number of childless adults disqualified from Medicaid to 135,000, compared with the original proposal of 250,000.

"If you want to smoke, go for it," said Monica Coury, spokeswoman for Arizona's Medicaid program. "But understand you're going to have to contribute something for the cost of the care of your smoking."

She said the proposal is a way to reward good behavior and raise awareness that certain conditions, including obesity, raise costs throughout the system.

Ms. Brewer's surcharge would apply only to only certain childless adults: Those who are obese or chronically ill, and those who smoke. They would need to work with a primary-care physician to develop a plan to help them lose weight and otherwise improve their health. Patients who don't meet specified goals would be required to pay the $50, under terms of the proposal.

In Arizona, 25.5% of residents were obese as of 2009, according to figures from the federal Centers for Disease Control and Prevention, ranking it about in the middle among states. About 46% of Arizona's Medicaid enrollees smoke daily, according to a 2006 survey by the state's Medicaid agency.

State Sen. Kyrsten Sinema, a Democrat, said such a fee would unfairly penalize those who can't control their weight. "If someone is obese because they're severely disabled or can't exercise, we shouldn't be punishing them," she said. "I mean, it's not their fault." Ms. Sinema said she would vote against the plan—mostly because of the enrollment cuts—and said such changes would require approval by voters rather than lawmakers.

Such a Medicaid fee typically would need authorization from the Centers for Medicare and Medicaid Services in Washington, and federal rules could prevent Arizona from enacting it. Mary Kahn, a spokeswoman for the agency, said no such levy has ever been approved.

Ms. Coury suggested federal rules may not apply to those affected by the proposal, because Arizona extends coverage to them beyond what Washington requires.

Unlike private insurers, which often charge different premiums based on customers' health status, Medicaid must enroll all those who meet its eligibility requirements.

Medicaid's rising cost has become one of the biggest problems for states struggling to balance their budgets. It is one of states' top two expenditures, along with education, and has ballooned in recent years as more people lose jobs and otherwise fall on hard times.

Ms. Coury said Arizona officials hadn't yet finalized how they would determine whether a person was obese or had sufficiently followed a wellness plan, but that measures such as body-mass index could provide some guidance. All childless adults enrolled in Medicare who smoke would be required to pay the annual $50 fee.

If approved as is, the provision would take effect Oct. 1.

Write to Janet Adamy at janet.adamy@wsj.com

http://online.wsj.com/article/SB10001424052748704530204576235151262336300.html

In the absence of any indication this would really have an impact, I think it seems like a silly bit of posturing. But I'd be all for it if it led to a looser Federal grip on Medicaid.

[GGT]

Same lady who claims there's too much gummint in our lives?

Why isn't she more focused on jobs and employment? Working people who can support themselves and their families don't need to apply for Medicaid. Oh, unless they have a chronic debilitating disease that's too expensive to cover with private insurance, like renal failure needing dialysis or a kidney transplant. She also tried to limit Medicaid paying for that.

[Ominous Gamer]

fining smokers = awesome
fining diabetics = not awesome

[Dreadnaught]

But diabetes has only gotten more prevalent because we eat more. Chicken and egg situation, nyet?

[Ominous Gamer]

But diabetes has only gotten more prevalent because we eat more. Chicken and egg situation, nyet?

not because we eat more, but because of what we eat. some of the cheapest food also happens to be some of the most unhealthy. and is the same shit thats most affordable to families and individuals that end up on medicaid. HFCS in place of real sugar has alone shown to cause weight gain.

[LittleFuzzy]

HFCS in place of real sugar has alone shown to cause weight gain.

Uuh. . .

[Dreadnaught]

not because we eat more, but because of what we eat. some of the cheapest food also happens to be some of the most unhealthy. and is the same shit thats most affordable to families and individuals that end up on medicaid. HFCS in place of real sugar has alone shown to cause weight gain.

How is this the government's fault and why should the government pay extra for it?

[Ominous Gamer]

No one said it was the government's fault

But there is a huge difference between having to cover complications from smoking, an expensive and known to be deadly habit, and fining people because of a disease that they likely knew very little about before hand, knew very little on how they could have prevented it, or much less have the means to afford a proper diet to combat it.

If the government wanted to step in and provide the food they consider important (much like WIC already does, another reason food stamps need fixed), then I'd be all for fining those that don't listen and still harm themselves, but simply telling someone that "hey, that cheap food you can already barely afford is bad for you, stop eating or else". Thats stupid.

[Dreadnaught]

I don't see why the government should put taxpayers on the hook to bail-out people who are addicted to cheap suger substitutes and hoarding cheap, government-subsidized calories.

[Ominous Gamer]

More jumping to conclusions

No one is suggesting anyone is addicted to any type of food, but HFCS (just one example) is in literally all cheap foods, because (you better sit down for this), its cheap. The 83 cent box of toaster pastries I just finished today: HFCS, the 67 cent Gatorade: HFCS, the 79 cent Banquet dinner I'm saving for lunch: HFCS. Don't know where you're getting the hoarding part from, but hey, thats you.
Medicaid is there to help these people with health problems, telling some people that they should be helped lessed simply because they are the way they are because thats all they could achieve (again, this is different from smokers who are what they are because they spent the time and money to put themselves there), thats not helping them.

[Dreadnaught]

I'm being slightly deliberately silly. But I also think it's silly to think that the taxpayer is endlessly on the hook for overeating. Is eating well tough and a financial drain? In many ways in our society, yes. But that doesn't mean we should just transfer the costs of not eating well directly to the government.

[Ominous Gamer]

you're still stuck on this being an overeating problem...

not eating well is bad, but when you're looking at this group of people, its between not eating well and not eating enough. Punishing people who are already in such a poor financial spot that they end up on medicaid, because of diabetes and the inability to follow a more expensive then they can afford health plan... that doesn't fix anything.

Government doesn't want to be on the hook for that? Totally understandable, but something else needs fixed first before you start attacking the people who need the help.

[Dreadnaught]

So let me get this straight. Government subsidizes cheap food for those who can't afford it. People get diabedes because of cheap food. Government pays for medical care as a result.

Do you not see where this is going?

[GGT]

More people are diagnosed with Type II Diabetes because we've increased the numbers being screened Much of that thanks to programs like Medicaid giving access to a clinic or physician, simple chemistry profiles, focusing on at-risk groups. Previously, poor or uninsured people just went undiagnosed and untreated.

Instead of states cutting Medicaid, they should put more into stuff like Health Education, meal planning, exercise programs, how to shop wisely at the grocery, block grants for community vegetable farming (because so many urban centers don't have affordable fresh produce). But that takes time and money, more money up front than just handing out food vouchers or a Medicaid card, and treating diseases after they've taken hold.

Republicans jeered Michelle Obama's health initiatives as "the gummint telling us what we should eat".

[Ominous Gamer]

Government subsidizes cheap food for those who can't afford it. People get diabedes because of cheap food. Government pays for medical care as a result.

I'm pretty sure i already mentioned that food stamps need fixed. If the government put actual effort in trying to steer people towards proper food (again, like WIC), perhaps this wouldn't be as big an issue.
I honestly don't see how its ok to provide people with just enough substance to eat the cheap unhealthy food, but not deal with the consequences of that.

[Dreadnaught]

Fair enough. Just probing at it, as I mentioned in the beginning I don't think this is a great idea.

[GGT]

Might be interesting to add this tidbit:

http://health.yahoo.net/experts/eatt...ermarket-foods

The movie theatre industry was able to lobby against labeling their popcorn and snacks.

[oldmunchkin]

Wyoming has a program called "Sensible Nutrition" that helps you learn to shop better, cook better meals, and learn about nutrition. It also helps you learn to budget your food budget, whether it's food stamps or someone who doesn't need assistance. I have taken the program, and it's very interesting. It does help the poor people on food stamps, because it give you healthier foods and shows you how to make healthier choices. The program is free to those on food stamps and a small fee is charged for those who can afford it.

I sincerely hope that the Arizona politicians are smart enough to let this bill die. In case they aren't, and considering they are a Republican majority legislature they might not be, I hope the federal government puts the brakes on this stupid mess. The way I read it, it sounds like ANY chronic condition will result in a $50 fee. Is this fair to the parents of the kids with diabetes? Or overweight kids? Or kids with asthma? Or any one of a number of chronic conditions that occur? Or a person who has diabetes, is following all doctor's orders, but is still overweight? Or the overweight person who follows doctor's advice, but is still overweight due to a medical condition?

Quite frankly, I think that charging someone who is already unable to afford good medical treatment, is wrong on a lot of levels. Instead, spend the extra and implement lasting solutions to these problems.

[GGT]

The bill, as written, only applies to certain childless adults. Which is kinda stupid anyway. But I agree with you munch....it's wrong on so many levels to "punish" people who are already poor and needing welfare in the first place, to add extra "hoops" they have to jump through.

[EyeKhan]

There should be a fat tax for everyone. Why just pick on the people without the money or the access to buy healthy food?

[Catgrrl]

How would they even determine who is obese? I hope not using the BMI, that crock of shit needs to go away.

[Aimless]

Hmmm. Wouldn't it be more sensible to offer the obese free bariatric surgery?


I'm not sure how I feel about the vaguely defined criteria. "Those who are obese or chronically ill??" What the hell does that second bit mean?

I think something like this might be worth a shot if it's done well, but not if the only thing they'll do is to fine people.

[EyeKhan]

It should go more like this:

1. Tax unhealthy food in restaurants, grocery & convenience stores and vending machines.

2. Subsidize healthy food in same to bring the cost down.

3. In innner city "food deserts" subsidize private supermarkets and/or open government run supermarkets that provide a full range of foods so everyone can actually access healthy food.

[GGT]

Hmmm. Wouldn't it be more sensible to offer the obese free bariatric surgery?

Surgery should be a last resort.

No, we don't need to subsidize private supermarkets or have government run them. But block grants for community vegetable gardens or tax incentives for groceries to build in those urban food deserts would help.

[Ominous Gamer]

This is unsurprising, but hilarious:

Smokers and the obese cheaper to care for, study shows
In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

woohoo for living longer. Maybe we should start fining old people?

[GGT]

This is unsurprising, but hilarious:

Smokers and the obese cheaper to care for, study shows
In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

woohoo for living longer. Maybe we should start fining old people?

Arthritis and joint replacements for all the runners. Alzheimer's and strokes in healthy people.....that end of life care that costs so much. Live long enough and eventually some form of cancer pops up. We can't make up our minds, when to treat or not to treat! They changed the guidelines for prostate cancer surgery and chemo since it didn't improve longevity (or quality of life), but now Medicare has approved the new $93,000 treatment to eke out 4 more end-months.

Longevity and costs of care are why Medicare and Medicaid costs are eating us alive, and costs of subsidized health plans for state workers (those public sector unions) keep going up, up, UP!

[EyeKhan]

Surgery should be a last resort.

No, we don't need to subsidize private supermarkets or have government run them. But block grants for community vegetable gardens or tax incentives for groceries to build in those urban food deserts would help.

IMHO a tax incentive is a subsidy.

[GGT]

IMHO a tax incentive is a subsidy.

Oh Gawd, let's not get into a semantic debate.

It wouldn't have to be an ongoing perk written in cement, maybe just a break for the first year or two? Making sure public bus routes connect city residents to their new store would probably hike the transit budget, but eventually pay for itself with extra riders? (That's a big problem where I live, and some people actually have to take a Taxi to get groceries.)

[EyeKhan]

Those incentive tax breaks to convince a business to move to your city or state have a way of getting renewed... The point in this is not HOW you irrigate the food desert, but that it is a problem that needs to be addressed if you want poor people to have a healthy diet. And the point of THAT isn't to be nanny to the ignorant masses but to reduce the overal cost of health care without resorting to letting some sick people die. And the point of THAT is to maintain some semblance of community and compassion in our culture and stave off the decadent decline, social unrest and civil strife that Conservatives seem hell bent on stirring up.

[GGT]

Those incentive tax breaks to convince a business to move to your city or state have a way of getting renewed... The point in this is not HOW you irrigate the food desert, but that it is a problem that needs to be addressed if you want poor people to have a healthy diet. And the point of THAT isn't to be nanny to the ignorant masses but to reduce the overal cost of health care without resorting to letting some sick people die. And the point of THAT is to maintain some semblance of community and compassion in our culture and stave off the decadent decline, social unrest and civil strife that Conservatives seem hell bent on stirring up.

And a gov't run supermarket isn't acting as "nanny"?

I think it matters HOW the food desert is turned into nutritious and accessible food. If it has to be transported from Brazil or Guatemala, using planes or ships using expensive fuel, that won't help in making food more affordable. To the contrary, that makes food more expensive while it has to trek the globe. And it attracts speculators who are more than happy to run up the price, in order to make their hedge profit.

Local and/or slow foods seem to make more sense. When importing food means the difference between thriving or starving, all hell can break loose. There might even be an argument to make about native populations eating local foods and being healthier, before global food took hold.