Here’s an interesting trend starting to show up in public employers’ insurance: tying a person’s premiums to their weight. For example, the state of North Carolina will pay 80% of an employees health care costs. But if he or she gains too much weight (or starts smoking), the number drops to 70%.
Lifestyle considerations aren’t new to insurance, but they’ve started to take a center role as prices continue to rise. Alabama–and now North Carolina–are the first states to impose this fat fee, allowing an increase in out-of-pocket expenses for state workers who smoke (without trying to quit) and who are morbidly obese (without trying to lose weight).
The Kaiser Family Foundation has shown that in the past ten years, employers’ premiums have gone up 131%. While insurers can’t say these costs are directly related to obesity and smoking, we do know that a) obesity and smoking are expensive and b) people are fat and smoke, so insurers might as well link the two.
Critics of the North Carolina plan say it’s too harsh. Smokers have already been shifted from the 80% plan to the 70% plan, although the 80% plan is still on the table if they take a smoking-cessation course. Obesity doesn’t kick in until 2011. Workers with a BMI of below 40 can be on the 80% plan for a year, but have to drop their BMI to below 35 or start a weight-loss course. Here’s a chart for reference–
40 to 35, the difference of about 30 pounds, seems like a good start to me.
Alabama, on the other hand, is opting to reward the healthy, not punish the sick. State workers pay a monthly premium of $70, but can get a $30 discount for not smoking and soon a $25 discount if they are cleared of any obesity-related risk factors via regular checkups.
I think these are, of course, great ideas. We reward drivers for being safer via their insurance, and there’s no reason why we shouldn’t reward people for being healthier. Safeway has a voluntary wellness plan, in which if employees pass regular tests for obesity-related risk factors, they get a break on their premiums. Their insurance costs have been flat since the program’s inception.
But, an amendment working its way through Congress that would change the level that companies can reward their employees or reduce premiums from 20% to 50% has met some heavy opposition from some big names. The American Heart Association, the American Cancer Society, the American Diabetes Association, and 60 other groups have protested this move. The general consensus is that a policy like this doesn’t encourage healthy behavior, it just punishes people for being fat. I think attitudes like this really play to a weird perception in America that I’ve touched on before, mainly behaviors like smoking are things people choose to do, but being fat is something they are.
In opponents’ minds, you can punish smokers just as car insurers can punish perennial speeders–it’s a bad habit they continue to exercise. But charging higher premiums for obesity would be like doing the same for a driver who was colorblind; Americans view this as an uncorrectable state of being. This makes little sense to me.
In the end, if obesity is putting a greater strain on health insurers, then the obese should pay their share. Skyrocketing obesity rates and insurance premiums have shown this is a trend, not an isolated incident, and yet few steps have been taken. And, for the most part, people respond to incentives. So forgive me if I’m a little insensitive to the “big boned” defense. Rewarding healthy lifestyles seems like a good thing for the healthy, a good option for the obese, and a smart choice for employers.
Right off the bat, this policy may sound unfair to some, but I completely agree with you. One’s health should play a big role in the price of health care. It is not only beneficial to health care companies (in theory, the healthier their clients, the less they would have to pay for medical costs) but to the actual person (it encourages healthy habits). I believe that health care providers shouldn’t have to cover smokers or obese people if they are doing absolutely nothing about it. While obesity may be linked to genetics or other things, it is an epidemic and needs to be addressed. I don’t think it’s a bad idea both if both the healthy were rewarded and the unhealthy were punished. Also, who says higher health care has to be just for smokers and obese people. Alcoholics could be included and thus another incentive for them to seek help.
I agree with you and Lora. Being overweight/obese is literally THE biggest risk factor for many of the most prevalent diseases in America. Think about it. Heart disease is the biggest killer in the world. And though things like smoking obviously contribute, being overweight is a huge part of it. Same with diabetes. Type II Diabetes is often caused by weight issues, and can usually be managed through simple healthy eating and exercise. Though it has to do with image and it might make some people feel bad, it’s a legitimate risk factor, and health insurance companies lose a lot of money by covering these people at the same cost. They should be charging a heavy premium for clients with this risk factor, just as they would for clients with pre-existing conditions. And maybe if overweight/obese people realize that they can save money by trimming themselves down, they’ll take action to keep themselves healthy and we can help solve our nation’s obesity problem. I really hope that amendment passes.
I think its fine if insurance companies charge higher premiums for people who smoke because it is a lifestyle choice that they are making and is controllable. However, raising rates because someone is obese seems politically incorrect. Obesity is considered a disease and is often out of peoples’ control. I mean no one really has to eat that extra cheeseburger, but Often times people really can’t control their weight.
On the other side, I guess you can argue that obese people are gluttons who indulge in more food than they should. It would then be the same argument with cigarette smokers, that their obesity is a product of their lifestyle. They could control their weight by exercising and eating healthier.
I believe, like smoking, obesity is able to be controlled. People are faced with choices everyday, and a few lifestyle changes can prevent people from becoming obese. For some reason, discriminating against smokers is okay, but when it comes to weight, no one is really held responsible. This health insurance option would hold people responsible. Their lifestyle choices ultimately lead to them being vastly overweight. Also, it sounds like this insurance would only benefit people who are in shape, not punish obese people, which seems like a great incentive to not become obese.
i think we’re missing something huge here. when we’re talking about obesity, individual choice is involved, but the environment and your opportunity to eat healthy is HUGE. I wrote about this recently in my post about food. In places like South LA, grocery stores with cheap, fresh food is rare and is hard to access. A USC study found that out of 100,000 residents, there were 3.6 fresh food stores. Also, think about the quality and healthiness of food served by already underfunded public schools. I’m privileged to have easy access to two large grocery markets within walking distance. This is rare for many who live in cities.
This being said, I still believe we should have responsibility over the way we take care of our bodies. Because of this, I’m more comfortable about rewarding healthy behaviors but that, when we talk about healthcare, we also have to talk about public health and preventative health planning. Why not ensure that schools can offer healthy yet cheap food and that there is a special kind of food impact statement about the accessibility of healthy and affordable food in an area. The healthcare debate is often too after the fact and doesn’t recognize the disparities in space that shape our behaviors.
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I also don’t care much for the big-boned defense when it comes to insurance policies, and I’m getting tired of obesity as being seen as something that people are instead of something that people do. If employers choose to charge some of thier employees higher insurance rates because they choose to follow an unhealthy lifestyle of fast food and late night snacking, then so be it. Maybe it will encourage Americans as a whole to be healhier and more conscientious of how they eat. Either way, obesity is a growing health problem that has plagued this country for years, and it’s time that we stopped sugarcoating it and swallowed the truth. Get it…sugarcoat, swallow the truth?
The BMI chart doesn’t take muscle weight into consideration. According to the chart, at 5’11″ and 208 lbs, I am borderline obese, which couldn’t be further from the truth. I have the physique of a bodybuilder, I wear size 32 jeans, I lift weights competitively in powerlifting competitions, in addition to running and biking several times a week. My diet is excellent.
Most NFL players would fall under “obese”. They should use body fat composition instead. Besides, lots of skinny people smoke 3 packs a day, or are alcoholics, drug addicts, etc.