AHCCCS

According to a recent New York Times article, the Arizona Medicaid program, known as AHCCCS, is considering charging a $50 fee to smokers and obese individuals. This would apply only to childless adults. The idea is that since both smoking and obesity lead to preventable disease and illness and increased health care costs then why not have such individuals pay more for their coverage?

On the surface, this seems reasonable. An extra $50 fee might be just the incentive individuals need to make lifestyle changes relating to tobacco use, healthy eating and active living. If they make the needed changes to quit smoking and/or lose weight, then everyone wins – they’re healthier in the long run, and AHCCCS incurs less medical costs. If they don’t manage to make the behavior changes, then at least the State of Arizona can apply the extra revenue from the fees to partially offset the additional health care costs these individuals incur.

However, the third alternative is perhaps the most worrisome. If they don’t have the extra $50 to spare and can’t make the changes needed, then they will be deterred from receiving health insurance coverage. These individuals are indeed at increased risk for illness and therefore have a disproportionately high need for routine medical care – the very care that can help them quit smoking or work to drop some pounds. Perhaps AHCCCS should consider offering smoking cessation assistance and weight management counseling to all those who would be impacted by this new policy prior to its implementation?

Also, one could argue that obesity is not purely an individual behavioral choice. Genetics do come into play, and studies indicate that the economic, social and physical environment in which people live can influence obesity-related behaviors such as diet and physical activity. To a lesser extent, tobacco use is a product of both individual choice and environmental circumstance. In my mind, though, obesity is perhaps too far outside an individual’s choice to make it a logical candidate for penalization through a fee.

Lastly, I found it interesting that this fee would only be applied to childless adults. Don’t obese and smoking parents also incur greater health care costs related to their obesity and tobacco use? In fact, wouldn’t decreasing tobacco use among parents decrease the likelihood of secondhand smoke exposure among children?

In any case, one has to give credit to AHCCCS for thinking creatively about both revenue stream and health-related behaviors. It will be curious to track the impact of this proposal if it gets implemented.

- Doug Hirano, MPH, APCA Executive Director