According to a recent New York Times article interviewing Monica Coury, spokeswoman for Arizona’s Medicaid program, Arizona can’t adequately finance its Medicaid program. State Governor Jan Brewer (pictured above)has proposed a plan requiring federal approval to impose a $50 annual fee on childless adult recipients who either smoke or are overweight.

Arizona’s “Justification”

Coury justifies the fee, citing by way of example a program already in place for Arizona’ Maricopa County workers:

“Maricopa…has started a program among its employees where smokers have to pay $450 more for health insurance than non-smokers.  They take a swab to detect nicotine.  The bottom line is that there’s plenty of evidence and studies that show there is an undeniable link between smoking and obesity and health care costs.”

Swabbing to detect nicotine?  What’s next? Daily weigh-ins?  Further, Arizona is ignoring all of the other things contributing to rising health care costs. The sky-rocketing costs of prescription drugs in the United States compared to what other countries pay.  The aging of the population.  Perhaps the elderly should be cut off for deigning to live for so long.  Malpractice insurance costs continue to rise.

Discriminatory? Coury doesn’t think so, instead calling it a “matter of fairness.”  She said since there is a budget crisis “if there’s something you can do to help out—we’re just asking you to put a little more back into the system.”

Will Fifty Dollar Fees From Poor Fat People Balance Arizona’s Medicaid Budget?

Ironically, when Coury was asked by the New York Times whether this fee would be sufficient to offset Arizona’s Medicaid fund budget crisis, she admitted Arizona hasn’t “done the math, but it’s not about how much we would collect.” So Arizona hasn’t crunched any numbers to see whether this fee would have any effect on their Medicaid fund budget problems, the reason cited for imposing the fee. Nor have they provided any indication they’ve done a cost-benefit analysis to determine the efficacy and profitability of implementing such a program.

Fifty Dollar Fine Will Get Those Fat Poor People Off Their Couches

But Coury does reveal Arizona’s true motivations, telling the NYT interviewer that “what we want to test is whether making people pay is going to affect behavior. We think it will.”  Her justification is that “[i]t is totally about testing the efficacy of this strategy. Obesity is costing us billions in health care costs, so our thought is ‘let’s test some of these strategies.’”

Coury states charging an annual fee will motivate Medicaid recipients to lose weight. She cites no studies or evidence to support the efficacy of this belief. Her feeling is that this fee will give a wake-up call to “able-bodied people who have the capacity to manage their weights.”  If only charging a fee were so easy. The entire weight loss industry, into which unspeakable amounts of money Americans pump money into annually, would be turned on its head and have to close up shop.

Should “Preventative Medicine” Provide Incentives Or Penalties?

On the flip side, a federal grant program created under the Affordable Care Act is offering states $100 million to reward Medicaid recipients who make an effort to adopt healthy measures such as quiting smoking or losing weight.

“One way to encourage difficult changes in life habits such as overeating or smoking, research has shown, is to offer economic incentives to those who reach stated goals. With that in mind, CMS will encourage states to adopt such strategies as rewarding Medicaid enrollees who meet goals established for them such as weight loss, smoking cessation or diabetes prevention or control. Rewards could range from direct cash incentives, gift cards to grocery stores or other retailers, reduced Medicaid program fees (if any apply) or offering services not normally available through Medicaid.”

In other words, the Federal grant program’s approach is to provide an incentive to become healthier rather than punishing those deemed to be unhealthy.

Similarly, New York City recently initiated the Green Cart Initiative to combat the lack of healthy food options in poor neighborhoods.  Many of those neighborhoods lack supermarkets and the bodegas have a very limited and expensive selection. Fast food restaurants are prevalent in these areas and calorie-dense foods contributing to obesity are often the only affordable option. New York City is issuing permits for mobile carts selling fruits and vegetables in areas where consumption of fruits and vegetable are low.  Through $1.5 million grant from the Laurie M. Tisch Illumination Fund, the initiative also includes an array of supports to help vendors succeed in their new businesses.

The theory of preventive medicine is to cut off health issues at their beginning stages before they develop into more chronic, serious problems.  This makes sense both for the individual patient and the insurers’ bottom lines. The federal government’s incentives, New York City’s initiative, and Arizona’s proposed “fee” are touted as measures towards this goal.  But at least the federal governments’ and New York City’s approaches are providing resources to facilitate this goal. Conversely, Arizona is simply saying “get your act together or pay up.”

Cutting Poor Fat People Off Medicaid Is One Way To Get Arizona’s Medicaid Fund Budget In Check

And what happens to those individuals who can’t afford to pay the fee?  Presumably, they’d no longer be eligible for benefits. After all, Coury cited one of the long-term goals of Arizona’s Medicaid program to change eligibility from an

“open-ended entitlement program to one that that the state manages based on available funding, which means we can freeze the program and then open the program back up should we come into additional funds.”

Reading between the lines, Arizona’s Medicaid program simply has too many recipients receiving benefits. And if they can find a legal way to unload some of who they consider to be the “undesirables” and improve their bottom line, they will enact any means necessary. This is perhaps the real motivation they are glossing over.

In a nutshell, Arizona is looking for a scapegoat to blame for skyrocketing health care costs and the overweight serve as the perfect subjects.  Particularly when they are poor and can’t fight back. Fifty dollars might not seem like so much. But when you are living on a low income, that $50 means a lot.

Besides, in the words of Coury, it’s a “matter of fairness.”