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Arizona considering $50 tax for smokers, obese


PHOENIX — Arizona's cash-strapped Medicaid program is considering adding a $50 tax on single patients who smoke, have diabetes or are overweight.

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Arizona Health Care Cost Containment program spokeswoman Monica Coury says the tax is intended to push patients to take better care of themselves.

Coury says the issue is getting at the cost of health care while trying to stretch dollars and get people to take better care.

"If you're not going to manage those things and take some personal responsibility, and in turn that costs the state more money, then you need to have some skin in the game," Coury said.

One part of the proposal affects those with diabetes. Coury says patients with diabetes who fail to follow their doctor's orders to lose weight would be subjected to the $50 tax.

State Sen. Kyrsten Sinema of Phoenix says it isn't fair to charge diabetics $50. Sinema says the fee fines people who may have medical conditions beyond their control.

The changes are part of a major revamp of Arizona's Medicaid program to find funds to restore transplant coverage — eliminated amid much controversy last fall. Other changes include enrollment freezes that would reduce the number of people in the program by about 138,000 over the next year.


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Associated Press




4/1/11






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The changes would save the state a projected $500 million to help close a $1.1 billion budget shortfall.

The gradual reduction in enrollment — which would mostly affect childless adults — is about half of the enrollment rollback that Brewer previously included in her budget proposal for implementation later this year.

But the total number of people denied coverage could reach 200,000 by 2014. Arizona's program has an enrollment of approximately 1.3 million.

"The whole point of the governor's proposal is to preserve coverage to the greatest extent possible," said Monica Coury, assistant director of the state's Medicaid program, the Arizona Health Care Cost Containment System.

'Your smoking costs us more'
Details on how the fee on smokers would be implemented remain to be determined, but options include relying on enrollees' statements and random audits, Coury said.

"You need to be responsible for the fact that your smoking costs us more," Coury said.

Brewer said her proposal is comprehensive enough to put the Medicaid program on solid long-term footing, so she is asking the Legislature to restore the cuts of coverage for certain transplants that have drawn sharp criticism. Approximately 100 people lost eligibility for coverage under those cuts.

Democratic Rep. Anna Tovar, a past transplant recipient who has championed efforts to restore coverage, said Brewer should have reversed course on the issue months ago because the $1.2 million cost is affordable.

"We don't need federal approval on that. The Legislature can do that separate and alone from the federal government," Tovar said.

She expressed concern about the rest of Brewer's Medicaid proposal, saying it would harm people who couldn't re-enroll or enroll anew. The enrollment freezes, she said, "are very detrimental."

Under the submission to the Department of Health and Human Services, the Arizona program's changes would generally take effect when its current authorization ends Sept. 30.

HHS Secretary Kathleen Sebelius has already told Brewer that Arizona can reduce eligibility that now exceeds federal Medicaid minimums, and Brewer's proposal target those populations.


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However, federal approval is needed for various cost-saving steps such as co-pays and fees, and Brewer said Thursday she's counting on Sebelius' previous stated willingness to be flexible.

"Your partnership is critical to my efforts to preserve Medicaid coverage for more than 1 million Arizonans," Brewer said in a cover letter to Sebelius.

Federal action on Arizona's proposal could take months. "It does take a lot of back and forth," Coury said.

Mary Kahn, an HHS spokeswoman in Washington, said the federal agency would not comment on Arizona's proposal except to cite Sebelius' previously statement that she'd work with state officials. She agreed that the process could take months.

Besides needing clearance from HHS, another obstacle facing Brewer's Medicaid plan is the near-certainty of a lawsuit challenging eligibility rollbacks.

Critics say reducing eligibility violates a state constitutional protection for a voter-approved ballot measure that increased eligibility.

Kahn said she didn't know whether other states have proposed similar reductions of their optional Medicaid populations.

Under Brewer's plan, most of those people who could not either re-enroll or newly enroll because of the enrollment freezes taking effect at various points this year would be eligible for coverage in 2014 under the federal health care overhaul.

The freeze approach is preferable to abrupt cutoffs of eligibility that would occur under Brewer's previous proposal that became the basis for a Senate-approved budget plan, Coury said.

Approximately 20,000 people now getting ongoing cancer treatment from doctors and hospitals could remain on the program, she said.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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29 Responses
585414 tn?1288944902
    I would think its a bit much to monitor whether people with diabetes are losing weight and potentially discontinue their needed medical care if they don't. That kind of legislation almost makes it seem like its a moral decision to follow up or not which is wrong. To their credit the state does have the Medicaid Buy in Program for Working People with Disabilities and they should use more positive approaches to cost cutting such as returning people back to the community who can live there (which no state has done due to the nursing home lobby, although it has been proven to reduce expenditures). Also the health of one person can affect other people eventually and also if diabetes goes untreated not only will it eventually be detrimental or fatal for a person, the needed care at that time will be far more expensive. I do agree that they should work with people to remain in treatment but they should use a positive approach.
535822 tn?1443980380
I think this is a really bad thing, overweight people and those who smoke need support not punishment ,its  going to work the other way and make them eat/smoke more out of the anxiety of it all.what a nasty invasion of other peoples lives ...yuck
1032715 tn?1315987834
I go to the gym 6 times a week,have a personal trainer 3 of those times who pushes me till I have literally thrown up,I do boxing twice a week and spin bike once a week,every session is an hour long,I have been doing this for nearly 3 years,I do watch what I eat also and I do not drink alcohol,I have only lost 10kg in that time and still weigh 130kg,
I don't eat wheat,or dairy,or high carb foods
I only eat oat based cereals,rice noodles instead of pasta,no bread at all,rice milk instead of cows milk,sweet potato instead of potato.

Am I doing enough?or would someone like me still be made to pay?
377493 tn?1356505749
I also don't think this is the way to help people at all.  One of the things we have done here is that people can use the cost of exercise classes like Narla describes as a tax write off.  For children too.  Also, things like cigarettes are highly taxed at time of purchase, and the tobaccos companies are very highly taxed.  This helps compensate for some of the future medical costs associated with smoking.

I agree..punishing doesn't work. Supporting and encouraging does.  
1032715 tn?1315987834
I wish we could get a tax write off at the gym,
It costs me $350 for a years membership and then $300 a month for my personal training sessions,we find it really hard to find this money on one wage,but we have to,my hubby goes to the gym too so that's another $350 a year,he is very fit by the way and only weighs 75kg,we eat much the same in food(go figure)

It's hard when you know people look at you and decide you are lazy,and have no control over food consumption

I also run,do fun runs-did 10km in 2 hours,and a 5km one in 50 minutes,so fat people can also be fit.
  
377493 tn?1356505749
Ignore ignorance.  Seriously.  People can be very nasty and no matter who you are, what you look like, how heavy or thin you are they will find something.  They need to spend more time looking at themselves then worrying about others.  

Being overweight does not mean unhealthy.  You are doing everything right, and are focused on being fit.  You will far outlive Miss Skinny who does nothing physical to take care of herself, know what I mean?  Genetics play a huge role in our physical appearance.  You just ignore anyone who thinks your lazy!  I hear that I just get ticked off.  BTW...I am really thin and based on what you said, you could out run me anyday, anytime!  You are obviously in great shape!!  WTG girlfriend!!
Avatar universal
I kind of liked a few things Arizona was doing, but this is a turn in the wrong direction.  If they are going to tax us fat folks and smokers, they probably ought to tax drinkers because of all of the potential health risks regarding drinking..... probably ought to tax all athletes, because of the heightened risk of injury..... probably ought to tax readers, in risk of horrible paper cuts.  Ridiculous.....
377493 tn?1356505749
...and how about anyone with any disease.  Why stop at diabetes!  Heck, who are we kidding, let's just kill em off!  No more problems right?  We can achieve the perfect race...Heil!

Ok, a bit over the top, but honestly..punishing people for being people?  Every one of us is less then perfect..what next.
Avatar universal
It seems like I went to bed one night, woke up the next morning and the whole world had gone mad! All the rising up in the middle east, seemingly all at the same time and the tragedy in Japan, then the ongoing nuclear disaster and even here in the states where it seems there are people trying real hard to get an uprising going here over any thing they can. Now I read about this nutcase preacher burning the koran and setting off a string of events that is costing lives as we speak. The sea is contaminated and god only knows where that will lead with the domino effect that it has started. People act wild and crazy and seem to have no caring for one another anymore. It is scary!

Someone needs to take this Brewer person and get her a couch doctor asap, she is nuts! If you dont want people smoking, quit selling em and in case no one told her, obesity happens for more reasons than overeating! Like genes maybe?  Man we sure can pick em! Is all I can say!
377493 tn?1356505749
Not just US Teko.  We have just called our 4th federal election in 7 years...talk about a waste of time and money.  Our Liberal party (of which I have always been a supporter) is supposedly going to form a coalition with the NDP (can anyone say communist party?) and the Bloq du Quebcois (seperatists if you can believe it).  So for the very first time in my voting life this hard core liberal may vote conservative (hell must be freezing over..lol).  

You are so right...the whole world has seriously gone insane.  Maybe Ghadaffi is right...someone is spiking the water with hallucogenic drugs or something, because it sure wasn't like this yesterday.
Avatar universal
Teko is right on the subject of selling tobacco.  You don't want smokers, don't sell tobacco.  As for addressing the obese/overweight.... tax the ever loving hell out of anyone producing anything but the healthiest foods.  

The other day I mentioned something about Rick Santorum.... he said something ridiculous.  Now Jan Brewer goes and says this..... I just don't get it.  Right when I think something is going in the right direction, the guy that's driving the boat sneezes and jerks the damn boat off course.
535822 tn?1443980380
of course like Santorum .. Brewer is a Republican ..so a big deal is being made of it  I dont agree with it, but I can see what the media agenda is here...yet again ..
377493 tn?1356505749
Left, right, whatever.  A dumb comment is a dumb comment...doesn't matter whose mouth it comes out of.  Personally, I think all politicians from pretty much everywhere need a major overhaul.  I wish our upcoming federal election had someone with absolutely no experience in politics...that would be who I would vote for.  I mean, can't be any worse right?  The pre election campaigns here are heating up and it's amazing what these guys come up with.  Would be funny if it wasn't so scary that one of these yo yo's might actually wind up running our country.  Maybe I'll just destroy my ballot...
535822 tn?1443980380
Yes I agree it was a very stupid thing to say and she surprised me and many others, I have liked her up to now .
203342 tn?1328740807
I saw this in the paper and thought this was very sad and arrogant to tax overweight people or smokers. They need our support and help. Since when did shaming someone or humilitating someone help them lose weight or quit smoking? Doesn't work. If anything, it backfires. Shame on Arizona for their lack of compassion and arrogance in this matter.
Avatar universal
So where do they draw the line? Smoke, diabetes, overweight?
What about those that have thyroid issues?
What about those that were born with diabetes?
So if they punish those who smoke, then how about  those who drink, how about those who use drugs, how about those who have sex with more than one person, how about those who dont exercise the right amount of time, or who spend too much time in the sun or out of it. or eat meat or whatever-- My point is, all these things, depending on who we talk to can cause health problems that can be avoided, so who exactly is going to be making these decisions? A vegetarian will tell you no meat, a Christian will tell you no sex outside marriage, etc....
535822 tn?1443980380
Yet we have and Arizona certainly has paid taxes for the healthcare of the illegal aliens in this country,it costs money for the free clinics and the ER treatment they use .
Avatar universal
Its definately quite a mess. I wish them luck trying to figure it all out.
I have so many questions about so many things going on, but then its probably just me.
What if health insurance is made manditory and then the insurance companies make it manditory that you have invasive screeings that you personally believe are not worth the risks? What if they insist you never eat certain foods?
Should people who can not afford to pay their medical bills be allowed to have as many kids as they want?
There are so many questions with tricky answers.
Avatar universal
I saw somewhere in the news yesterday, I can't remember where it was, but they are proposing a tax on T.V. viewing.  (It was one of the cash strapped states.)  Of course watching T,V. isn't such a good thing, but to tax watching T.V?  Other than generating revenue, I don't see what they plan to accomplish.

I am dumbfounded at how taxation works in this country. I really appreciate the fact that we are taxed on the money we make, we put that money into a bank account or an inverstment, then we are taxed on the revenue it makes..... and if you take funding from an account before it matures, they tax you even harder.  You are essentially taxed for making money and  trying to save it...
535822 tn?1443980380
they have this in UK  have for many years .the tax . is quite high, when I lived there they used to send out government  vans to the houses, sit outside  check if a TV was in a house, and being used, the folks then got a huge fine .,its all big brother .They call it the TV licence ...they have many rules and regulations in the UK its one of the reasons I escaped .hahah now you can see why I and other immigrants are horrified what we see happening in the US
Avatar universal
Wow--I am glad I no longer watch tv--lol. Of course the computer use will be next right? lol
Avatar universal
Basically what I see is they are attacking old and poor and middle class, taking away and giving it to the rich. Every single thing they are doing affects the backs of the middle class. Look at GE.... Didnt pay a dime in taxes and look at BP who gave huge safety bonuses even tho that disaster cost 11 people their lives. They want to get their hands in medicare and medicaid but cut taxes for the corporations that dont pay in anyways. Someone explain that to me?
Avatar universal
There is no excuse for G.E. not paying taxes.... none.  And as for BP and bonuses.... remember them belly aching about how much the spill was costing them?  If you didn't know a thing about that situation, you almost might feel a bit sorry for them...... but, when they turn around and give bonuses like they do, it really lets you know that the oil companies are really doing ok.  (The cost of that spill was a drop in the barrel to BP)

This is so frustrating.  Am sitting here trying to squeek out a living.  Everything is going up with the exception of my pay.  Every two weeks, my money is spent....... and you hear of guys that are getting bonuses worth 500 times more than I make a year, and their business is tangled up in the worst oil spill ever..... unbelievable.
377493 tn?1356505749
Brice, that is exactly my problem with our Canadian conservative gov't.  They are all about protecting big business, cutting their tax rates and giving them all sorts of loopholes, but then they turn around and tax the heck out of middle class people like my husband and I.  I am just fed up.  I don't want anything more then what's fair.  But same problem here...cost of food is sky high now.  Electricity just shot up 60%!!  My husband works his butt off and I work part time and take care of our child, but the way things are going I will be forced to work full time.  I know, lots do, but we have always been careful with money, lived within our means in order to be able to do this.  It's really not fair that we pay the price for corporate greed.  I am not against anyone who works hard doing well, and we need those business' for sure, but come on.  When is it the working man's chance to get a bit of a break.  I know, I am going on about Canada and most of you probably could care less about what happens here, but it seems to be very similar to what you folks are facing.  I am just so frustrated like the rest of you.  Sad thing is, no matter who gets elected I don't think much will change.
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