Arizona considering $50 tax for smokers, obese

[teko]

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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[narla]

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.
  

[adgal]

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.  

[narla]

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?

[margypops]

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

[ILADVOCATE]

    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.