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North Carolina to Penalize Obese Workers, Smokers

RALEIGH, N.C. — North Carolina is poised to become only the second state to impose a fat fee on its state employees by placing them in a more expensive health insurance plan if they’re obese.

Smokers will feel the drag of higher costs, too, as North Carolina state employees who use tobacco are slated to pay more for health insurance next year.

North Carolina officials, coping with a steady uptick in health care costs for state employees each year, are aiming to improve state workers’ health, which saves money in future medical expenses.

“Tobacco use and poor nutrition and inactivity are the leading causes of preventable deaths in our state,” said Anne Rogers, director of integrated health management with the N.C. State Employees Health Plan. “We need a healthy work force in this state. We’re trying to encourage individuals to adopt healthy lifestyles.”

State workers who don’t cut out the Marlboros and Big Macs will end up paying more for health insurance. Tobacco users get placed in a more expensive insurance plan starting next July and, for those who qualify as obese, in July 2011.

Some state employees, though, are criticizing the planned changes. The State Employees Association of North Carolina opposes the tobacco and obesity differentials as invasive steps that could have been avoided if the legislature had fixed the plan.

“It’s my understanding they’re talking about testing (for tobacco use) in the workplace which, to me, would create a hostile environment,” said Kim Martin, a sergeant at Piedmont Correctional Institution in Salisbury. “And it’s an invasion of privacy. This is America, the land of the free. I don’t think (body mass index is) a very good measure. I know some folks who would have a high body mass index because they’re muscular.”

The health plan covers more than 600,000 state employees, retirees and teachers at a total cost last year of $2.6 billion. Last spring, the legislature bailed out the plan with an infusion of $250 million to pay the bills after rising costs and inaccurate projections left little money for claims. Over the next two years, the state general fund will pump about $408 million into the health plan.

While officials have not yet estimated any potential savings from the obesity requirement, the higher costs for smokers could save $13 million in the 2010-2011 budget year, Rogers said, emphasizing that the plan’s priority is to improve health and save money in the process.

The idea of penalizing unhealthy lifestyles and rewarding healthy conduct is hardly new among insurance plans. Public health insurance plans in other states already penalize smokers or reward nonsmokers in insurance costs. South Carolina’s state employees health plan is scheduled to add a $25-per-month surcharge on smokers in January. Elsewhere in the southeast, Kentucky and Georgia impose surcharges, and Alabama gives non-smokers a discount.

Alabama was out front on weight testing. Starting in January, state workers will have their blood pressure, cholesterol, glucose and body mass index checked by a nurse. If they’re in a risk category, such as a body mass index of 35 or greater or a blood pressure of 160/100 or greater, they are charged an extra $25 per month on their insurance premium. If they go to a health screening, either offered by the state or by their personal physician, then the $25 is subtracted, according to Gary Matthews, chief operating officer for the Alabama State Employees Insurance Board.

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