Republican Gov. Jan Brewer, as part of a broader package to reduce costs of Medicaid in Arizona, is proposing an annual $50 charge for patients who are obese. The Wall Street Journal called this a “Fat Fee,” though it could go by many other names: Corpulence Cost, Plumpness Payment, Overweight Outlay, Stoutness Setback, Big-Bottom Dollar. Wordplay aside, if her proposal is approved by the state legislature and the federal government lodges no objections, it would mark the first time Medicaid patients have been financially punished for what the state deems unhealthy habits.
The charge would only kick in if the obese patient failed to follow a plan for slimming down. Similar fees would be levied on smokers who don’t quit and people with chronic diseases who fail to manage them as directed. There are also plans to freeze enrollment of certain classes, cut others and use some of the recaptured funds to revive coverage for organ transplants — a cut that got more than a little bad press when it went into effect last fall. All told, the plan is projected to fill in about $500 million of a $1.1 billion budget shortfall.
Some state legislators say that obesity can be out of a person’s control and shouldn’t be a reason to subject them to special costs. But this proposal is not unique. In 2008, Alabama — a state with consistently high obesity rates — announced that obese government employees would have to pay $25 a month for insurance, otherwise free, if they didn’t attempt to lose the weight. (There were already surcharges for those who smoked.)
Estimates for the costs of obesity in America range from about $150 billion to $270 billion a year. According to the latest CDC statistics, from 2009, 25.5% of Arizonans are obese, about 1.7 million people. (Not all of them are on Medicaid). Only Colorado and the District of Columbia come in under the 20% mark, and the highest rate is in Mississippi, with a population that is 34.4% obese.