View Full Version : MI Medicaid Patients may be penalized for health bad habits

06-12-2005, 05:24 PM
Jun 12, 8:09 AM EDT
Lawmakers tell Medicaid patients: be healthy and pay less

Associated Press Writer

LANSING, Mich. (AP) -- Exercise regularly, pay less.

Light a cigarette, shell out more.

It may not be as drastic as a company telling employees to quit smoking or look for work elsewhere, but the message to adult Medicaid patients under a Republican budget proposal to reduce rising health care costs is similar: live healthy and be rewarded - or as detractors see it, be penalized less.

Under a plan that could be the first of its kind nationwide, Medicaid recipients in Michigan who sign a "personal responsibility agreement" would pay a lower premium. Those patients would agree to exercise regularly, not smoke and show up for scheduled medical appointments. Those with children would pledge to make sure they're properly immunized.

State Sen. Tom George, a practicing physician, said he developed the plan in part after learning of a Kalamazoo-area community college's decision to stop hiring smokers for full-time positions.

"I've got people in my district who are quitting smoking so they can work, so they can pay for my Medicaid patients who choose to keep smoking," said George, R-Portage. "There's a disconnect that's becoming more obvious as private employers begin to look at rewarding healthy behavior."

Perhaps the best-known example of encouraging healthy behavior is at Weyco Inc. In an effort to curb health care costs, the Lansing-area health benefits administrator made it a firing offense to smoke. Its offer of cessation classes helped about 20 workers quit smoking, but four others lost their jobs.

The Medicaid proposal would affect a lot more people. The joint state-federal program covers health care costs for more than 1.4 million poor people in Michigan - many of them children, seniors, pregnant women and the disabled.

Medicaid recipients would be charged a premium on a sliding scale based on income - also a first in Michigan - but it wouldn't apply to the disabled, pregnant women or nursing home residents. The average premium would be $5 per month. Patients who sign the pledge would get a 75 percent discount.

To impose the premium system and healthy lifestyle agreements, the state would need permission from the federal government.

In his Lansing office last week, George explained the reasoning behind the plan.

The cost of Medicaid has soared in recent years partly because of increased utilization he attributes to an aging population and newer but more expensive forms of medical treatment.

"We can't control those things," George said. "The only thing left is behavior. Unhealthy behaviors are known to contribute to at least 25 percent of health care costs."

Michigan stacks up poorly in national rankings of states' incidences of chronic diseases such as cardiovascular disease and diabetes. Medical care for people with chronic diseases accounts for most of the country's health care costs, but the diseases are among the most preventable, according to the Centers for Disease Control and Prevention.

In Michigan, 25 percent of adults smoke. But among Medicaid patients, the number is 42 percent.

"It's an area where there are huge potential gains if we can affect people's behavior," George said.

Critics are skeptical.

While Gov. Jennifer Granholm and some Democrats appear open to the idea of giving Medicaid recipients incentives to live healthier, they question the logistics.

Paul Reinhart, the state's Medicaid director, said the Senate's budget proposal includes no new money to administer the personal responsibility agreements. The state Department of Community Health already is overseeing the $8 billion program with fewer staff because of budget cuts in recent years, he said.

Reinhart also noted that Republicans propose eliminating Granholm's suggested funding increase for the Healthy Michigan Fund - which pays for tobacco prevention, mammograms for low-income women and diabetes prevention programs.

"That seems inconsistent," he said.

Others are critical of the personal responsibility pledges altogether.

Sharon Parks, vice president for policy at the Michigan League for Human Services, said the plan singles out low-income people who already can't afford healthier foods and exercise equipment.

"Just because someone receives Medicaid assistance doesn't mean it's appropriate to legislate their behavior," she said.

John Roy Castillo, director of the Cristo Rey Community Center in Lansing, which provides health services for Medicaid recipients, questioned how the pledges would be enforced.

"Are you going to check people every day to make sure they're not smoking?" he said.

Under the GOP proposal, all Medicaid patients would be required to get an annual health exam. At the exam, those who signed an agreement could be tested to determine if they have smoked, George said.

While acknowledging the idea is novel, Republicans defend it as a good step toward addressing residents' overall health, and predict it's only a matter of time before incentives-based insurance predominates the private sector, too.

"We want to make a difference long-term and actually work toward solutions," said Sen. Tony Stamas, R-Midland.


The Medicaid proposal is Senate Bill 267.

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06-13-2005, 06:06 PM
This is scary. Since when does smoking cause diabetes. They use our tax money to shame and penalize citizens for smoking then they take some more to subsidize the tobacco farmer to make sure he makes a profit. :confused: (The last I heard anyway). Really makes sense.

I have a theory. :rolleyes: Nicotinic acid is in tobacco. Guess what! That's niacin. I'm smoking my RDA of nician. :thumbsup: Also, it's my spiritual ritual. Remember how God led the Jews through the wilderness with a pillar of smoke? And the prayers go up day and night in smoke/incence before the throne of God. We are all God's children. :D I enjoy the fruits of the earth with respect, thankfullness and moderation. End of Sermon

:bow: :hee: :beer: I'll be abstaining from the "spirits" for my sweetie's sake though.