One of the major differences between the bills are the wellness provisions the Senate proposed, including the smokerlyzer that will be used to subject state workers to random nicotine tests.
The House took a more responsible position by establishing a Blue Ribbon Commission to study State Health Plan changes and make long-term recommendations. House members smartly included the wellness provisions on the Commission’s agenda. That way the Commission can examine how other states pursue wellness initiatives and how state employees have responded.
Besides the smokerlyzer, there are many troubling aspects of the Senate proposals. One is that if someone is caught smoking or has a body mass index that classifies them as obese, they would shift into a bottom tier insurance product with higher cost sharing.
But the idea, as designed by the State Health Plan, is to shift everyone to the bottom tier plan and let them move up if they can verify that they are properly proportioned and don’t smoke. This could present a logistical nightmare. If, for example, a retiree is confused by the paperwork and fails to send the smoking verification form, could they get pushed into the high cost plan? Perhaps. What if the State Health Plan does not get someone’s paperwork? Do they default into the high cost plan? Maybe.
It is also true that no other state runs its wellness program in this way. North Carolina would lead the nation in punishing state workers for smoking or obesity. Only Alabama has passed a law that will require higher premiums for obese workers. And only a few states charge higher premiums for smoking. Generally, states add $25 per month to premiums for smokers. As far as I can tell those states do not conduct random blood and breathalyzer tests as North Carolina is proposing.
And no other state actually moves people to a new insurance product as a wellness initiative.
The obesity provisions in the Senate bill are also scary. It relies entirely on body mass index, or BMI. BMI was designed for making general statements about large (pun intended) populations for statistical analysis. It is not a reliable gauge of individual health for designing insurance products.
There are many ways North Carolina can lead the nation in health reform. But leading the nation in imposing draconian new health requirements on state workers is not a happy prospect. Let’s allow the Blue Ribbon Commission to study these ideas and come up with better ways to save money and improve health.