North Carolina’s State Health Plan stands alone

imagesThe remarkably punitive wellness provisions developed by the North Carolina State Health Plan and authorized by the General Assembly are uniquely invasive.

Indiana provides a premium discount to non-smokers and reserves the right to conduct random cheek swabs, but no other health plan uses our state’s strange combination of severe punishment for smoking and obesity combined with regular, random testing. South Dakota reserves the right to verify smoking status but seems to test for tobacco use only when it has cause (i.e., someone snitches on a fellow employee).

Nearly every state that uses smoking surcharges or premium discounts rely on the honor system including Georgia, Alabama, Tennessee, Kentucky, Kansas, Missouri, and South Carolina.

In West Virginia you can give the health plan access to your medical records so it can check for signs of smoking. I can’t imagine it’s practical for the plan to actually look through medical records, although it could pull a sample every now and again.

So North Carolina is really pioneering in its distrust of public employees.


  1. Alex

    October 6, 2009 at 11:22 am

    People keep telling me they like the State’s idea. Of course none of them are on the State Plan.

    What bothers me is not honoring HIPPA and a Body Mass Index which does not take in to account muscle mass.

    The State Plan is only going to have one PPO soon so what is the point?

    We had the dose of mistrust when we got the nasty letter saying we had to prove we were married this Spring.

    On the other hand there is no audit or oversight of BCBSNC with there no bid contract.

    If the State wants to save money they should find out how much BCBSNC is pocketing on the State Plan.

  2. Medicare 4 All

    October 6, 2009 at 2:21 pm

    the so called leaders of North Carolina are deeply authoritarian

  3. Adam Linker

    October 6, 2009 at 7:29 pm

    I think when people say they like the SHP charging more for smoking they are ignoring — or are ignorant of — the larger administrative issues like tossing HIPPA and random cheek swabs.

    There is no defense of the way the SHP is implementing its wellness provisions.

  4. Paul Slobodian

    October 7, 2009 at 8:30 am

    John Mackey’s Whole Foods has the plan most consistent with anti authoritarian principles….but progressives seem to be supporting the massive authoritarian approaches to health care reform. Sigh.

    I have posted a q and a that explains some of the issues brokers and non proft insurers have as they fight to see that reform maintains their piece of the pie.

    Disclosure: I do a little consulting helping companies adopt Whole Foods type plans, fighting resistant insurers and brokers.

    This link includes a link to an interview with Mackey

  5. Alex

    October 7, 2009 at 7:15 pm

    My Doctor just told me the Body Mass Index is tougher on African Americans. Here is an article on that subject http://www.sciencedaily.com/releases/2009/06/090611142407.htm Does the State know it is participating in racism?

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  7. Concerned

    October 8, 2009 at 10:22 am

    How about penalizing people who are anorexic? or alcoholics? or thrill-seekers?

    Most people are obese have underlying mental health issues that affect their ability to lose weight, yet mental health benefits are severely curtailed by the state health plan.

    How about a proactive plan that rewards (and assists) people trying to lose weight or stop smoking? Many of these people have experienced a lifetime of pain that is buried beneath the blubber. Women, in particular, have often been sexually abused as children and their pain manifests itself in excess weight. This is not to say that efforts shouldn’t be made to reduce obsity, smoking and other unhealthy behaviors. However, we need to understand where the obesity and smoking come from and help, not hinder. The punitive nature of this plan adds insult to injury for many individuals.

  8. BIG LOU

    October 8, 2009 at 12:31 pm

    I have posted this issue many times and no one wants to deal with…. What will the state do when a VA lawyer takes the state to federal court because the state tried to test a disabled veteran and knocked down their health benefits due to them refusing the test? I have left this message with someone at the state benefit health plan to be passed on to someone in their legal department, but no one has ever responded.. Of course, this issue takes away from the strength of the new laws they are trying to apply to everyone.. Does our state really have the extra time, money, etc. to go to court and inevitably lose due to a federal law, the American Disability Act?

  9. […] those who hope that the NC State Health Plan new punitive “wellness” provisions (random cheek swab workplace salvia tests for smoking and random […]

  10. Sad at UNC

    October 9, 2009 at 4:18 pm

    I am truly sad that working for the State is not a healthy thing to do. If smoking don’t kill me the stress of worrying about getting laid off or feeling abused, truly abused by the BCBS Health Plan or not getting any type of increase in pay but cost of living has skyrocketed will kill me first. If smoking or obesity was the only health issue that took people to doctors/hospitals then I would say “heck yes” lets put this great plan to work. But, I could name so many other things that we abuse our bodies with that can cause health issues. How many injuries from exercise, sports, healthy bike riding take folks to the doctors/hospitals? I could go on and on! I am so sad! I do not want to be another person on welfare, food stamps, etc., but the rate we are going……God help us.

  11. The Progressive Pulse – Top of the morning

    October 29, 2009 at 8:13 am

    […] Carolina is the only state in the country to use the invasive procedure as an insurance policy enforcement […]

  12. […] plan is reminiscent of legislation passed by the General Assembly that authorizes the State Health Plan to contract with a private company to […]

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