State employees will pay for using all tobacco products

imagesMany people have asked me if the random checks of state workers conducted by the State Health Plan will detect only cigarette use or all tobacco products including cigars.

I didn’t know — so I put the question to my toxicologist friend last night (she has an actual PhD from an accredited university). She says the tests would catch cigar smokers and users of any tobacco products. It would also likely pick up any researchers or extension agents who work closely with tobacco.

Not that I’m a big defender of cigar smoking, but it’s interesting because the justification for charging smokers higher insurance rates is because they allegedly cost the State Health Plan more on average than non-smoking enrollees. But what about users of other tobacco products? Do we have any evidence that cigar smokers cost the plan more than workers who abstain from cigars?

16 Comments

  1. Alex

    December 4, 2009 at 12:03 pm

    How much is it going to cost each employee with dependents for the testing? Will not the testing come out of all dependents premiums? I can not see the State paying for the testing. The money has to come from somewhere. So I who do not smoke will be paying for the testing. I can see this as another reason for higher premiums for dependents next year since we are the only ones who pay into the plan.

  2. AdamL

    December 4, 2009 at 12:06 pm

    When you actually go for the test it will not cost anything. But the expense of administering the wellness provisions will likely outstrip the projected savings. That means it will add to the financial strain of an already financially strained plan. That will mean increased cost sharing for state employees down the line.

  3. Something Clever

    December 4, 2009 at 12:14 pm

    Am still cannot settle my opinion on this subject.

    On the one hand, I understand and support the motivation for these kinds of tests. In order to control health care costs, we have to change health impacting behaviors. One of the best ways to do that (see cigarette tax for proof) is to make the behavior cost more. Obviously a proper analysis will have to be done (as was mentioned by AdamL) but in theory it is sound, AFAIK.

    On the other hand, I understand that this is Pandora’s box where cost sharing potentially goes out the window as people are hit with an endless of string of individualized surcharges and we are left with the same problem of great health care for the wealthy and diminishing options for the rest.

  4. AdamL

    December 4, 2009 at 12:32 pm

    I can understand your dilemma, but the real problem is the larger context.

    We should get health costs under control, but all of the measures proposed during the legislative session to control costs that impacted pharmacies, drug companies, or insurers were rejected because of political pressure. Only the provisions burdening state employees were adopted. So there is a basic fairness issue.

    Also, you give a great example of a way to better change behaviors (i.e. a cigarette tax). That is why the Justice Center advocated for a cigarette tax large enough to change behavior. We also advocated for the smoking ban, which will also change behavior. We just don’t have good evidence that the wellness provisions as designed by the SHP will change behavior. And it is doubtful the programs will save money.

    It is also the case that we should undertake other wellness programs before shifting entire families into new insurance products because the state employee struggles with their weight. What are the cafeterias in state buildings serving? What do the snack machines look like? Are there opportunities for state employees to exercise at lunch? Are there showers at the job site?

    The state is moving too fast to implement wellness initiatives that will have a big impact on how much families pay for health care. It should slow down and first do its homework.

  5. Something Clever

    December 4, 2009 at 12:52 pm

    On who is asked to pay the cost, I agree with what you say. It is unfair.

    How would you get evidence that the program would save money and change behavior? Someone is going to have to make that leap, just like someone did with the cigarette tax, no? I am not saying this is the way to do it, just pointing out that there will always be an element of the unknown and at some point we have to go forward.

    Your third paragraph really hits a big issue that people. Wellness isn’t a program, it is lifestyle. It isn’t a policy decision away from solved in six months. Yet, even knowing this, I still end up in no better place from which to form an opinion. Say we put healthy snack machines in the buildings, provide exercise opportunities and everything else. Without an incentive, what will the participation rate be? Probably not much higher than the rate of people who have found a way to live healthy in spite of their work. As you point out, if you put the wellness financial incentive first, then once again you have a one-sided burden. And are we realistically at a budgetary point where both can be done?

    I do agree that this seems rushed, but at the same time, I see the need to get started changing how we view our health and wellness. It is something we must actively be involved in. The question still remains, who else should be involved in it as well?

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  7. uberVU - social comments

    December 4, 2009 at 3:31 pm

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  8. Alex

    December 4, 2009 at 3:36 pm

    What I am saying is implementing this plan is a hidden tax on all state plan dependents. The state pays 100% of the employees premiums. It is the dependents who pay our own premiums who will pay for testing all employees single or married. If you are a dependent you know when ever the state needs money for the plan since they get no money from employees it is we who get our rates increased.

    Besides the 70/30 plan people will be forced to has lower monthly premiums than the 80/20. So again those who are picking up the bill are dependents who do not smoke or are not obese. If they raise the rates more people will drop down to the 70/30 plan. Soon I think there will only be a 70/30 plan making this argument moot.

  9. Something Clever

    December 4, 2009 at 3:49 pm

    Alex – “The state pays 100% of the employees premiums.”

    Thanks, I didn’t realize that. So, if you have no dependents, how will a wellness program provide any incentive to you to be healthier? You can’t get a discount on nothing and a 10% surcharge on nothing is still nothing.

  10. gregflynn

    December 5, 2009 at 12:05 pm

    Just to add some perspective, of the State Health Plan’s membership about half are employees, about one quarter are dependents and about one quarter are retirees.

    I’ve not heard that SHP will be testing dependents or retirees but maybe that’s coming. The swab testing is an imposition on non-smokers that will affect a few smokers. The SHP should be trolling for smokers instead of trawling through schools of healthy non-smokers for the occasional smoker. It might be more efficient to test after flagging claims for potential smoking related illnesses.

  11. IBXer

    December 7, 2009 at 10:40 am

    The left has had a war on smoking for years now and when it comes to this you guys are all upset. Why?

  12. Generic Staffperson

    December 7, 2009 at 1:36 pm

    I refuse to be subject to this testing, and am particularly incensed by the rules regarding BMI that kick in in 2011. I am opting to drop to the 70/30 plan voluntarily rather than submit to random testing of my weight and/or smoking habits. Do they “win”? Yes- but they would anyway. This way I don’t lose my dignity in addition to my insurance.

  13. UNCrunner

    December 7, 2009 at 2:02 pm

    What I have been trying to understand is why I haven’t been _rewarded_ in some way for years of living a healthy lifestyle. I am a forty year old with very healthy BMI, regular exercise and require no prescription drugs. Let’s see something with carrots and not sticks, esp sticks that involve intrusive test measures. I agree with whomever said that if there is to be a penalty, flag smoking related claims. For the rest of us, how about a break for being fit?

  14. Michelle

    December 7, 2009 at 6:38 pm

    Not only tobacco users….what about drinkers? Alcoholic beverages cause car accidents, liver damage, heart damage…just to name a few. Why is it always against cigarette smokers? Atleast if you smoke a cigarette, or dip snuff, it doesn’t put you in another frame of mind, or blur your vision, or any of the other side effects that are caused by alcohol use. You’re not going to kill someone because you smoked a cigarette!!! What’s all the fuss?

  15. lee

    December 8, 2009 at 12:52 am

    you people should stop and think that these tests are an invasion of privacy and should not go on. If you want to weed out people who abuse the health care system you’d better random test for drugs and alcohol as well. in my opinion the drug abusers and alcoholics use as much of the health care system as any.

  16. Something Clever

    December 8, 2009 at 12:18 pm

    lee – “these tests are an invasion of privacy and should not go on.”

    True, but coverage is voluntary, is it not? It is not like a drug test upon which employment is contingent; a practice that is legal. Don’t like the test? Don’t take the coverage.

    Again, I haven’t been able to settle my opinion on this matter, but on this point, I have no problem. Your health records and activities define your risk to insurers. They need to know that in order to assess costs.

    On Michelle’s point about drinking, I agree. I see no reason why a DUI or drunken disorderly shouldn’t cause your health insurance rates to go up if you support the idea of health profile assessment in any form.