Alabama's new health plan: "fat tax" or empowerment?

Alabama recently announced a new health plan for state workers. The plan would begin in 2010 and is designed to encourage "at-risk" employees to take control of their health and well being. When the plan is initiated, employees will begin paying $50 a month for health insurance, twice what they pay now. Employees will then be offered a free screen for health risks including high blood pressure, high blood sugar, and body mass index. If this screen finds employees with these risk factors, they will be offered a free doctor's visit, and if they accept they will have their insurance premium reduced to the original $25 a month. If the employee opts not to take the screen or the free doctor's visit if they are found to be at-risk, then they will continue to pay the $50 per month premium.

The state insurance board denies this plan is a "fat-tax," though admits part of the reason for the new plan is that 10% of state employees are at risk for at least one of the screening factors, saying healthy people will cost the state less money (a person with a BMI of 35 or greater costs the state 40% more than a person with a lower BMI). While this plan may be designed to educate employees, is it something that will work? Simply going to a doctor doesn't mean the employee will follow a course of treatment, or that the treatment would be successful. Will the state confirm the person who sought treatment is really taking prescribed medications, or following the doctor's advice on a healthy lifestyle? Opponents claim this plan presumes that obese employees are simply weak willed and does not fully account for people who may also have genes working against them. Others argue that this is simply a ploy to help the state make an extra dollar, but with costs for extra screenings totaling $1.6 million, money may truly not be the main motivator.

This brings up the issue of patient privacy. Under HIPAA, medical information can be released to the employer without patient authorization under extremely limited circumstances, including when health care is given to an employee at the employer's request. In Alabama's proposal, there would not be a violation of privacy since the employer would be requesting the screen and any follow up doctor's visit. Further, HIPAA does not prohibit employers from making employment conditional on the individual authorizing release of medical information to the employer. While potentially humiliating to employees subject to such measures, there is no true violation of privacy here.

The plan also raises the issue of how much an employer can meddle in the life of employees. Some may argue that if these risk factors do not impair the person's ability to do their job then the employer shouldn't care. Some may also feel that this plan coerces employees into seeking medical treatment, but this may also be a wake-up call that some people need to get checked out. While this plan may seem offensive and questionable, it might just work and help people take control of their health. Time will tell if this plan will be successful.