SPECIAL REPORT: Changes to Your State Health Plan; Comprehensive Wellness Initiative

If you're one of the thousands of North Carolinians covered on the State's Health Plan some of you need to be prepared to dig deeper into your pockets. In April, the state legislature passed Senate Bill 287, which says if you or any of your dependents use tobacco products or have a Body Mass Index higher than 40, you'll essentially be paying more for your insurance.

It's called the Comprehensive Wellness Initiative and it applies to about 540,000 people.
That includes active state employees and teachers, retirees, COBRA participants and dependents whose primary health coverage is provided by the State Health Plan.

It's a decision that has sparked an emotionally charged debate. In this special report we examine the changes coming to the State Health Plan and why people are so upset.

Laura Price asks herself, "Are you going to eat? What are you going to eat this month? What are you going to buy? Are you going to feed your family, are you going to clothe your family? Or are you going to go to the doctor?”

Those are the questions Price, a state employee, says she and thousands of other State Health Plan members will have to answer.

And she's not okay with it. Price says, "My daughter is covered by her father and he is a tobacco user. So if he doesn't choose to put down his tobacco products my daughter will have to go on a 70/30 plan and that's not fair to a 5-year-old child."

Michael Bell, a long-time smoker, says even though he's healthy, he plans to stop smoking because of the higher costs. He says, "They're passing on the costs to the employees in those target groups. They feel like they’re being discriminated against.”

The State Health Plan's Anne Rogers says that's not their intention. She says, "There’s about 50 percent of our members with chronic disease."

Rogers says the Comprehensive Wellness Initiative is an effort to prevent those numbers from getting worse. She says, "What we're trying to do is put some things together to do what we can to prevent the development of chronic disease."

Starting July 1, 2010, members, not on Medicare, will be enrolled in the 70/30 basic plan.

If members can prove they and their dependents don't use tobacco products, they can enroll for better benefits and less out-of-pocket expenses in the 80/20 plan.

If members do use tobacco products, they could qualify for an exemption, proving they're trying to quit.

And in July 2011, a weight management component will be added to the plan
If a member's body mass index is less than 40 they can enroll in the 80/20 plan.

Members can qualify for an exemption if they participate in a weight management program or if their physician says they have a medical condition that prevents them from reaching the required BMI.

Members who say they and their covered dependents meet the weight management and tobacco use requirements also means they could be randomly selected to be tested at work to verify they meet the criteria.

Rogers says, “We are truly interested in participation in a healthy lifestyle behavior.”

But there are those who are not convinced.

Toni Davis says, “This is the wrong approach. This approach is all stick and no carrot. Where are the wellness incentives in this plan? Where are the proposals to reduce and subsidize gym memberships to promote healthy lifestyles? What we have here is purely a punitive plan, it's all based on punishment and there are no incentives."

Davis of the State Employees Association of North Carolina, also known as SEANC, says her agency fought the legislature and the State Health Plan to keep the initiative from becoming a reality.

Chuck Stone was one of those strong opponents. He says, "There was a feeling among many legislators we got to save money. ‘How do we do that?’"

Another issue that's raised concern: privacy. Why was the State Health Plan allowed to address these lifestyle issues at all while other private health care plans are not.

Rogers says, "This HIPAA waiver allows us to be able to address lifestyle issues."

Stone says, "There's an issue of moral and ethical right “is this what we want in the United States? I've heard so many people talk about they don't want government coming between them and their physician. I can't think of a better example of government intervening between state employees and their health care providers."

And while the Comprehensive Wellness Initiative will inevitably take effect… Davis says,
"We will be back at the General Assembly advocating on behalf of state employees and retirees to stop these punitive measures which invade everyone's privacy".

The State Health Plan says with implementing the initiative, they project a $13 million net savings in fiscal year 2011. They say that doesn’t account for any potential medical cost savings that the plan might create in the following years. They also say it will cost approximately $10 million over a 2-year-period (July 1, 2009 – July 1, 2011) to implement CWI. The $13 million in projected savings, they say, comes after the $10m amount has been factored in or covered.

The State Health Plan says they are currently working out how to execute testing for tobacco use and weight management at the work place.

For more information on the plan, the initiative and how you can qualify for an exemption, check out the following links:

SEANC http://www.seanc.org/index.aspx

State Health Plan http://www.shpnc.org/