With more talk about the new health care plan come more people are asking if fat people should be charged more for health insurance I posted about this a couple years ago so I’m reposting that with some updates today:
I was in line at the grocery store when I noticed the woman behind me eyeing my enchiladas. Always one to make conversation I said “They are actually really good for frozen food, no preservatives or weird chemicals, and they’re tasty.”
She sighed, in what I’ve been taught to recognize as longing”, and said – “I can’t, I’m on Atkins”. She paused, smiled wryly and said “sixth time’s the charm…”.
I must have made a “huh” face because she went on “my work charges me extra for my insurance if I’m overweight – it costs me about $600.00 a year. I’ve been on and off every diet and I’m heavier now then when I started. I’ll lose 30 pounds and gain back 35, lose 20 and gain back 40, it’s a vicious cycle but $600 is a lot of money to me so I have keep trying, right?”
Now, this is something that I’ve heard of but don’t know much about. Since I run my own business, I am not covered by a company policy. I am literally too fat to qualify for private insurance but that’s another blog.
So I went to a friend who I know is charged $50 per month extra for her insurance. I asked her how it works. For her company if her BMI is over a certain number OR if her BP/Cholesterol/Glucose does not meet a certain standard, she is charged $50. She meets the BP/Cholesterol/Glucose standard but her BMI is too high so she gets charged.
Whether you call it additional premium for large employees or “incentives” for small employees (like the ridiculous Whole Foods policy), companies and their insurance plans that charge more for fat people are penalizing their employees for failing to do something that nobody can prove is possible, for a reason that nobody can prove is valid, with a probable outcome of leaving their employees less healthy than they were when they started.
It’s not just size discrimination, it’s ludicrous. You’ll hear that size is a matter of personal responsibility. I think that personal responsibility includes not trying to find a way to justify participating in widespread discrimination.
These yearly weigh ins encourage unhealthy behaviors as employees trying to “make weight” participate in all kinds of unhealthy and dangerous crash diets, many knowing that they will gain the weight back but needing to save the money.
It also sets a dangerous precedent. When these fat penalties stop being fun money for insurance companies, what group will they target next to increase revenue?
Why not charge employees who bike to work an extra premium because their sun exposure increases their risk for skin cancer? Charge people who eat a lot of fish since high mercury levels in fish correlate to health issues. What if they find out that people who live in a specific zip code tend to get the flu more often – can they be charged more too?
Currently the Genetic Information Nondiscrimination Act precludes charging more based on the results of genetic testing. In reality though, isn’t that just only until the Insurance and pharmaceutical lobbies go to work? They’ve managed to lower the threshold for obesity as well as the numbers that indicate high blood pressure and high cholesterol to help bolster their profits. They are already charging based on outcomes that can be genetic in nature (like cholesterol and body size) so I can’t imagine that working on charging based on genetic predisposition is far behind.
This is an extremely slippery slope that should concern everyone. There are serious problems with healthism and ableism in the way that we charge for insurance in general but when you look at charging fat people more – which would be a bad idea even if it was supported by the evidence, it is not: Despite the fact that there is plenty of evidence that shows that weight is not changeable for most people, and that habits are a much better determinant of health than body size, companies are currently charging more for insurance based upon how someone looks. It’s not right, it’s discrimination, and it needs to stop. Right now.
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If you had an insured with “bad” numbers for cholesterol, blood pressure, etc., wouldn’t it make more sense to charge them less (perhaps lower co-pays) to encourage them to seek preventative care? Actually, something like this has been piloted and was found to be quite effective in lowering overall costs. Programs have taken the “sickest” members of employee plans and provided them lower cost and more comprehensive care. Darned if they didn’t stay out of the hospital. You can bet your woman with enchilada envy has trouble with her $20 or $50 co-pay if she is that desperate to save $600.
Any details on that pilot program? I’d love to be able to point to it when people snort and refuse to believe that easier access to health care makes people use it more for preventive measures.
The one I originally heard of was, I think, sponsored by a union in Nevada. Here’s a similar Medicaid program from Oregon:
http://www.npr.org/templates/transcript/transcript.php?storyId=153982708
And what happens to Enchilada Lady’s insurance costs once she’s dieted herself out of any possibility of the lower rate her thinner colleagues get AND severely increased her risk of conditions and illnesses she probably would never have gotten if she hadn’t messed around with her body size?
I remember hearing on the radio and seeing on television and reading in newspapers and magazines about the dangers of yoyo dieting back in the seventies. Since well over 90% of diets result in people weighing at least as much as they did when they started, virtually all dieting is yoyo dieting. And yoyo dieting has been linked in multiple long term studies with high blood pressure, organ damage, depression, heart disease, and a host of other ailments.
It occurs to me sometimes that the heightened risk for so many diseases and conditions associated with high weight may actually be the result not of being fat but of trying so desperately not to be fat that we damage ourselves.
Looked at in that light, higher health insurance premiums and refusal of service to the fat are very likely adding to our health issues.
Thanks, insurance industry!
You bring up a hypothesis I, too, have reached!
I think it would be lovely if someone did a scientific study that studied the risks of dieting and correlation of health issues in fat people who became increasingly larger after years of yo-yo dieting.
The underlying problem here isn’t that people are charged extra for their perceived health status. It’s the very concept of risk-rated health insurance e.g. that people at higher risk of making a future claim should be charged higher premiums.
Under this system, it makes sense to charge people much more for their genetic heritage, for their pre-existing conditions or for their forecast future risk, as they will ultimately cost the system more. The risk profile is calculated by actuaries using population data, which can over their life time, based on their health profile.
Specific individuals might not use these health resources, but that’s their bad luck. If the group they fall into shows a certain risk profile, then that’s where they will be put.
There is no way to make this system ‘fair’. It IS fair from an actuarial point of view, which is that people with a higher risk score pay more. That’s why you get ludicrous things like companies trying to force people to change their risk profiles by offering bogus ‘wellness’ programs. The idea is that the company has done its best, and if the person persists with their higher risk profile, that’s their bad luck. It’s a way of guilt-free cost shifting – of costs that were going to be shifted anyway.
You can argue that insurance companies shouldn’t discriminate against fat people because the way the risk scores are calculated, but it’s an unlikely basis for a win. Insurance companies can already raise the risk profile based on something as trivial as acne rosacea, so something that correlates as highly with ill health as obesity has no chance.
Your example of people living in high risk post codes being charged more is quite likely to happen. That’s the system that’s currently used to assign credit scores, so there’s already a precedent.
The only way out is to move away from risk-rated insurance altogether, which means moving to universal health care. That’s the real fight that needs to happen.
While one incarnation of this (charging more or giving “incentive” discounts based on weight) relates directly to size, in my opinion the real problem here is how our healthcare system works overall. It’s simply a case of insurance companies charging more for what they think are higher-risk patients to insure (and in some cases they’re wrong about what constitutes high risk, but that’s another story), because they can. It’s not that different than the whole pre-existing condition thing. The solution here, IMO, is to make sure everyone has access to affordable health care, which is good for individuals who need care (obviously), but also good for our economy (medical bills being the number one cause of individual bankruptcy) and for governmental costs (because guess who eventually picks up the tab when a “predisposed” or “preexisting condition” patient who couldn’t afford preventative because of that care instead waits and shows up in hospital in need of a $30k surgery?).
It’s a terrible policy, and one part of it is grounded in discriminating against fat people, but the overarching policy and set of policies it fits into are linked inextricably to our bizarre model of health care more than anything else.
I just wanted to thank you, Ragen, for tackling these tough social issues in a smart and factual way. I’ve been visiting your posts a lot lately as I illustrate to my students how to support their claims and engage in critical thinking; you’re a good example for my undergrads. Kudos, and hugs.
Insurance premiums should be community-rated, period. (Or, additionally, income-based, which would be amazing.) Where I live, for a Blue Cross Blue Shield HMO high-deductible ($5,000) plan that includes preventative services (yearly physical, pap and pelvic) and Tier-1 formulary prescription coverage before the deductible is reached, the premiums for women in my age group are more than twice the cost of men’s premiums, in the same age group (men pay $90 per month, women pay over $200). And maternity care is excluded by this plan completely. Apparently, even after correcting for childbearing, women are sicker than men, or seek healthcare more, or our healthcare costs more. Is it the pap smear?
Of course, with this particular plan you might not qualify if you have certain preexisting conditions. Thankfully, the Health Care Reform Act will eliminate “gender rating” starting in 2014, and also make it illegal for them to deny coverage because of preexisting conditions. It also expands Medicaid to include poor childless adults (people age 19-64 who make less than 133% of the Federal Poverty Level, which for 2012 is $14,856 per year for single person household). As it is right now, in many states, Medicaid only provides coverage for poor adults if they have children, and only temporarily.
For anyone interested in a really brief history of attempts at healthcare reform in the U.S., I found a good article: http://www.investigatorawards.org/downloads/research_in_profiles_iss14_jan2006.pdf
A more in-depth (but not overwhelming; roughly 200 pages long) investigation is provided by Jill Quadagno’s book, which has the same title as the article I linked to above (One Nation, Uninsured: Why the U.S. Has No National Health Insurance). http://www.amazon.com/One-Nation-Uninsured-National-Insurance/dp/0195312031
This book is a real eye-opener. Of course, it was published in 2006, so it’s not completely up-to-date.
The only insurance right now that fat people can get whose BMI is too high for mainstream companies, if they don’t have employer-sponsored insurance and don’t qualify for Medicaid, is to join their state’s high-risk insurance pool. This insurance covers anybody, regardless of size, who has been denied due to pre-existing conditions or weight bias. The premiums of course are a lot higher, however, my state (Maryland) has a separate plan for lower-income individuals and families at a reduced cost. I’m on this insurance and until 2014 rolls around or my job decides to make me a non-contractual employee, this is the only way I can get care.
Insurance companies need to stop equating health with thinness. Everyone is going to get sick in their lifetime. Determining who gets covered and who doesn’t based on a ridiculous height/weight ratio is dangerous and just plain wrong.
Determining who gets covered/premium cost should not even be based on health status! The whole point of insurance is that everyone pays a reasonable, affordable amount into a pool so that if someone happens to become ill, he/she isn’t crippled financially. There’s no reason why ill people shouldn’t be covered by the same insurers as healthy people, or why we shouldn’t all be able to pay the same amount (or have it be income-based).
You may have heard little about it before but frankly speaking that i only know that the Age differs the insurance plans but i never expected that the Body weight even counts !