09/27/09 — Workers might pay for eating too much, smoking

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Workers might pay for eating too much, smoking

By Steve Herring
Published in News on September 27, 2009 2:00 AM

Within the next two years, being overweight and/or a smoker will pose more than a potential future health risk for county employees -- it could cost them more, too.

When the county begins preliminary budget work early next year, discussion also will begin on changing the county's health plan -- to one that could be modeled somewhat on the state's new plan, which will be more expensive for smokers and for those who are overweight.

The state estimates that more than 70,000 people on its health plan use tobacco, resulting in a cost to the plan of $2,000 per member per year more than the cost of providing coverage for people who do not use tobacco.

In addition, more than 60 percent of North Carolina adults are obese or overweight and obesity is linked to an increase of more than 37 percent in health care spending at a cost of $2,445 per plan member per year.

The new state plan has two levels, basic and standard. People who smoke will be placed in the costlier basic plan effective July 1, 2010. Overweight employees could be affected July 1, 2011

"We are wholly self-funded and insured and the county is totally separate from the state. We do not participate in their program," said Sue Guy, Wayne County human resources director. "So what I know about their program is -- only what I have been told -- and that is, because of the cost, they are looking at what statistically has caused the most increases in their coverage and that appeared to be attached to smoking and obesity.

"They are requiring their employees who fit into those two categories to participate in the lower (and more expensive) tier."

Wayne County Public Schools does operate under the state insurance plan.

The issues of smoking and weight also concern the county, Ms. Guy said.

She said whatever the county ends up doing will be patterned somewhat after the state plan.

"We are forewarning our employees little bit more than I believe state did, but they were in more of crisis situation than we are," Ms. Guy said.

Two options are on the table -- a flexible savings plan and one that would require smokers and overweight employees to contribute more to their plan.

"We can do it by making benefits more restrictive, but we didn't really want to do that," she said. "Our goal is to be better consumers."

This past year, the county faced an anticipated 13 percent increase in insurance.

"If you look at what is causing it, 80 percent, industry-wide, of your cost is probably the result of 20 percent of your folks, and that is kind of what is going on here in Wayne County," she said.

In Wayne County, without identifying the employees, Blue Cross and Blue Shield, who serves as the county's third-party insurance program administrator, said that about 29 employees or their dependents were either obese, a smoker or both and mostly had heart issues.

"Not everyone is going to be the perfect size," she said. "If we can help them make lifestyle changes, it is sort of like encouraging them to go see a doctor every year or two for a physical. It improves their lifestyle, their health and, as a result, also saves the county the money although that is not necessarily our primary goal right now because we have a very compact (insurance) program.

"The bottom line is that we want people to make wise decisions. So we decided maybe we need to do something similar to what the state is doing."

It would be at least two years before the changes would kick in.

"We probably will not making any decisions until after the first of year during the budget process since that is normally when we look at program changes, but I am already talking to some brokers," she said.

Under a flexible spending account, employees would contribute pre-tax dollars into the account. Any money not spent on health care would be carried over to the next year. The county already offers a flexible savings account, but funds not used within 12-14 months are lost.

"We may be heading in that direction (flexible spending account)," Ms. Guy said. "What that would do would be to force people to be a better consumer. If you know that the first 'x' number of dollars of your care comes out your pocket, you are going to be very, very concerned about shopping around. Just because a doctor says you need an MRI, do really or do you not, and it is OK to question doctors."

An employee, she said, could put "some serious dollars" into the plan that would be there until he or she retired.

It is too early to say how much it would cost, Ms. Guy said. Employees would put whatever amount they wanted to, shey said. It is unlikely the county would provide any matches.

"That is one thing we are looking at," she said. "Another is leaving the plan like it is and saying, 'OK those of you who are obese or smoke, then if you don't make some lifestyle changes to correct that situation, then you may have to contribute more to the cost of your care.'"

She said the county is not far enough into the process to consider whether there would be two levels like the state plan.

"We are really leaning more toward the flexible savings account or something along that line," she said. "We had been talking not just about the cost of health care, that is a concern, but we want to try to be out front with wellness. What we really want are healthy employees. They more productive and they show up for work. That is what our real goal is to help employees take ownership of their own health care and also to make good lifestyle decisions."

She noted that the county has used health initiatives in the past including mandatory physicals. Some employees resisted, only to find out that they had high blood pressure or other issues did not know about, she said.

The need for the plan is two-fold, she said.

"We want employees to know if something is coming down the road that they can forestall through lifestyle changes or medication that might prevent a stroke or heart attack or something serious later on," Ms. Guy said. "The other piece to that is if an employee has a relationship with a primary caregiver, they are less likely to use emergency rooms and emergency rooms are expensive."

The county has experienced an 11 percent decrease in emergency room visits attributed to its wellness program. Ms. Guy called that a "significant drop." It is a $100 doctor's visit vs. $1,200 or more for already flooded emergency rooms, she said.

The county has begun getting the word out about the pending changes. The county's Blue Cross/Blue Shield account manager has been in the county to talk about the plan, how to use it wisely. Resources are also available online.

Also, county Wellness Committee members have been asked to go back to departments and say, "this is what we are looking at," she said.

"We are two years out from even getting to that point," Ms. Guy said. "What we are doing this year is making decisions about getting some programs -- some weight control, smoking cessation programs. These are things we have offered before, but by telling employees this is what we intend to do down the road, we think this will raise it to a different level of employees taking little more responsibility for taking part in these programs and start making decisions that will help them down the road."