Copays and deductibles

When I complete my yearly health benefit enrollment I am asked if I consume nicotine. If I have been “nicotine free” for 12 months I receive lower costs for my health insurance. This is similar to so-called “sin” taxes. The states and federal government levy taxes as a disincentive for consumers to engage in those activities deemed a health risk: tobacco products, alcohol, junk food, sugary drinks. Other countries, such as Australia have taken this a step further with MDs beginning to refuse to do elective surgeries for those illnesses related to these risky behaviors. A patient that needs, for instance, a femoral popliteal bypass (clogged artery in the leg) as a result of smoking, and for whom it was not an emergency, might be refused the surgery until they stop smoking.

Consider this scenario: You are the manager of a small business. One of your responsibilities is to oversee the health care plan for 10 employees. In examining last year’s costs you note that the smokers in the group averaged 20% higher health care related costs than the nonsmokers. However, the employee diagnosed with cancer had higher costs than the other nine together. You must make a change to break even. Your options are:

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Raise weekly fees, deductibles, and copays for all 10 employees

Raise weekly fees, deductibles, and copays for just the smokers and cancer patient (who never smoked)

Raise weekly fees, deductibles, and copays for the smokers but not the cancer patient

Lower the quality of the plan for all employees to maintain the same costs

Raise premiums for all but offer lower deductibles and co-pays for nonsmokers and those who quit smoking

Customize your health care plan costs for your employees

Include the following aspects in the discussion:

Describe your thought process as you work through each option

Did what is moral or ethical play a role in your decision

Discuss the role of punishing behaviors that can hurt health vs the role of encouraging healthful behaviors by offering incentives such as lower premiums

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