NC HEALTH REPORT: Stein on health costs; Draconian State Health Plan smoking provisions

Editors:  Adam Searing and Adam Linker
Check out all our videos on HAC's  YouTube channel.
VIDEO:  State Senator Josh Stein has an innovative proposal to get at the major driver of skyrocketing health costs - the billions of dollars we pay for drugs, medical devices and treatments that are simply ineffective or more expensive than other alternatives. In our latest HAC commentary, Adam Linker and I interview Senator Stein and take a look at this issue.
VIDEO:  NC Rep. Brad Miller - highlights from his talk about the housing crisis at this week's NC Policy Watch Crucial Conversation lunch.
Why the NC Senate's reported proposal to increase NC's cigarette tax by 15 cents makes little sense.
Our own stalwart Senator Richard Burr speaks out - this time on why health care reform proposals are bad for the pharmaceutical industry.  What's good for GlaxoSmithKline plc. is what's good for America.
UNC Healthcare's new upfront charges to uninsured patients announced at the same time as multiple building projects for new hospitals. 
The Washington Post uses North Carolina as an example of how bad the health care crisis is becoming in the nation.
Pulitzer prizewinners - the list.
Why there are much better ideas to reduce smoking rates than the ones proposed in the state health plan reform legislation.
Different interpretations on the mission of the UNC School of Public Health.
FOCUS:   NC's unprecedented proposals on smoking for state workers
The final version of the state health plan bailout bill is up for a vote soon (perhaps today) in the House and Senate.  Reportedly, the "smokerlyzer"- style smoking provisions are in the compromise version of the bill.  These proposals are more draconian than in any other state in the nation.
Public employee health plans in nine other states do either impose a surcharge on smokers or provide premium incentives for nonsmokers.  However, NC State Health Plan officials want to enroll every employee and retiree in the 70/30 plan, the lowest coverage tier, unless the employee signs an affidavit certifying that he or she is a nonsmoker. Those state employees and retirees who sign the affidavit would be eligible to enroll in the standard 80/20 plan. The State Health Plan will conduct random blood and breathalyzer tests to verify that members are not smoking. If nicotine is detected on the breath of a state worker during a random audit the member will be shifted to the 70/30 plan along with their dependents.
Other states do not use such drastic measures
Six states add a monthly surcharge to the premium of smokers. Kentucky, for example, charges $15 extra per month to smokers with individual coverage and $30 per month for members enrolled in family coverage. In Alabama a $25 per month surcharge is imposed on smokers. In three states - Indiana, West Virginia, and Missouri - workers who do not smoke or who enroll in lifestyle coaching programs get a monthly premium discount. In Missouri, for example, state employees who enroll in the lifestyle coaching program pay $15 less per month in premiums.
Little serious discussion of current wellness proposals
There are a host of problems with the North Carolina proposal but the legislation has attracted little serious discussion or analysis. Raising co-pays and deductibles for state employees will have many unintended consequences, especially when dependent premiums and deductibles are increasing steeply over the next two years for all State Health Plan members. Shifting an employee into a new insurance product will affect the likelihood of the worker to seek needed care. The program will also cost the state money and savings are not guaranteed.
There are also administrative problems with defaulting employees to the 70/30 plan instead of the basic 80/20 plan. If paperwork is not successfully completed or forms are misplaced workers will be stuck in a high-deductible health plan and will likely not discover the problem until a hospital stay imposes thousands of dollars in costs. It is already difficult to keep retirees informed about major changes to the State Health Plan. It is likely that information will not reach all of the retirees and many will not fully understand the automatic 70/30 enrollment. And shifting employees and their dependents to a new insurance product is much more extreme than adding a premium surcharge. While surcharges generally add several hundred dollars in annual costs, the 70/30 plan potentially adds thousands of dollars in costs for struggling families and uninformed members.
There are also many unanswered questions about the program. Will users of all tobacco products be shifted to the 70/30 plan? What about occasional users of tobacco products? What about those who have only used tobacco products twice within a given year? Must that person declare tobacco use on an affidavit? What if a state employee smokes a cigar at a friend's wedding?  What about if a dependent or spouse smokes once or twice? Will the entire family then be shifted to the 70/30 plan? The currently proposed legislation does not answer any of these questions and allows State Health Plan officials wide latitude in designing the program.
Less harmful solutions to combat smoking
If we want to help state employees break a smoking addiction there are less harmful and punitive ways to proceed. Legislators could ask that state employees declare their smoking status on enrollment forms. If a state employee is a smoker then they should have the option of enrolling in a smoking cessation program. If they decline to participate or do not actively participate in the smoking cessation program then the State Health Plan could impose a monthly surcharge. There are serious privacy implications with giving state employees random breathalyzer and blood tests. Most employees would be insulted by such testing. North Carolina currently offers skimpy benefits, and often low pay, to state employees. Random blood tests would act as another deterrent for smart, competent people to seek state employment.
Wilmington: Sunday May 3rd;  Wilmington Yes We Can meeting.
Location and time TBA.
Durham:  May 7th;  6pm to 8pm; Dinner provided.  Goldenbelt Building; 807 E. Main St.  Bldg. 2, 3rd Floor.  HAC is organizing a small business roundtable discussion about health reform and what small business concerns are moving forward.
Wilmington: Friday May 8th;  8:30-10am;  Cape Fear Health Policy Council meeting ;  New Hanover Health Department Auditorium;  2029 S. 17th St.
Raleigh: Saturday May 16th; 12-5pm; Yolanda Adams Health Fair; Wake Chapel Church
Raleigh: Monday May 18th;  10am-12pm; NC Health Access Coalition quarterly meeting; AARP-NC office.
For more information on above meetings:  HAC Outreach Coordinator Hope Marasco ( 919-863-2405)
FREE OR LOW COST HEALTH CARE RESOURCE:  The NC Institute of Medicine maintains an excellent resource for information about how to get health care in NC if you don't have much money.
MORE STATE REVENUE:  Check out the NC Budget and Tax Center's alternative revenue plan to raise additional revenue to close the budget gap by closing tax loopholes and making our tax system more fair.
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