I strongly agree with Marcy Morrison, the Colorado Insurance Commissioner, on her recent statements regarding personal accountability for health:
“If people take better care of themselves, we can look at other options besides how to get more care. We read a lot about diet and exercise, but we have to ignite the public to put two and two together. Disease management and prevention are the key, and as state insurance commissioner, I’m pushing that issue hard to bring down costs.”
Public policy needs to address the fact that 770,000 Coloradoans are uninsured, but we also need to start holding people more accountable for their own health. The individual health insurance market already does this, but the majority of Colorado insureds get their coverage through an employer, where there is virtually no incentive to work at staying healthy. The policies are guaranteed issue, and pre-existing conditions are covered. Some employers offer discounts on insurance premiums for employees who are actively taking care of themselves. A similar program could be instituted by the state, allowing a tax credit for residents who keep their weight in check, don’t smoke, and maintain health blood sugar levels, cholesterol, and blood pressure. This type of program could apply to all Coloradoans, regardless of where they get their health insurance.
There should also be consequences within the insurance industry for those who take no responsibility for their own health. As it stands now, a person who develops Type 1 diabetes as a child will have the same medical underwriting as a person 100 lbs overweight who is daignosed with Type 2 diabetes at 50 years of age. Either one will be declined for individual coverage, and both would be covered on a group policy. In the eyes of the insurance industry, they are equal risks, even though the person with Type 1 diabetes did nothing to cause his illness, while the Type 2 diabetes was self-inflicted.
Denying coverage doesn’t seem to be a good answer, as that just exacerbates the cycle of uninsured people waiting to seek care and not having access to treatment. If policies are offered with higher premiums for people with self-inflicted health problems, there needs to be very clear, upfront language explaining the situation, and what the client can do to remedy the problem. For example, a person who smokes and is 60 lbs overweight might be offered a policy – group or individual – with a 40% rate increase. His policy should clearly state exactly what he must do in order to have the rate lowered. He can check in with his doctor every three months for a nicotine test and a weigh-in. For every 10 lbs that he loses, his premium could be lowered by 5%. And if he stops smoking, he could get an additional discount. The premium discounts (or further increases, should the client gain weight instead) should be effective quickly. Most policies currently require that an insured wait a year after losing weight or giving up smoking before a premium adjustment will be made. For most people, that is not enough of an incentive. If we knew that every three months we have the opportunity to lower (or increase!) our health insurance premiums, the sense of immediate gratification would be a strong motivator for a lot of people.