Should We Pay for Health Insurance by the Pound?

Big Brother or smart policy?

If North Carolina has its way, state employees will pay more for health insurance if they are obese. Smokers were already slated for an increase next year.

"Tobacco use and poor nutrition and inactivity are the leading causes of preventable deaths in our state," Anne Rogers, director of integrated health management with the North Carolina State Employees Health Plan, told the Charlotte Observer. "We need a healthy workforce in this state. We're trying to encourage individuals to adopt healthy lifestyles."

The new rates start in July for tobacco users and, for those who qualify as obese, in July 2011. Workers with a body mass index (BMI) of up to 40 will avoid the increase, although a BMI of 30 is considered obese by some experts. So there's a little leeway there. Procedures to measure employees' BMI have not yet been worked out. Under an Alabama plan, which my colleague Jill Lawrence reported on, starting in January a nurse will check state workers' blood pressure, cholesterol, glucose and BMI.

Though encouraging a healthy lifestyle with financial incentives is hardly new, the practice remains controversial. "It's my understanding they're talking about testing [for tobacco use] in the workplace, which, to me, would create a hostile environment," Kim Martin, a sergeant at Piedmont Correctional Institution in Salisbury, N.C., said in the Observer. "And it's an invasion of privacy. This is America, the land of the free. I don't think [body mass index is] a very good measure. I know some folks who would have a high body mass index because they're muscular."