Arizona Governor Jan Brewer Wants to Fine

YOU!! Yes, you read me right. Tonight ABC Nightly News reported that Arizona Governor Jan Brewer has proposed leveling a $50 fine on MedicAid participants who (1) Smoke; (2) Are obese; and/or (3) Have a chronic condition and fail to to meet the goals set by their primary care physicians. According to Phoenix ABC News 15, Governor Brewer proposed this in order to raise funds for the cash-strapped MedicAid program and to encourage people to take responsibility for their own health. The funds raised from these fines would be used to help support the organ transplant program that was pretty much shut down last year and to allow an increase in the number of people eligible for the MedicAid program.

I see a number of problems with this, not the least of which is that Arizona will be punishing people for things they may not have any control over. For instance, in 2007, the doctor I was seeing placed me on Metformin when my A1c rose to 8%. While the drug brought down my fasting numbers, it did nothing for my post-meal numbers, which were just as high as when I was not taking any medications. Was I being non-compliant? I was certainly taking my medications and following the meal plan given to me by the dietitian. My doctor tried to accuse me of being non-compliant with exercise, even though I did not have a car and had to walk every where I went! Should I be fined because the medication didn’t work and because the doctor refused to run the tests that would have helped guide his decision making process? If Actos is the drug that works best at keeping your bgs down but it has also caused you to gain a substantial amount of weight, should you be fined for that, though the weight gain is a direct consequence of the medication? Is it fair to fine someone who has been following his or her program religiously, who has had good bgs for (perhaps) years, but whose body has changed and for whom the program no longer works?

IMO, it’s a bad plan. It punishes the people who are least able to afford it. As it is being reported, the behaviors that trigger the fines are not well-defined. A doctor who is angry at you and who wants to “teach you a lesson” (like mine did back in 2007) may write “non-compliant” on your records though it is not the truth and cause you to be fined, for instance. Why fine obesity? For the same reason they’re fining cigarettes, IMO: The governor has a misguided belief that both are due to “willful bad choices” and you have a choice in whether you’re obese or not. It fails to take into account the contribution of genetics, it fails to take into account that there are some who are both fat and fit. It is unfair legislation, though with good intentions – and we all know which road is paved with good intentions!

If you live in Arizona and you agree with this, I hope you will take a moment to write to your governor to express your thoughts and offer alternatives. I know these are difficult times but there must be a better way!


It sounds sort of evil. OTOH, if there was a quid pro quo involved like “If I give you $50, you will give me an assload of test strips” I would be interested?

I know diabetes is expensive but I pay lots of ER bills at work (investigating car accidents…) and have seen other medical records that suggest that even though an insulin pump costs thousands of dollars, there are much more significant medical costs out there.

Too bad this isn’t an April Fool’s prank. Here’s a suggestion–fines for doctors who misdiagnose or fail to appropriately treat patients. Seriously though, a punitive approach to healthcare is absurd. Blame & punish the victimized patient. Bet I’ve got big red non-compliant stamped on my medical records since I refuse statins. Hope the good people of AZ vote her out of office.

Probably too many right wing albertans have moved down to arizona I am not sure if that would fly here.

What about high blood pressure? More kidney transplants (I think 48%) go to people who needed them because they have high blood pressure than those who have diabetes.

I actually don’t mind paying extra for my insurance because of the diabetes. I already pay about $150/month for my prescriptions (insulin, strips, allergy meds, cholesterol meds, and kidney meds for copays) on my HMO. I pay $15 for each dr visit, and $50 if I go to the ER. What is an extra $50/year or $5/month?

I see people buy lunchables and soda with food stamps. I am pretty sure that people who get free medical insurance can afford the extra $5/month.

I wish everyone was required to use food stamps just once to experience what it’s like. Over 35 years ago, I was on food stamps for several months. I was a student, completely self-supporting, working but made little money. In those days the requirements weren’t as rigorous.

Having people judgmentally examining food in my shopping cart was humiliating.

I heard the report too on the news. One of the things I heard was 46% of the Medicaid participants in Arizona smoked. I can see assissing a fee for smoking. When you buy private insurance you are assessed a higher fee for smoking and sometimes if you are overweight. The way I understood it you would only be charged the fee if you don’t follow your doctors orders. I know losing weight and lowering bg is hard. I started out with an HbA1c of over 10% and now it is 5.3. I have also lost all the weight I needed to do. Since I pay for my own insurance , well over $1000 per month because I am diabetic I don’t think it is outrageous to ask people who are on government insurance to kick something small in if they don’t follow doctrors orders.

It’s a slippery slope when government dictates health behavior & we are forced to become slaves to following doctor’s orders when we don’t agree for fear of being fined or losing coverage. Not a world I want legislated.

Hi acidrock, it not only “sounds sort of evil,” but I have long since concluded that Gov. Jan Brewer is herself evil. I cannot understand the punishing of people for having diseases and/or needing transplants. I am outraged, to say the very least. I try not to be political on this diabetes website, but once in a while we all break our own rules.

It’s not $5/month, nor is it $50/year, or at least that is my impression. It appears it’s an extra $50 for each visit/incidence, but it’s not clear.

What about high blood pressure? More kidney transplants (I think 48%) go to people who needed them because they have high blood pressure than those who have diabetes.

Where did you get that statistic? According to the NIDDK, more people with diabetes have ESRD (End-Stage Renal Disease) than do people who have hypertension. Here are the statistics from that page:

End-stage Renal Disease (ESRD) Prevalence (2007): 527,283 U.S. residents were under treatment as of the end of the calendar year. Resulting from these primary diseases:

Diabetes: 197,037 <===
Hypertension: 127,935
Glomerulonephritis: 81,599
Cystic kidney: 24,828
Urologic disease: 13,139
All other: 82,745

Incidence (2007): 111,000 U.S. residents were new beneficiaries of treatment.

Resulting from these primary diseases:

Diabetes: 48,871 <===
Hypertension: 30,657
Glomerulonephritis: 7,571
Cystic kidney: 2,633
Urologic disease: 1,554
All other: 19,714

The United States Renal Data System reports that the prevelance rate (defined as: “the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how common a condition is within a population over a certain period of time. It helps physicians or other health professionals understand the probability of certain diagnoses and is routinely used by epidemiologists, health care providers, government agencies and insurers.” [1]) reports that in the first quarter of 2010, there were 584,079 individuals living with ESRD. Of that, 218,947 individuals had diabetes while 143,348 individuals had hypertension. So, of the population of people with ESRD (a necessary condition before a transplant will be considered), 37.49% have diabetes as a primary diagnosis, while only 24.54% of the same group have hypertension as a primary diagnosis. Given that the ratios of kidney transplant recipients with the various diseases will be approximately the same as the ratios of ESRD patients with various diseases, then for 2010, when 13,743 individuals had kidney transplants, we can expect approximately 5085 of those recipients to have diabetes and 3372 to have hypertension. All of this reinforces what I’ve heard for the last 18 years: That people with diabetes are at high risk for kidney failure.

Now, I do agree that people make dumb decisions – regardless of whether they’re on food stamps or are among the wealthiest people in the world. I’ve worked with children whose parents receive food stamps/WIC funds and whose mothers will opt for Twinkies instead of the banana (weird, since the one kid I’m thinking of actually wanted the bananas and tried shop lifting them). NOT a bright decision. But if you make $8/hr flipping hamburgers at the local McDs or work at “Wally-World” for minimum wage and then are forced to work extra hours for no pay (a practice so well known that it was mocked in the Simpsons episode, “On A Clear Day, I Can’t See My Sister”) and if it costs more to make a healthy lunch of fruits, vegetables, cheese, etc than it does to pick up a Lunchable or a Whopper, jr with cheese and fries, then which are you going to do? I agree that there does need to be change. I’m also not against (100%) fining people for smoking, though if you’re going to fine someone for smoking AND you accept that nicotine is an addicitive substance which changes brain chemistry, wouldn’t it also make sense to help out the people who are addicted to smoking by making the stop smoking programs free? What I am against is fining people for some things they cannot help. Your diabetes might not be “in control” because of “willful disobedience”, as Gov. Brewer seems to imply. It could be that the diabetes is simply changing because the person’s body is changing. I noticed you were a child when you were dx’ed. When you hit puberty, chances are, your bgs were not exactly on-target 100% of the time, despite your best efforts. It’s also a good bet that you weren’t a perfect saint, either, eating only the foods you should, exercising consistently, taking your insulin 100% perfectly. Should your parents have been fined because your body didn’t behave or because you, as a teenager, made some bad decisions? Should you now be fined for any complications you develop because you didn’t perfectly manage your diabetes since your dx? Perhaps you ought to be the one who should be fined, since it seems that you have had access to excellent health care due to having outstanding insurance, as well as having the money to afford whatever food you would like. You should be able to have taken outstanding care of yourself and not have any diabetic complications…it MUST be YOUR fault, right??? So, because it’s your fault, perhaps YOU ought to be fined and have to pay higher copays, meet higher deductibles, etc, because you, as an educated engineer, should have known better and you failed to do so.

See how mean-spirited that attitude is? I bet you’re fuming at me at this second. Good. That’s what I wanted. I want you to see how, when some of what I’m seeing as your underlying assumptions are turned on their head and pointed right back at you, how ridiculous they are, how nasty and hurtful they are, and just how WRONG they are. They’re no more true for you than they are for most of the individuals this law would target. So, go ahead, call me every name in the book. Been done before. But before you pass judgment on your fellow human, remember the call to “judge not, lest ye be judged.”

I understand personal freedom and the ability to choose what you do with your body. But if you are expecitng other people to pay for your healthcare you need to show your doctor that you are at least trying to lose weight or stop smoking. I would imagine this fine would only be imposed if the doctor says you are not trying . Quite frankly I am a Libertarian and don’t believe the Govenment should be involved in any part of your life. But when you accept the free insurance you do give up certain liberties. I don’t want to be mean here, I know how hard it is to lose weight when you are a diabetic. But it can be done with a balance of exercise, diet and meds. I would imagine you just need to show your doctor you are trying.

A lot of diabetics also have thyroid problems and other metabolic problems that cause weight gain. I have been thru the thyroid crap twice and it is hard to find a doctor that actually understands thyroid. I was sitting with labs on my lap when I had a doctor tell me that there was nothing wrong with my thyroid. My FT4 was so low that the lab did not even assign a number. I went to another doctor & was told those same numbers were horrible. Unless your thyroid is properly treated, you don’t have a snowball’s chance in h*ll of losing weight. People on Medicaid have very limited choice of doctors because most doctors won’t take it. They are usually stuck with who they have, like it or not. Why should they be punished because they have crappy doctors?

I don’t live in Arizona, but I know that this woman should be run out of office for some of her wants and desires while in office. The people of Arizona should recall her and get someone who understands the job they are doing…or supposed to do.

Sorry jeannie, I can’t agree with you on this one. I do have medicaid in my state, and I am not giving up any freedoms because I utilize this method of insurance care. Yes there are some who scam the system, and that gives us all a bad name. But you would take that care away from people who are already most likely down on their knees hoping to be well. Sounds pretty callous to me.

Do we provide public education & a ton of other services without people having to prove they’re deserving of them? Do we toss kids out of school, or fine parents, if they’re not getting A’s? But somehow healthcare isn’t considered as criitcal .It’s a travesty that healthcare is preceived as a luxury & not a basic human necessity.

Honestly, I don’t expect that doctors will give people credit for trying. They don’t now. It’s an authoritarian structure.

As usual, the most vulnerable in need are targeted as “wasting recsources.”

There are so many complaints about “big government”. This law would make government intrude in people’s everyday lives to an intolerable extent. Way way too big, yes callous and mad and without compassion and just unbelievably evil.

Hi Angela,
If it is $50 per visit then there is no way a person would even go to the doctor if they are on Medicaid as they wouldn’t even be able to afford it. It woudl come down to what do I use the $50 for? To buy food or pay for a doctors visit? And a lot of people on fixed incomes do that already. If they charged each person on Medicad $50 that is one thing but when they single a person out because he has a certain condition or the treatment he or she is on is not working for them that is discrimination and also “Let’s blame the patient mentality.” Either way you look at it, this idea is just plain wrong.

yeah, that would be dependent on having a doctor who could do something besides Rx the dietician who, in turn, rx’s 60G/ carbs/ meal and 15-30G of carbs/ snack?