/ Kentucky Politics

05:03 PM EDT on Sunday, October 17, 2004

Associated Press

FRANKFORD, Ky. — Kentucky is one of at least three states looking at charging higher health insurance premiums for workers who smoke.

The Senate is expected to vote Monday on a proposed health insurance plan that would require state workers to answer whether they were a smoker on July 1, 2004. If workers answer yes, they would pay between $15 and $30 a month more than nonsmokers, depending on the coverage they choose.

Richard Cauchi, with the National Council of State Legislatures, said he is not aware of any other state that charges employees who smoke higher premiums.

But others are moving in that direction. A state insurance commission in Georgia recently recommended that the state do the same thing, and a month ago officials in Alabama recommended charging state employees who smoke a monthly insurance surcharge.

The idea to charge more in Kentucky was originally proposed by Gov. Ernie Fletcher, a physician.

Fletcher's health plan, though, was roundly criticized by state workers and teachers as too expensive and offering too few coverage options. The governor said it was what Kentucky could afford, even with the smoking fee.

When teachers threatened to strike, Fletcher asked the legislature to try to improve the plan, and House lawmakers said they believe they have done so, but at a cost of an additional $182 million.

The House bill kept the basic structure of Fletcher's plan by dividing the state into eight regions in which employees will be insured by four carriers and have a choice of three benefit levels.

The bill kept mandatory deductibles for all options, but for two options reduced them from the levels in Fletcher's plan to the levels in a 2004 insurance option. It also reduced out-of-pocket maximums and reverted to fixed payments for prescription drugs and doctor's visits instead of percentage costs.

The smoking fee is expected to generate about $6.7 million in 2005, said David Wille, an actuary who is working as a consultant to the House. That figure assumes that smokers make up about 20 percent of the state's work force, Wille said.

Some smokers are fired up about the proposal; others agree with it.

Ron Greene, 57, a history teacher at Valley High School in Louisville, said he chooses to smoke, but other than that he has a healthy lifestyle.

"This is discriminatory. Why don't they do the same thing if you're overweight, or if you eat red meat, or if you drink too much?" Greene said. "This just opens up a can of worms."

Joe Whitehouse, a 21-year state employee who said he has smoked since he was a teenager, said he supports the fee.

"It's fair. It really is," said Whitehouse, 57, who works as a welfare fraud investigator in the Inspector General's office.

Brent McKim, president of the Jefferson County Teachers' Association, said the Kentucky Education Association supports the overall bill and does not object to requiring smokers to pay more.

Another way to look at the change is that it would reward employees who don't smoke with lower premiums, he said.

"I don't think that $15 or $30 a month will cause people who smoke to stop their coverage," McKim said. "But if they kept adding factors — like obesity or whether you exercise or not — that could cause some people to not afford insurance at all."