Alabama Slaps a Tax on Fat People

Should you pay more if you weigh more? That’s what Alabama’s State Employees’ Insurance Board thinks. In 2011 the board will start charging overweight state workers—those with a body mass index greater than 35—$25 a month for health insurance, which is currently free for all state employees.

(The state is giving workers a two-year head start; if they sign up for free health screenings and make progress, they won’t face the insurance fine.)

Being the second fattest state in the country—behind Mississippi—costs Alabamians lots of money—up to $1.32 billion a year in estimated medical charges, according to a 2004 study.

But is a pay-as-you-grow tax fair to the obese? Well, Alabama, like some private employers, already charges an extra fee to state workers who smoke. Private health insurance companies, of course, base their rates—and coverage refusal—on complex data related to the buyer’s health. Some private employers, who often encourage workers to lose weight with onsite diet and exercise programs, are considering more aggressive measures: Next January, one company in Indiana will begin charging employees up to $30 a month for missing health targets based on smoking, weight, blood sugar, and blood pressure.

At the government level, however, most health levies have been consumer taxes—on cigarettes and booze, for example—and few people, beyond the conservative-leaning Tax Foundation, have argued that taxing fat people simply for being fat is a good idea.

At first glance, the Alabama initiative rang warning bells in my head: Government using a blunt instrument to attack a very complicated problem. (And I say that despite the fact that I pay Alabama taxes, which contribute to the health-care costs of state employees.) But now I’m not so sure it’s a bad idea. Being both Southern and fat, I could use an incentive to lose my extra weight. And if I could, so could they. Maybe this kind of program would begin to reverse the tide of obesity in the Deep South. Or maybe a whole bunch of initiatives need trying to find out what will work.

For many people, $300 isn’t a lot of money. But if the fear of diabetes, heart disease, and death isn’t enough to motivate people to lose weight, fees and taxes tend to get everyone’s attention.