Florida State Senator Proposes Legislation that Could Deny Medicaid Coverage for Smokers Who Fail to Quit

According to an article in the Palm Beach Post, smokers who fail to quit could potentially be kicked out of the Medicaid program if legislation being proposed by State Senator Joe Negron (R-Stuart) is enacted.

According to the article: "Sen. Joe Negron wants fat Floridians and smokers to get healthy or else. Included in Negron’s revamp of the state-federal Medicaid program – which Negron will release tomorrow – is a component aimed at what senators are calling “personal responsibility.” Sen. Don Gaetz, a Niceville Republican who helped craft Negron’s bill, said Medicaid patients have to take control of their health care just as he had to do when his doctor told him to lose weight. “We’re saying that an individual who’s been diagnosed as morbidly obese needs to be on a medically-directed program of weight loss to manage that health care problem that could turn into an increased taxpayer liability. The same thing with smokers,” Gaetz said."

"The bill would require smokers and alcoholics and drug addicts to get treatment, Gaetz said. Negron said his bill would include incentives for Medicaid patients to lose weight, quit smoking and stop drinking but did not give details about what they would be. If they don’t get thinner and put down the smokes, Negron said their coverage could be cut off."

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The introduction of this legislation in Florida, on the heels of a similar bill that has been proposed in Maine, suggests that we are seeing what soon may become a new trend: discriminating against smokers in health insurance coverage in order to save health care costs.

Of course, the premise behind the legislation is flawed in the first place because not even smokers can be denied medical treatment if they show up in an emergency room with a heart attack or stroke. The state is going to have to pay for it anyway because the individual lacks health insurance. The issue is simply whether the funding comes out of the free care pool or the Medicaid pool.

But with that aside, this legislation violates the very premise of medical care: that physicians and hospitals treat everyone, regardless of the reasons why they became ill. Even prisoners of war are provided with medical treatment. So are prisoners who have committed felonies. Are Senators Negron and Gaetz saying that smokers deserve fewer rights than prisoners?

Once we begin to make health insurance coverage dependent upon lifestyle decisions - even unhealthy ones - we have entered the ugly territory of bigotry in medical treatment. Do we really want lifestyle to be a criterion for determining eligibility for public health insurance? And why just pick on smokers? What about people who do not wear seat belts? Those who forget to put on sunscreen? People who eat out at Burger King five days a week?

The beauty of the entire medical system in the United States is specifically that we do not make moral judgments about people's character in making decisions about whether to provide health care to them. Once we undermine that principle by allowing medical treatment decisions to be made based on the moral perspectives of one group or another, then all holes are barred and medical treatment becomes a religious establishment rather than a right.