As part of a plan to revamp the state's Medicaid program, Arizona Gov. Jan Brewer announced on Thursday that she is proposing fees for adults who lead unhealthy lives.
Childless adults who are obese or suffer from a chronic condition and who fail to work with their doctor to meet specific goals would be charged $50 annually. The $50 annual fee also would apply to all childless adult smokers.
"If you're not going to manage those things and take some personal responsibility, and in turn that costs the state more money, then you need to have some skin in the game," said Monica Coury, assistant director of Arizona's Medicaid program.
Employers are taking notice of the costs of obesity and making changes. Alabama charges obese government employees $25 a month for insurance if they don't attempt to lose weight. A hospital in Tennessee won't hire anyone who's a smoker and neither will Alaska Airlines or the county of Sarasota, Fla.
According to the Centers for Disease Control and Prevention (CDC), in 2009 25.5 percent of Arizona residents were obese and in 2010 15.9 percent of the adult population smoked cigarettes, a total of more than 762,000 individuals.
Arizona ranked a little below the average when compared to other states for the percent of residents that were obese, according to the CDC. As for smoking, the state was listed in the bottom 10 by the CDC, with one of the lowest smoking rates in the country.
Specifics on the implementation of the smoking fee are yet to be determined, but options could include random audits and relying on enrollees' statements, said Coury.
"You need to be responsible for the fact that your smoking costs us more," she said.
In a letter to Health and Human Services Secretary Kathleen Sebelius, Brewer wrote: "My proposal includes requirements and incentive strategies that will encourage individuals to take greater control of their health."
Democratic State Sen. Kyrsten Sinema told ABC News that while she supports efforts to encourage people to live healthier lives, she feels the fees penalize the wrong people and reach too far.
"There are some people who have diabetes and are obese through no fault of their own," Sinema said. "To fine people for medical conditions that might be beyond their control, that's just not right. ... This would punish people with disabilities who have done nothing wrong.
"We know that drinking Coke and soda pop isn't good for you, and people do it; the governor herself is one of those people," Sinema added. "It's very nanny state, which is very interesting because historically Arizona has been a very libertarian state."
ABC News reached out to ethicists and obesity experts from across the country and the vast majority said the fees are both unfair and unlikely to work. They added that the fees open the door for going after other personal decisions that increase medical costs.
Brewer's overhaul is projected to save the state $500 million, helping close a $1.1 billion budget shortfall.
It also would restore transplant funding from Medicaid, coverage that, controversially, was cut last fall. If approved in its current state, Brewer's plan would go into effect Oct. 1.
The Associated Press contributed to this report.