The Affordable Care Act contains a number of provisions intended to incent “personal responsibility,” or the notion that health care isn’t just a right — it’s an obligation. None of these measures is more prominent than the law’s individual mandate, designed to ensure that every American obtains health coverage or pays a fine for choosing to go uninsured.
But one provision that’s gotten much less attention — until recently — relates to smoking; specifically, the ACA allows payers to treat tobacco users very differently by opening the door to much higher premiums for this population.
That measure has some health policy analysts cheering, suggesting that higher premiums are necessary to raise revenue for the law and (hopefully) deter smokers’ bad habits. But other observers have warned that the ACA takes a heavy-handed stick to smokers who may be unhappily addicted to tobacco, rather than enticing them with a carrot to quit.
Under proposed rules, HHS would allow insurers to charge a smoker seeking health coverage in the individual market as much as 50% more in premiums than a non-smoker.
That difference in premiums may rapidly add up for smokers, given the expectation that Obamacare’s new medical-loss ratios already will lead to major cost hikes in the individual market. “For many people, in the years after the law, premiums aren’t just going to [go] up a little,” Peter Suderman predicts at Reason. “They’re going to rise a lot.”
Meanwhile, Ann Marie Marciarille, a law professor at the University of Missouri-Kansas City, adds that insurers have “considerable flexibility” in how to set up a potential surcharge for tobacco use. For example, insurers could apply a high surcharge for tobacco use in older smokers — perhaps several hundred dollars per month — further hitting a population that tends to be poorer.
Is this cost-shifting fair? The average American tends to think so.
Nearly 60% of surveyed adults in a 2011 NPR-Thomson Reuters poll thought it was OK to charge smokers more for their health insurance than non-smokers. (That’s nearly twice the number of adults who thought it would be OK to charge the obese more for their health insurance.)
And smoking does lead to health costs that tend to be borne by the broader population. Writing at the Incidental Economist in 2011, Don Taylor noted that “smoking imposes very large social costs” — essentially, about $1.50 per pack — with its increased risk of cancers and other chronic illness. CDC has found that smoking and its effects lead to more than 440,000 premature deaths in the United States per year, with more than $190 billion in annual health costs and productivity loss.
As a result, charging smokers more “makes some actuarial sense,” Marciarille acknowledges. “Tobacco use has a long-term fuse for its most expensive health effects.”
But Louise Norris of Colorado Health Insurance Insider takes issue with the ACA’s treatment of tobacco users.
Noting that smokers represent only about 20% of Americans, Norris argues that “it’s easy to point fingers and call for increased personal responsibility when we’re singling out another group — one in which we are not included.”
As a result, she adds, “it seems very logical to say that smokers should have to pay significantly higher premiums for their health insurance,” whereas we’re less inclined to treat the obese differently because so many of us are overweight.
This approach toward tobacco users also raises the risk that low-income smokers will find the cost of coverage too high and end up uninsured, Norris warns. She notes that tax credits for health coverage will be calculated prior to however insurers choose to set their banding rules, “which means that smokers would be responsible for [an] additional premium on their own.”
Alternate Approach: Focus on Cessation
Nearly 70% of smokers want to quit, and about half attempt to kick the habit at least once per year. But more than 90% are unable to stop smoking, partly because of the lack of assistance; fewer than 5% of smokers appear able to quit without support.
That’s why Norris and others say that if federal officials truly want to improve public health, the law should prioritize anti-smoking efforts like counseling and medication for tobacco users. And the ACA does require new health insurance plans to offer smoking cessation products and therapy.
But as Ankita Rao writes at Kaiser Health News, the coverage of those measures thus far is spotty. Some plans leave out nasal sprays and inhalers; others shift costs to smokers, possibly deterring them from seeking treatment.
Some anti-smoking crusaders hope that states will step into the gap and ramp up cessation opportunities, such as by including cessation therapy as an essential health benefit.
“The federal government has missed several opportunities since the enactment of the ACA to grant smokers access to more cessation treatments,” the American Lung Association warned in November. “Now, as states are beginning implementation of state exchanges and Medicaid expansions, state policymakers have the opportunity to stand up for smokers in their states who want to quit.”
Dan Diamond (@ddiamond) is Managing Editor of the Daily Briefing, a CaliforniaHealthline columnist, and a Forbes contributor. This post originally appeared at CaliforniaHealthline.org.
Categories: Uncategorized
smoking is a choice for everyone who are smokers. but they need to be responsible and consider the people who are nonsmokers. smokers, if you are about to quit but you can’t, read this http://www.suncig.com.au
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Since 04/14 after divulging medical conditions (affected by smoking as there is no safe exposure from secondhand smoke) were brought to the attention of prospective landlords as well as having a child & a cat, they had the wherewithal to advise us it was a dog building due to having a cat but not that they allowed smoking in ALL their buildings because we had medical conditions & a child.
So after starting to move into this Section 42 Low Income Tax Credit Property, Hinsdale Lake Terrace, were met with severe marijuana odors, reported it to mgmt., which yielded an attitude only to then be bombarded by severe cigarette smoke…requested reasonable accommodation (ie curtailing indoor smoking of ALL types, sealing holes/gaps/etc…to eliminate routes of entry…yet Julie refused to saying they have always been smoking buildings & they were not changing any time soon.
Their Attorney Todd sent another email 08/04/14, after DuPage Co. Economic Dev was out on 07/30/14 (now an open investigation) stating they would let us out of the lease without penalty & pay moving costs (but we need a security deposit and another willing to reasonably accommodate) so in the interim of this we continued to report to the office the marijuana odors/toxic irritant pollution trespassing our unit as well as the loitering by our door with knocking on wall & loudness late at night, and were advised by their onsite patrol 08/07/14 that their golf carts were taken away by mgmt & responses would take longer only to have this mgmt now give us a 10 day notice to terminate taped to our door 09/04/14, dated 09/02/14, after their online site would not allow us to pay rent like we have done, advising us they are having technical problems with their site.
The 10 day claimed we were harassing and violating right to quiet enjoyment when all we have done is report to the Office & never confronted any tenant like the one across the hall did to us after she was first given a letter about the loitering but Julie did nothing about that tenant violating our right to quiet enjoyment, harassing us & trespassing our unit.
The Governor of Illinois has the ability to implement revitalization plan changes for this type of property, it is suppose to be following IRS guidelines appearing to be enforced by IHDA (Ill. Housing Dev. Auth.) whom is suppose to make sure it is safe & habitable (who attempted to put boundaries on the definitions of safe & habitable) appearing to be acting on behalf of IRS & is suppose to follow the Indoor Air Quality Act & ADA (which includes a history of having the conditions not just those receiving disability).
We continue to have problems with trespass to our unit of the toxic irritant pollutants (cigarette & marijuana…) and this is how we are being done for reasonable accommodation, keeping to ourselves, reporting to the office.
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What I can say is that, smoking is a choice its part of being human and being human requires freedom and that freedom is used but in a different way. It will be good if they would act properly, its not bad to enjoy being free but please take it a consideration to think of others or think of the action before doing so.
These wood-burning stoves are certainly meant to be used outdoors so I can only imagine the air quality in these countries are extremely poor. Improvement in the stove quality will help with the number of cases of lung cancer and other airborne diseases that come from cooking in tight quarters. If there was only more available space outdoors, then this wouldn’t be an issue.
You know what, I’m for an increase in what smokers have to pay. Many smokers try to quit smoking but the motivation to quit was never there. There was never a driving force except loved ones telling you its not good for your health. But now when it hits them where it really hurts (the pocketbook), I bet you’re going to find people really putting a concerted effort into the addiction, whether it’s cold turkey or moving towards the e-cigarettes.
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ENOUGH IS ENOUGH…….!!
SMOKERS ARE DRUG ADDICTS…..!!
IT SHOULD NEVER HAVE BEEN FAIR IN OUR PAST FOR THEM TO EVER HAVE “THEIR DRUG HABIT”….AFFECT US IN ANY WAY….ESPECIALLY AFFECTING OUR HEALTH…..!!
LETS NOT FEEL SORRY FOR THEM……BUT WE SHOULD ALL BE SHAMING THEM…??
SINCE WHEN IS IT OK TO HURT SOMEONE WITH YOUR BAD HABIT….???
SHAME ON ANY WEAK PERSON THAT HAS TO STARVE THEIR BRAIN OF OXYGEN TO FEEL GOOD…!!!
WOULD IT BE OK FOR
I didn’t look at it like that… in my opinion it will split 50/50… some people may use it as incentive, others just ignore and be very, very angry that their premiums go up. Only time will tell
i am 100% against smoking and i am also 100% against the higher premiums for smokers through Obamacare. but don’t you all see that Obamacare is setting the higher premiums because he does care? surely its incentive to quit??????????????
yes smokers put their health at risk BUT 50% higher premiums?! Obamacare needs to actually pretend to CARE about smokers and help the 70% who are willing to stop smoking STOP. not just make them pay more money.. at the end of the day paying more money probably wont stop them spending money everyday on packets of cigarettes because it IS and addiction
agree with Isabelle94, and PatriciaBarklay (regardless of the use of the word ‘worser’) however, to be as unbiased as possible, smokers put their health at risk. Fact. but 50% higher premiums for smokers vs. non smokers? Excessive.
being seriously fat is worser than smoking. and ‘NON SMOKERS UNITE’ i would like to know how the drug addicts you describe push the habit on to you?
Smokers should have to pay more for their insurance, BUT so should people who are Obese. American society doesn’t urge people to smoke but it does urge people to eat super-size! What’s all that about? When obese people will probably benefit from the same medical misfortunes as smokers. Smokers are addicts and need the right kind of care to come off of the habit, after all it was society in the 60’s etc that encouraged smoking! It is people who have smoked for years now smoking because it is what their families did when they were younger. Don’t be so quick to condemn and judge.
In all seriousness, nobody, smoker or non smoker, is going to have a clean bill of health! Inheritance of illness needs to come into account and most importantly so does obesity! Not just smokers should face the hard new regulations under Obamacare, as stated ‘70%’ of smokers want to quit, how about you attack the companies who sell the products to the people who are addicted rather than attack the victims of the addiction? You say they did it to themselves, well so did fat people. And its the fat people that have driven America to become a super-sized nation in need for super-sized clothes and super-sized food and super-sized medical bills…
denied surgery on my neck by Oregon health standerd now have plus will that make any difference
I have been charged for over a year now a (smokers fee )which is actually more than full coverage insurance WTF …so yea the two of them together really takes a huge bite out of my check and i do understand why they think smokers should pay more but come on REALLY …..WE ALL ARE NOT ALL HEALTH FINATICS….so please everybody pointing fingers at smokers….. hello….NO ONE IS PERFECT….honestly it charging me MORE only makes me want to keep smoking because they are trying to FORCE me to quit
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To say that only smokers should pay is just not right there are more people who drink and what.about all of the sexually transmitted diseases and heck and everyone who treats patients woth diseases yhats risky behavior or everyone who works with cancer causing agents thays risky behavior ive knowm ppl who smoked all their lives and never get lung cancer and ppl who say they never smoked and got ling cancer. Also to deny smokers employment is just not right to say u cant have a job cause u smoke but if u drink do risky sexual behaviors which have ppl working with diseases they dont even know they have but can transmit to others. Its not right to pick on one specific population I would call that prejudice. N
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Well I will be the first to scream discrimination… Go after the drunks druggies and the obese as well….
What about people who drink, or use recreational drugs, are obese and have type two diabetes, or engage in risky sex? Why just smokers?
Why isn’t smoking considered a pre existing condition? Then when they have subsidized health coverage (or not) they will be afforded programs to help them kick the habit. Why are drug users not charged more? Why aren’t alcoholics charged more as they often times cause accidents and many other variables..
Totally agree with you Stephanie. And I like the ACA. But like they have said before, Medicare & Medicaid had glitches and so will the ACA. We have to be patient.
No, as Medicare is not under the ACA. Medicaid does not have the smoking clause in it.
A smoker in KY will be charged a 40% higher rate than a non smoker. Do a google search for smoking premiums under the ACA. This info is just now coming out and it unfair to single out one particular group/
Hopefully, this will be repealed after things get off the ground.
Im not wealthy. I work and age 45 to 55. This age group pays the highest health insurance premiums that has tripled in past 2 years while copays and out of pocket cost have increased also. Somebody has to cover the uncovered amounts. Im puzzled over increasing smokers premiums and have not seen, heard or read anything on so called social drinkers or alcohlics paying higher premiums. Look at health related, property damage, increased car insurance, disfigurement and body damage to others, tax increases and so many other problems they cause to not only to themselves but to others. Wow! Major cost in health care and beyond!!! Then, who will pay for the ones who can work and getting free health now? My nickel can’t stretch any further. Look at what is being taken from our seniors health care. Time for the free ride to end. Make them pay for their own gas. I can’t afford them.
D. Walk beat me to it with the caveat about open enrollment. It’s something to think about.
But you may be independently wealthy with no financial constraints on how much medical care costs. If you feel no civic responsibility to be part of the solution I have no argument to change your mind. I’m sure you are not alone. I see lately an organized Republican campaign urging healthy young people to eschew health insurance entirely, burning symbolic Obamacare cards in protest. That should address the rising cost of health care and make the insurance industry happy at the same time, no?
In the same way that taxes collected from people without children are used for public education, insurance premiums are collected from healthy people for the benefit of those who need health cafe. But there is little to prevent anyone’s gaming the system.
I, for one, do not begrudge a singe dollar of health care insurance premium if it means I never use the system enough to “get my money’s worth.” It’s like life insurance. The benefits of “winning” do not outweigh the price of having won.
Be careful about timing your choice not to be insured. There will be “open enrollment periods” and then is when you can apply. If you become ill and it isn’t at the time of an “open enrollment period” you may be in trouble getting care and you won’t be able until the next “open enrollment period”
Well for me as a 52 year old smoker. My ins usage for the last 4 yrs is under 500.00 while my non smoking co worker(s) are each in excess of several thousand dollars year after year. That aside, if you look at just the stats that older smokers have higher health cost, I would like to know for how long? Using those same statistics we are on average going to die 13 years sooner than our non smoking counterparts. What is the cost of paying ss and other age related health costs for an additional 13 years! Also in this figure they lump all health costs regardless of reason together, and call it a “smoking related cost”, things such as arthritis etc.
In short I have looked at Kaiser’s estimate for my ins premium, it is projected to go from 4212. this year to 11118.00 next year, of which 2180.00 would be subsidized. So before I ever file a claim I will cost the taxpayers 2180 in subsidies and double the amount of my own out of pocket. My solution as I’m sure will be for a lot of folks I will be one of the newly UNINSURED. I will save the premiums I otherwise would of paid and self pay general services. If and when I need more I will then apply for ins(they’ll have to take me) and if I am then that sick I will not be working so would qualify for full subsidy! Hmm problem solved
Smokers are disgusting. We should NOT have to pay for obese, drunks, smokers, or anyone that has taken drugs that has stopped, now having mental problems, or TEENS that does bungee cord jumping, dirt bike riding, some of the stupid things they do to get hurt…I have a family to take care of…as with many other people. As tax payers, we already get screwed by this government to pay for a lot of women on welfare that obviously doesn’t know what causes pregnancies……We lost our jobs last year, I have worked all my life, I asked for food stamps, was told NO, because we made to much last year, again we pay for these BIG grocery stores that pays min. wage, having once again the tax payers paying for their food stamps plus!!!
Geneva, you are clearly working hard and doing a good job keeping your house in order, whether or not you use tobacco. For that you are to be recognized and encouraged.
But you, like may others, have a seriously misplaced resentment of people receiving public assistance. Phrases like “on drugs and can’t work as they say because the have drug problem.but can get everthing handed to them” reflect not just your impressions but those of manyothers equally misinformed. The fact is that the 1,118,588 adult recipients [of welfare] compose less than four-tenths of one percent of the U.S. population at any given time. The actual number is not only relatively small, but it is a continuously changing group since about half are “cycling” on and off the roles as circumstances change. Here are a couple of links you and others may find informative.
► http://www.mdrc.org/publication/profile-families-cycling-and-welfare
► http://voices.yahoo.com/welfare-america-myths-facts-8524989.html
People who pay cash for their insurance should not be charged.People on wefare should be charged.we have to pay fir everyone of these people who are on drugs and can’t work as they say because the have drug problem.but can get everthing handed to them.charge them make them work.and leave the working people aline that is willing to pay for their medical.really no of get paid a whole lot.my insurance cost me half my wages.were is that fair.yes I smoke but 16.00 a week out of my check at 9.00 hour.that adds up to one of bills every month.but I still make it.my bills come to 760.00 a month my insurance is734.00 a month.I have to work 60 hrs a week to to make ends meet.But I’m not on welfareplus raised 3 boys.
This may not make you feel better but it may help explain what’s going on.
“It’s not just Obamacare: any system that shifts health expenditure from the private sector to the public sector causes transfers like this. If we had no government financing of health care at all, healthy people with high incomes would spend a very small percentage of their income on health care, and the sick poor would spend a large percentage. If we had a fully socialized system where the government paid for everything, rich people would bear most of the cost of providing health care to everyone. And systems that involve a split of public and private expenditure — including Obamacare — have distributional effects somewhere in between.”
http://qote.me/P2CQIN
The article is longer than that and does a pretty good job of explaining how expenses are being spread among those who need it.
Good points. You have explained in clear language how the combination of private health care providers (operating at a profit) and private insurance companies (operating at a profit) differs from government provided health care (which is not organized around profitability).
The high cost of this combination has resulted in millions of people who cannot afford health care at all, which is why ACA was enacted.
States have different rules, but in most states, uninsured children 18 years old and younger whose family incomes are up to $46,000 per year (for a family of 4) can qualify for either Medicaid or CHIP. America’s so-called “middle class” is rapidly vanishing, being replaced by the working poor. Federal subsidies will soon be forthcoming to assist them buying health insurance through the exchanges.
Well if you are going to charge for supposed bad behavior then do it fairly. Medical costs associated with not wearing seat belts is extream so require the insurance data bank to be notified if you are ticketed. Alcohol same thing, require random testing and if you drink you pay. Then lets get into the people that eat nothing but junk food… terrible habit and associated with heart disease, stroke etc. You could monitor that with debit card purchases. Last but not least all who use illegal drugs or any drug that has a risk of side effects similar to smoking. Since there are 10’s of thousands employed by the tobacco industry in this country so they can just find another job.
With about 315 million people in the US and 1/5th of them are smokers (abaout 63 million) that currently pay about $1200 per year in taxes on those cigerettes it might be time to realize that will be an additional 75.6 billion in revenue that you will need to make up for. Course the seniors that can no longer afford to pay the premiums and the minimum wage workers I guess are just surplus population so who cares. Having been raised in a household of smokersthat lived into thier mid 80’s, having tried to quit myself just to end up in the hospital on nitro because my body freaked out I guess I have a different view on all this.
Especially since I have been covered by insurance since birth paid for by my parents and self. What happened to all those premiums? Now in my 50’s you want to penalize me. Well guess that while I paid for all the 20 and 30 year olds that went out and ruined thier livers drinking or using drugs and/or thru fast cars, sports or downright stupidity managed to injusre themselvesI should have been demanding they be penalized. Will start now. That is easy to track….then they can pay for the rest of thier lives. This is opening pandoras box and the results will be nothing like you expect. All for what – insuranc e companies that are a profit source for investors, pay out millions to CEO’s as bonuses every year and provide as little care as possible. My husband just got laid off…..our Cobra is 1367.00 per month if that doubles just how do you think we are supposed to pay for it? Oh thats right working class doesn’t matter either. Since thay only earn about 24000 per year they can just pay it all to insurance and live under a bridge. People you need to get off you high horse and realize that you are just getting played.
Kay, you sound like a ridiculous, whimpering smoker. Sure, all the things you mention DO in fact damage your health to some degree, but not at the level that smoking does. Smoking is absolutely horrible in countless ways for your body. I don’t think it makes anyone self righteous or “churchy” as you put it, for pointing out this fact. I’m all for taxing the hell (that’s what this forced mandate is, a tax) out of anyone with unhealthy/bad habits. The only thing I’m sick from is walking around and looking at a bunch of unhealthy, weak minded, lazy American’s who think they are entitled to everything under the sun without taking any personal responsibility at all for anything they do. Welcome to letting the government take care of you, it’s all down hill from here.
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Smokers may be “drug addicts” but do you drive a car, put trash out on a curb to be picked up by the trash man, spray chemicals on your lawn to kill bugs or weed, use paper, buy gas from final or any other gas company, or use any product or electric power that pollute the ground,water,or air? Well I’m sure you do. Don’t preach to these people if you do the same thing only in a different way. Its the same thing. Your killing thousand of people a day with your trash,smog,waste water, ect. You can’t preach to the church and be hypocrite.
It should not be fair to raise premiums on smokers due to higher health risk and not raise health premiums on obese. It 60% to 20%. And smokers are only 20%. You can’t criticize the smokers and no one else when it seems like everything you do has a health consequence. It should be equal premiums to allow all aspects people to afford insurance since they seem to think they are not breaking any laws or our rights by making us take insurance. It should be a choice not a law. Same as smoking, just because some people think its disgusting habit doesn’t mean it should turn illegal. Should food turn illegal too since its caused 60% obesity? And to think that congress doesn’t have to abide by the laws. How dare they!!!! What makes them so special and different? And the smoking cessation should be free since the government wants to but a ban on smoking.
You people are so full of crap. There are many
Other things in society that put all of us at risk
Of something. Now that smokers have to go outside
To smoke it doesn’t affect no smokers health at
All. So stop judging others and trying to strip
Others’ rights. Btw, are you overweight, have
Diabetes that is weight induced, drink alcohol?
When you and your self righteous alliance
Become perfect then you will have the right to
Preach
Well I believe if smokers are going to be made to pay
Higher premiums then so should the obese, who have
Far more health issues than smokers. What about
Alcoholics, they should be included with the
Horrible habit of smoking. It’s easy to pick a group
And ostracize them when you are perfect.
Problem is that none of us are