Allowing insurers to charge smokers extra for Obamacare health insurance appears to have discouraged them from getting it , "undercutting a major goal of the law ," Carolyn Y. Johnson reports for
The Washington Post. "The surcharges , of up to 50 percent over nonsmokers' premiums , also showed no sign of encouraging people to quit." That's according to a study at the
Yale School of Public Health , published in
Health Affairs.
"To explain how the surcharge works , Friedman and colleagues provided this example: Take the case of a 49-year-old with an income at 150 percent of the poverty level. If that person were a nonsmoker , he would pay only $60 per month for a particular health plan , because the tax credit would pay the rest ," Johnson
writes. "But the premium surcharges that smokers face are not eligible for tax credits. So a smoker would — based on an analysis of 43 states that allowed surcharges in 2014 — pay a median $70 surcharge on top of that premium , doubling their out-of-pocket costs of insurance."
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| 26.5 percent of Kentuckians smoke , second only to West Virginia. |
Kentucky was one of those states , allowing surcharges of up to 40 percent. It has the nation's second-highest smoking rate , 26.5 percent.
The researchers found that in 2014 , the number of U.S. smokers with insurance rose to 76 percent , from 70 percent in 2013 , but "estimated that if the surcharges did not exist , that number would have risen to 80 percent ," Johnson reports. "The effects were especially noticeable for smokers under 40 years old. In 2014 , 65 percent of the smokers in the sample had health insurance , but 75 percent would have enrolled if the surcharges were eliminated , the researchers estimated."
Scaring away younger smokers backfired. "Younger smokers tend to have health-care costs similar to other young nonsmokers , so their participation in the marketplaces helps balance the risk and makes insurance work ," Johnson notes. "Second , stopping smoking when people are younger can have big , long-term health benefits for individuals and in helping to prevent costly chronic conditions."
A spokeswoman for the Centers for Medicare and Medicaid Services noted that before the health-reform law , insurance companies could refuse to cover smokers. And the law required insurance plans to pay for smoking-cessation programs and medications.
The authors of the study said states could reduce or eliminate the surcharges , or (and this would be harder to administer) eliminate them for people who enroll in smoking-cessation programs. "A separate concern that Friedman raised was that the rules could lead people to
lie about whether they smoke , to avoid the surcharge ," Johnson reports. "If that also led to patients lying to their doctors , it could have real public-health consequences."
