A new study published in the journal Health Affairs shows that the pricing structure of the Affordable Care Act (ACA — also known as Obamacare) has prevented many smokers from buying insurance they’re eligible for, and has not encouraged smoking cessation among at-risk Americans. Because smokers as a group have higher health care costs, the ACA allows insurers to impose a surcharge as high as 50 percent on smokers buying coverage through the ACA’s health insurance Marketplaces.
The study was conducted by researchers at the Department of Health Policy and Management at the Yale School of Public Health. According to an article on the Yale School of Public Health’s website, the researchers “combined data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System with newly collected data on tobacco surcharges.”
Smokers are being left behind
Surcharges discourage smokers from signing up
According to the study, coverage increases in 2014 were 12 percentage points lower among smokers facing high surcharges than smokers facing no surcharges. “Our findings suggest that high tobacco surcharges undermine attempts to achieve universal coverage, a key goal of the Affordable Care Act,” said Professor Abigail Friedman, one of the authors. “Moreover, they do not appear to increase smoking cessation, at least in the first year after the marketplaces’ implementation.”
Among smokers under age 40, those required to pay the highest surcharges for coverage were even less likely to buy insurance. “The larger effects among younger smokers are particularly concerning,” said the senior author, Professor Susan Busch. “This group has lower healthcare costs than older individuals, so their exclusion may reduce the marketplaces’ long-run stability by limiting risk-pooling.”
The study encourages states to keep the tobacco-use surcharges lower than the maximum allowed in federal law to increase coverage rates among smokers. The ACA goal of universal coverage will be impossible to achieve without participation by smokers.
While it may be that the administration officials who negotiated the details of Obamacare were forced to impose a surcharge on smokers in order to get cooperation from health care insurers during the law’s passage, the end result looks a lot like a wholesale abandonment of smokers by government and the health care industry. To make it worse, they are now attempting to wipe out the vaping market through the FDA’s deeming regulations.
The Obama administration’s attempt to destroy vaping, in combination with the financial disincentives for smokers buying insurance through the health care Marketplaces, will result in more disease, more death, more bankruptcies, and more misery for the family members of American smokers who are trapped between the government’s good intentions and the rotten realities of the “war on tobacco.”