Should Smokers Have to Pay 50 Percent More for Health Insurance?

Nurses at Mount Sinai Medical Center in New York City still chuckle about the elderly gentleman who was a patient at the hospital years ago. He would always respond the same way when asked if he smoked: “I gave it up when they raised the price to 35 cents a pack!” That was about 40 years ago. Cigarettes now hover at $10 a pack in New York City and only a bit less elsewhere.

But the pack price is not the only cigarette-related cost that’s rising. Under the rules of the Affordable Care Act, people who smoke are likely to see a big jump in their health insurance premiums starting in 2014 if they buy coverage under the new state insurance marketplaces. If you’re a smoker over age 50, your premium surcharge can be 50 percent higher than a nonsmoker’s; younger people are likely to be penalized too, but probably at a lower rate (it remains to be seen what the surcharge will be, exactly).

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And if you’re a smoker counting on a subsidy to help you pay for insurance, you won’t qualify. A recent article in the Washington Post cited research suggesting that premiums for some low-income individuals who smoke could jump from about $700 per year to over $3,000.

It’s definitely a harsh rule. “We do not think smokers should be penalized. Smokers should be provided with cessation services and support,” says Diane Canova, vice president, government affairs, at the American Legacy Foundation, which develops programs to help smokers quit. In fact, some advocacy groups intend on putting pressure on states to remove the smokers’ premium penalties, which states have the authority to do if they choose.

While the fate of the surcharge is still unclear—at least in some states—smokers who want to avoid the extra expense can do so by signing up for a program geared toward helping them quit. That means that even if you’re still smoking when it’s time to register for 2014 health insurance coverage later this year, you can avoid the penalty if you can show you’re enrolled in a smoking cessation program. 

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Close to 20 percent of U.S. adults still smoke, according to the Centers for Disease Control and Prevention, and tobacco use remains the leading cause of preventable illness and death in the United States. It’s a factor in a wide variety of cancers, as well as chronic lung diseases like emphysema and bronchitis, as well as heart disease and pregnancy-related problems. (Want to see how your state compares with others in its number of smokers? This map has it.)

But why wait for the insurance marketplaces to open next October before signing up for help now? (For many smokers it takes several attempts at quitting to be successful.) Cost shouldn’t be a barrier: Many smoking cessation programs are free—and can include counseling, medication, and nonprescription stop-smoking aids, such as nicotine patches.

These resources can connect you to smoking cessation help in minutes:  

·   Go to, from the Department of Health and Human Services, for a range of strategies and resources.

·   Call 1-800-QUIT-NOW (1-800-784-8669) to be connected directly to your state quit line. All states have lines in place with trained coaches who provide information and help.

·  The Department of Defense offers dedicated, free cessation services for military personnel and their families.    

·  Enroll in a smoking cessation research study; you could be paid to quit smoking!

·  The American Legacy Foundation has a free program called “Become an Ex,” which teaches smokers to do everyday things, like drinking coffee or alcohol and handling stress, without the need for a cigarette.

In the end, smokers who quit will save a lot more than money on insurance premiums and cartons of cigarettes: On average, those who smoke die 13 to 14 years sooner than nonsmokers.

Do you think smokers are being unfairly punished by the premium surcharge? If you're a smoker, will you try to quit before these changes go into effect?


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Fran Kritz is a freelance writer specializing in health and health policy and lives in Silver Spring, Maryland.