You鈥檝e heard all the campaigns and statistics: Smoking Kills. It鈥檚 the in the U.S. And it鈥檚 expensive.
The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses. That鈥檚 why the federal聽Affordable Care Act permits insurers to charge smokers up to 50 percent more for coverage than non-smokers.
So, says , why not ask smokers to pay more for health insurance?
鈥淚f we鈥檙e ever going to control costs, we鈥檝e got to make sure that we don鈥檛 over-socialize the system,鈥� Hurst says.聽鈥淚n other words, we don鈥檛 make people pay too much for somebody else鈥檚 health care costs.鈥�
Fifty percent more for smokers might be too much, continues Hurst, 鈥渂ut let鈥檚 not dismiss outright, the ability for employers to try to incent people to get healthier.鈥�
The debate about whether smokers should pay more for health insurance has created unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.
鈥淔irst of all there is very little evidence that financial incentives or disincentives through premiums change behavior,鈥� says Amy Whitcomb Slemmer,听executive director at聽, a Massachusetts group that advocates for affordable health care access.
Health Care for All and the group鈥檚 allies in the public health world routinely support higher taxes for smokers. But Whitcomb Slemmer says higher insurance premiums could lead many smokers to drop their coverage.
鈥淲e were concerned that more would pay the penalty to not be insured,鈥� Whitcomb Slemmer continues. 鈥淎nd, specifically, we鈥檇 be concerned that they (smokers) wouldn鈥檛 have access to what has been demonstrated to be very 辫谤辞驳谤补尘尘颈苍驳.鈥�
In Massachusetts, Vermont, Rhode Island and the District of Columbia, this public health perspective has won the debate, for now. Insurers will not be allowed to add a surcharge for smokers. .
But aides to Massachusetts Gov. Deval Patrick says he鈥檚 open to allowing the surcharge in the future 鈥� if insurers find accurate ways to determine who smokes and who doesn鈥檛.
The largest insurers in the Bay State are mostly on the sidelines in this controversy. Here鈥檚 one reason why: They鈥檝e had the option of hiking premiums for smokers since the state passed its landmark health care act in 2006, and they haven鈥檛 done it.
鈥淲e try to moderate premiums for the entire market, not seek to target particular populations or individuals because of certain behaviors,鈥� says Eric Linzer, senior vice president at the Massachusetts Association of Health Plans.
The Massachusetts legislature will likely need to amend state law so that a ban on higher charges for smokers takes effect.
And just to make things a little more complicated 鈥� it won鈥檛 apply to everyone. Large employers, who are self-insured and follow federal insurance rules, will be able to target smokers, if they choose.
This story is part of a partnership that includes聽,听聽and Kaiser Health News.聽