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You’ve heard all the campaigns and statistics: Smoking Kills. It's the leading cause of preventable death in the U.S.
And, it’s 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.
The federal Affordable Care Act says insurers can charge smokers up to 50 percent more for coverage than non-smokers.
So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?
"If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system," Hurst says. "In other words, we don’t make people pay too much for somebody else’s health care costs."
Fifty percent more for smokers might be too much, continues Hurst, "but let’s not dismiss outright, the ability for employers to try to incent people to get healthier."
The debate about whether to make smokers pay more for health insurance has created some unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.
"First of all there is very little evidence that financial incentives or disincentives through premiums change behavior," says Amy Whitcomb Slemmer, executive director at Health Care for All.
Her group and others in the public health world routinely support higher taxes for smokers. But Whitcomb Slemmer says she’s worried that higher insurance premiums will lead many smokers to drop their coverage.
"We were concerned that more would pay the penalty to not be insured," Whitcomb Slemmer continues. "And, specifically, we’d be concerned that they (smokers) wouldn’t have access to what has been demonstrated to be very effective smoking cessation programming."
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. The Patrick administration says it's open to considering this action in the future — if insurers come up with more accurate ways to determine who smokes and who doesn't.
But there's a twist. Insurers in Massachusetts have been able to hike premiums for smokers since the state passed its landmark health care law in 2006 (the one used as a model for the federal law). But almost no one is doing that.
"The idea here is that we try to moderate premiums for the entire market, not seek to target particular populations or individuals because of certain behaviors," says Eric Linzer, senior vice president at the Massachusetts Association of Health Plans.
The ban on higher charges for smokers will apply to about half of Massachusetts residents who have insurance through their employer. Large employers, who follow federal insurance rules, will be able to target smokers, if they choose.
This program aired on May 21, 2013. The audio for this program is not available.
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