Health Reform WK-EDGE ACA’s tobacco surcharges lessen enrollment among smokers
Tuesday, July 26, 2016

ACA’s tobacco surcharges lessen enrollment among smokers

By Lauren Bikoff

The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) allows health plans to levy a surcharge of up to 50 percent on a tobacco user’s health premiums. A new study from the Yale School of Public Health reveals that these high surcharges resulted in lower rates of insurance enrollment among smokers in the first year of the ACA’s implementation, without increasing smoking cessation.

The researchers combined data from the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System with newly collected data on tobacco surcharges. The analysis revealed that increases in insurance coverage in 2014 were 12 percentage points lower among smokers facing the highest surcharges—between 30 percent and 50 percent of their unsubsidized premium—than smokers facing no surcharges. Those facing medium surcharges (10 percent to 30 percent of premium) showed a smaller 4-percentage-point reduction in coverage relative to the zero-surcharge group. The study also found no beneficial effects of the surcharge on smoking cessation: Smokers facing medium and high surcharges were no more likely to quit than those in the zero-surcharge group.

"Our findings suggest that high tobacco surcharges undermine attempts to achieve universal coverage, a key goal of the ACA," said Professor Abigail Friedman, one of the study’s authors. "Moreover, they do not appear to increase smoking cessation, at least in the first year after the marketplaces' implementation."

Companies: Yale School of Public Health

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