Smoking has its risks 鈥� but in California, higher prices for health insurance probably won鈥檛 be one of them.聽
The federal health law allows states to charge smokers up to 50 percent more for a health plan 鈥� but legislation that will make sure that doesn鈥檛 happen.
And unlike other efforts around the country to alter the law, this is one coming from a Democrat.
The Affordable Care Act is supposed to remove discrimination in the pricing of health insurance for things like gender and a person鈥檚 medical condition. And some say a tobacco surcharge creates a new category of discrimination that singles out smokers.
Furthermore, the surcharge would mean people who smoke would not get the benefit of the federal subsidy that鈥檚 supposed to make buying insurance more affordable for many, says Karen Pollitz of the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
鈥淪o if you鈥檙e a low-income person and you would otherwise be buying a $6,000 policy but qualify for a subsidy that would buy it down to $3,000. Well, the tobacco surcharge would knock it back up to 6,000 again,鈥� Pollitz says.
If state opted for the maximum surcharge, health insurance would become unaffordable for those with the lowest incomes, according to Rick Curtis, president of the Institute for Health Policy Solutions in Washington D.C. And, he points out, that is the group that鈥檚 most likely to smoke:聽鈥淔or somebody who is totally hooked after many years and older鈥nd those kinds of people are more expensive and often do need more medical care 鈥� they have two bad choices: go without health insurance and be impoverished that way or get health insurance and be impoverished.鈥�
The Centers for Disease Control and Prevention says tobacco use costs the nation about $190 billion in medical care and lost productivity each year.
And that鈥檚 exactly why health policy analyst Micah Weinberg, with the Bay Area Council in the San Francisco region, thinks higher rates for smokers make sense.
鈥淚f we鈥檙e ultimately interested in bringing down the price of health care for everybody, including low-income folks, then we need to make sure we get a handle on unhealthy behaviors such as smoking.鈥�
Weinberg says higher insurance premiums for tobacco users 鈥� as long as they鈥檙e not too high 鈥� provide the type of financial penalties that work. Research shows a financial hit causes people to quit smoking. By contrast, he says, banning higher rates because smoking disproportionately affects the poor, reflects paternalistic policy-making that doesn鈥檛 fix the problem.
鈥淚 think we have to be very careful what types of favors we鈥檙e doing for people,鈥� Weinberg says. 鈥淏ecause if the end result of this policy is greater numbers of smokers, then that鈥檚 not actually helping the populations that we鈥檙e trying to help.鈥�
But California Democratic Assemblyman Richard Pan of Sacramento disagrees. He鈥檚 a pediatrician and he believes rate hikes of any amount on smokers鈥� premiums may dissuade some from buying health insurance all together.
鈥淲e want smokers to actually have health care coverage,鈥� Pan says. 鈥淎nd through having health care coverage they will have access to smoking cessation treatment as well as, of course, health care.鈥�
And for many 鈥� in California, at least 鈥� that . Pan鈥檚 proposed law has so far encountered no formal opposition 鈥� be it from anti-smoking groups, cigarette companies, insurance companies or the American Lung Association.
Officials at the American Lung Association鈥檚 California branch said in a written statement that because it鈥檚 so hard to quit smoking, it鈥檚 essential to provide tobacco users with affordable health insurance.聽
It is not the first time the California legislature has tackled the issue. According to , the surcharge has already been eliminated for people who work for small businesses, and a bill similar to Pan鈥檚 passed both chambers last year only to be vetoed by Gov. Jerry Brown, who was reluctant to establish rules for the new exchange too early. The new bill appears to be on track. 鈥淚 expect it to pass,鈥� Dylan Roby of the UCLA Center for Health Policy Research told the Star.
If it does, California will join Massachusetts, Vermont, Rhode Island and the District of Columbia in making sure smokers aren鈥檛 charged more under the federal law.
This story is part of a partnership that includes , , and Kaiser Health News.