Un-Affordable Care Act Targets Smokers

  1. WASHINGTON (AP)-Millions of smokers could be priced out of health insurance because of tobacco penalties in President Barack Obama's health care law, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation.

    The Affordable Care Act-"Obamacare" to its detractors-allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1.
    For a 55-year-old smoker, the penalty could reach nearly $4,250 a year. A 60-year-old could wind up paying nearly $5,100 on top of premiums....

    Nearly one of every five U.S. adults smokes. That share is higher among lower-income people, who also are more likely to work in jobs that don't come with health insurance and would therefore depend on the new federal health care law. Smoking increases the risk of developing heart disease, lung problems and cancer, contributing to nearly 450,000 deaths a year.
    Insurers won't be allowed to charge more under the overhaul for people who are overweight, or have a health condition like a bad back or a heart that skips beats-but they can charge more if a person smokes....

    Although the law prohibits insurance companies from turning away the sick, the penalties for smokers could have the same effect in many cases, keeping out potentially costly patients....


    In yet another, "We had to pass it to find out what's in it moment," most Americans are jsut now learning that smokers face extremely high penalties that will likely make individual policies unaffordable.

    How does one access smoking cessation programs and medication if they can't afford health insurance?

    This disproportionately targets low income and minority Americans, who are both more likely to smoke and to work in industries without employer-paid healthcare coverage.

    Why is smoking being treated differently than any other pre-existing condition or risk factor? There are plenty of other "elective" and controllable risk factors such as drug use, alcohol use, risky activities, poor dietary habits, and sedentary lifestyle that don't result in huge financial penalties to insurance applicants under Obamacare.
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    About Jolie

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  3. by   herring_RN
    If this analysis is correct the older lower income smoker could have the choice to quit smoking or --- What?
    ... In today's world, insurers can simply turn down a smoker. Under Obama's overhaul, would they actually charge the full 50 percent? ...

    Older smokers priced out of Obamacare? - CBS News
  4. by   TheCommuter
    In the long run, Nicorette gum, Chantix, Zyban, and other smoking cessation tools are far less costly than continuing the habit of cigarette smoking. Perhaps the staggering costs associated with the ACA shall serve as a huge motivator for the millions of smokers in America to finally kick this highly addictive, deadly activity.

    I'm not being judgmental. I'm not being mean. I have nothing against smokers. I know nicotine is one of the most addicting substances in existence. After all, my middle-aged parents are longtime smokers. However, I'm being realistic when I say that cigarette smokers drive healthcare costs up way beyond the stratosphere during their final living days.

    If an individual chooses to partake in an expensive habit such as smoking, the same person should step up to the plate and cover his/her costs to society IMHO.
  5. by   VivaLasViejas
    I'm a longtime ex-smoker, so I don't really have a dog in this fight. My problem with this (other than the whole Obamacare cluster-mug itself) is that once a particular group is singled out for punishment in the form of higher costs, it won't end there.......I guarantee it. The next most loathed group is the obese, followed by addicts and alcoholics---in fact, anyone whose disease is, or may be, lifestyle-related will wind up paying out the wazoo. And considering the fact that these issues tend to be concentrated in the lower income classes, where is the extra money supposed to come from? Does the government really expect someone making $20-30,000 a year to cash out over $5000 just for health insurance?! I think the penalty for not having insurance would be cheaper....and in the meantime, the patient will wind up waiting until they're half-dead and then use the emergency room for care. Hmmm..... sounds like the way things were BEFORE Obamacare. Just saying.
  6. by   MunoRN
    I perplexed by your view on this Jolie. You've repeatedly stated in the past that the money you pay into insurance shouldn't go to pay for services for others that you yourself don't need. How is this different?
  7. by   tewdles
    I rather think that this provision would make some happy, based upon the posts I have read on AN
  8. by   leslie :-D
    i personally find it highly precarious to implement such costs towards a high-risk group.
    and as marla noted, i would think that a large % of these folks would end up utilizing the er...
    something we definitely don't want or need.

    although there was a decrease in tobacco use when the cost rose so drastically...
    i cannot imagine anyone essentially betting that this will motivate most to quit.
    i'm thinking that by incorporating these rate hikes, the govt is trying to recoup some of the money that'll likely be lost when "no preexisting conditions" is waived.
    which to me, begs the question, what other high risk group will/can they target in order to recover any anticipated losses?

    i can't see this working.
    yet another 'glitch' to be placed in the "needs fixing" pile.

  9. by   herring_RN
    The insurance executives were at the table but nurses and physicians for single payer were not.
    So the law is beneficial the those considered stakeholders.
  10. by   somenurse
    Jolie, private insurance companies have always charged obese people, smokers, people with pre-existing diseases, a far far higher rate, (IF they agree to cover that person at all).

    do you also object to this?
  11. by   Jolie

    I respectfully disagree with one point: Whether or not you smoke, you most definitely have a dog in this fight. Anyone who pays taxes, has or plans to purchase health insurance, or utilizes the healthcare system has a dog in this fight, because this rule will impact the cost of health care for everyone.

    Muno, you either misunderstand my previous posts or have chosen to misrepresent them. No matter really, because this pricing policy does not do what you imply that it does. Levying a cost-prohibitive penalty on top of smokers' health insurance premiums does not lower anyone else's costs. No one will be allowed to exclude smoking cessation services from their plan (and premiums) because they don't smoke. No one will be able to forgo lung cancer coverage (and costs) regardless of how low their risk of the disease may be, and no one will be able to delete COPD care (and expenses) from their list of covered services. Unlike "soaking the rich" in taxation where exorbitant taxes paid by some are offset by no taxation of others, "soaking the smokers" in Obamacare doesn't lessen the premiums of non-smokers.

    If you believe that charging much higher upfront premiums and penalties of smokers will actually cover the cost of their care, you are sadly mistaken. Using the example cited in the article, a 60 year old smoker may see a penalty of $5100 on top of premiums. Let's assume a typical premium of $3000/yr. That smoker must now pay $8100 per year in order to be in compliance with the individual mandate of Obamacare. The maximum subsidy available to a single individual to assist with the purchase of approved healthcare coverage is approximately $4K, leaving our theoretical smoker with a $4100/year outlay. In 2014, the penalty for a single individual who fails to comply with the individual mandate is $325. It increases yearly up to 2016 when it reaches a max of $695. You do the math. Since this individual cannot legally be denied coverage regardless of pre-existing conditions, nor charged more than the stated premium plus penalty at the time he purchases coverage, why would he choose to pay those expenses year in and year out, and not simply call his agent when the ER doc pronounces his lung cancer diagnosis 5 years from now at the age of 65?

    Had he been charged the normal premium of $3K, his subsidy would have enabled him to obtain health insurance coverage at little or no out of pocket cost. $15K worth of premiums would have been paid into the system on his behalf, which would have helped to offset the cost of his now very expensive care. Or perhaps during his preventive health visits with his primary care provider, his disease would have been diagnosed early, improving his outcome while minimizing the cost of his care. As the rules are now written, he will likely forgo healthcare coverage, continue to rely on the ER for urgent care needs and neglect preventive health measures. And since he is paying nothing into the system, the cost of his expensive cancer care will be borne entirely by other participants. Of course, as we know that defeats the effect of shared risk in insurance.

    Obamacare was sold to the American people (who still as a majority rejected it) as a means of providing affordable, comprehensive healthcare coverage to ALL, regardless of age, physical condition, lifestyle, or pre-existing conditions. Now, it is being back-tracked. Smoking is no longer a pre-existing condition? If not a pre-existing condition, then what, pray tell is it? I acknowledge that it is a CHOSEN pre-existing condition, but then so are sedentary lifestyle, overeating, excessive drinking, recreational drug use, indoor tanning, sex with multiple partners, skydiving, motorcycle riding, etc. Will we wake up tomorrow and find that these choices have been assessed prohibitive financial penalties as well? This is NOT what we were promised with Obamacare. Once again, so much for the "transparency" and integrity of this administration.


  12. by   mariebailey
    Oh my...I once smoked more than 1/2 a pack a day. I quit with the patch. I think I should be charged more for health insurance if I ever choose to smoke again b/c it is costly to treat the health consequences of this optional habit. At least smokers are covered under the ACA. One more thought - smoking is not a pre-existing health condition; it is a lifestyle choice.
    Last edit by mariebailey on Jan 27, '13 : Reason: add'l thought
  13. by   VivaLasViejas
    Quote from Jolie

    I respectfully disagree with one point: Whether or not you smoke, you most definitely have a dog in this fight. Anyone who pays taxes, has or plans to purchase health insurance, or utilizes the healthcare system has a dog in this fight, because this rule will impact the cost of health care for everyone.

    Touche`.......I stand corrected. Thanks for the reminder, Jolie.
  14. by   Jolie
    Quote from mariebailey
    At least smokers are covered under the ACA.
    Smokers have always been covered by traditional insurance, with higher premiums charged at the discretion of the insurance company. To be sure, those premiums are sometimes so high as to be unaffordable. As we were told during the run-up to Obamacare, unaffordable rates = lack of coverage.

    So what has changed?