ACA smoker penalty led to reduced enrollment: Study

A study conducted by the Yale School of Public Health suggests that the penalties imposed on smokers by the health law actually discouraged them

Life & Health

By Lyle Adriano

The results from a study by the Yale School of Public Health suggest that the higher charges placed on tobacco users planning to buy Affordable Care Act (ACA) health plans led to reduced enrollment among those who would have otherwise purchased coverage.

Additionally, the study found that the surcharges for smokers did not result in overall reduced smoking among people who actually ended up enrolling in ACA coverage during the health plan’s first year. Oddly, the researchers also found that smokers with lower surcharges than the maximum allowed actually "showed significantly less smoking cessation."

"Our findings suggest that high tobacco surcharges undermine attempts to achieve universal coverage, a key goal of the Affordable Care Act," remarked Yale professor and co-author of the study Abigail Friedman.

The study was published in the journal Health Affairs, reported CNBC. It analyzed the experience of tobacco users in the first year of the ACA enrollment in 2014.

"Moreover, they do not appear to increase smoking cessation, at least in the first year after the marketplaces' implementation," Friedman added.

Under the ACA’s stipulations, health insurance plans sold in the exchanges are permitted to charge smokers up to 50% more in monthly premiums compared to non-smokers.

A number of states banned the surcharges, while others limited the surcharges between 10% and 40%.

In states where the additional charges were implemented, the study’s researchers found that the "surcharges increased the out-of-pocket premiums substantially for many tobacco users." This was despite the presence of tax credits (subsidies allotted to ACA customers with low to moderate incomes), as the subsidies were based on the premiums non-tobacco users pay, rendering the credits insufficient enough to offset the tobacco surcharges.

"On average, 49-year-old smokers living in one of the 43 states that allowed surcharges in 2014 faced a median tobacco surcharge of $70 per month," the study’s authors wrote. "Smokers were 7.3 percentage points less likely than nonsmokers to have coverage."

After the ACA was fully implemented, tobacco users with higher surcharges saw insurance coverage increases that were 12 percentage points lower than those smokers who had no surcharges.

Tobacco users facing medium surcharges had increases in their health coverage that were 4.3 percentage points lower than smokers who had no surcharges.

Yale researchers believed that the higher surcharges levied on younger smokers was a cause for concern.

Susan Busch, the lead author of the study, said that since younger smokers have lower health care costs than older individuals, their exclusion may reduce the "long-term stability of Obamacare marketplaces by limiting risk-pooling."


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