We hypothesized that there would be lower enrollment among smokers, relative to nonsmokers, in states that allowed tobacco surcharges compared to states that outlawed rating by tobacco use. Tobacco users can . affordable care act; enrollment; health insurance; marketplace; premiums; smoking; tobacco surcharge. [5][6] Over 54% of the country's population lived in states that had signed legislation setting 21 as the tobacco restriction age at the time the federal law set the nationwide tobacco age restriction. CA, The program may include a tobacco surcharge to help motivate employees. 12 In the CPSTUS, smoking status was defined based on how frequently individuals report smoking. We examined the impact of state level tobacco surcharge policy on health insurance enrollment decisions among smokers. Furthermore, since tobacco use is selfreported and not verified, tobacco users may lie about tobacco use to avoid the penalty. 3 Michael F. Pesko, Georgia State University. In the 37 states that use the federal insurance exchange, healthcare.gov, the tobacco surcharge was paid by about 7 percent of 5.1 million consumers who enrolled, according to federal data. Allowing tobacco surcharges at all and having larger tobacco surcharges were each associated with lower takeup of insurance. 23 Thus, people who use tobacco are advised to not just avoid health insurance because many health insurers have implemented smaller surcharges or some have also sip them altogether. In August 2017, the United States Department of Labor (DOL), which enforces compliance with ERISA, sued Macys, Inc. as well as its third-party administrators for its self-insured health plan: Anthem Blue Cross Life and Health Insurance Company and Cigna. Allowing higher premiums for tobacco use in the nongroup market results in lower health insurance enrollment among smokers, which is driven by decreased enrollment in the nongroup market. Health Serv Res. 1865 into law. and transmitted securely. Tobacco Users Pay Health Insurance Surcharges as per State and Federal Rules, Complete Overview on Buying Private Health Insurance Plan, Significant Differences between Public and Private Health Insurance Plan, Master the Tips to Shop for Health Insurance, Get personalized help related to Insurance Products, Service & Claims, Tips to Choose between Obamacare and Employer-sponsored Health Plans, Enrollment in Individual Health Plan is still possible after Ending of COVID SEP in the Most States, Free Health Insurance for Uninsured Americans with Stimulus Package. , This finding was robust across a variety of specifications. Health Aff (Millwood). And in states like California, Rhode Island, Vermont, the District of Columbia, Massachusetts, New York, and New Jersey are not allowed to charge higher premiums from tobacco users. This blog post is for informational and educational purposes only. It is vital to note individuals cannot use their premium subsidies to cover the tobacco surcharge that is generally used by the majority of the enrollees to reduce their monthly premiums. Our results also show that the impact was largest in the exact insurance segments that were exposed to tobacco surcharges, increasing confidence that the policy has an effect on enrollment. Our results were not sensitive to the use of the alternative definition of tobacco use including the use of other tobacco products. Overall, this study found that tobacco surcharges led to significantly lower enrollment in nongroup health insurance among smokers. Specifically, our model compares the insurance status of smokers to nonsmokers across states with and without tobacco surcharges. Tobacco surcharges and the state laws that limit them theoretically have varying effects on different segments of the health insurance market. Will the premium surcharges be split and collected from each paycheck? 102. Please enable it to take advantage of the complete set of features! Alaska increased its tobacco age restriction from 16 to 19 in 1988. Another potential data limitation is that we only had complete, linked smoking and health insurance information for 2015 and 2019, which we pooled in our main analysis. Since 2014 the Affordable Care Act has permitted employers and insurance companies to charge tobacco users up to 50% more in premiums. We found that the tobacco surcharge rate averaged approximately 14 percent and that it was associated with lower total enrollment as well as a reduced share of total enrollees who reported any tobacco use. 26 USA. The interaction terms between surcharge state and current smoker show the key differenceindifference results. Although we did not have data from other years, the fact that our results were similar across the two years gives us confidence that pooling the data is a valid approach. We compared insurance enrollment in states that did and did not allow tobacco surcharges, using a difference-in-difference approach to compare the policy effects among smokers and nonsmokers. Our main source of data was the Current Population Survey (CPS). The ePub format uses eBook readers, which have several "ease of reading" features Descriptive statistics from linked CPSASEC and CPSTUS data pooled across 2015 and 2019. Thursday, Feb 7 2013 Assembly Bill Would Block ACA Tobacco Surcharge Last week, Assembly member Richard Pan (D-Sacramento) introduced a bill ( AB 1X2) that would block an Affordable Care Act provision that allows insurers to charge smokers with an individual policy up to 50% more in premiums from being implemented in California. The American Cancer Society opposed the tobacco rating provision during the congressional debate about the health-care law. In order to provide context to our results on the reasons tobacco users did not enroll in health insurance, we also included separate data from a June 2019 online survey conducted using Qualtrics Research Panel. Nineteen of those states set the tobacco age restriction to 21 before the federal law took effect, while the other 19 did so after the federal law took effect. This surcharge is considered a tax-sheltered amount for payroll. Credit Card Surcharge Laws by State: A Guide for AEC Pros. Tobacco products are mostly used by lower-income Americans than higher-income Americans. University of Southern California, Before Click here to contact us for media inquiries, and please donate here to support our continued expansion. Keywords: States that did not sign legislation had their age restriction raised to 21 by federal law in December 2019. By limiting the sample respondents in states with tobacco surcharges, we were able to estimate the effect of the size of the surcharge on insurance enrollment. !function(){"use strict";window.addEventListener("message",(function(e){if(void 0!==e.data["datawrapper-height"]){var t=document.querySelectorAll("iframe");for(var a in e.data["datawrapper-height"])for(var r=0;r Willow Creek, Alberta Fishing, Frigidaire Imk0028a Ice Maker Kit Installation Instructions, Articles T