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Steep smoke penalty to start

Smokers may face 50 percent surcharge on health insurance.

Sep. 28, 2013

Surcharge cost examples

Note: A tax credit is available for the health insurance plans. However, the smoker’s surcharge is not. The figures below represent the average cost of plans in Florida with the maximum surcharge.

• A 27-year-old smoker, who makes $30,000 and selects a bronze plan averaging $209 a month, may pay $313.50 with the surcharge.

• A married couple, both smokers, who make a combined $50,000 and selects a silver plan, may pay $396 with the surcharge.

• A low-income 50-year-old, with a premium of $100 a month, may pay $150 monthly with the surcharge.

• A family of four with one smoker and an income of
$50,000, on a bronze plan may pay $320 a month with the surcharge.

- Source: Kaiser Family Foundation

For help in quitting

Plans under the Affordable Care Act are required to waive the surcharge for any smoker who enrolls in a cessation program.

American Cancer Society: (800) 227-2345, American Lung Association: (800) 586-4872,
Tobacco Free Florida: (877) 822-6669,
National Cancer Institute: (877) 448-7848;


Smokers will have a decision to make Tuesday: Should they quit their habit or pay more for it?

As part of the Affordable Care Act, smokers will face up to a 50 percent surcharge on health insurance rates.

When the Health Insurance Marketplace opens Tuesday, people will be able to compare insurance plans, and they’ll be asked whether or not they smoke. A yes answer means paying more, which supporters say is only fair, given smokers incur more health costs.

The state Department of Health said health care costs caused by smoking Floridians are about $6.3 billion a year, $1.2 billion of which is paid by Medicaid. Tobacco Free Florida figures show about 17 percent of Floridians are smokers, and 28,600 deaths a year in the state are caused by tobacco use. A 2012 study showed 22 percent of Lee County adults were smokers.

Debbie Bautista, of Cape Coral, was a smoker for 30 years. Along with her husband, she stopped smoking in June and began “vaping,” but now, she is worried they’ll be classified as smokers and have to pay the surcharge.

Former smokers who use electronic cigarettes may be subjected to the surcharge as well, but it will be up to insurers to define who is classified as a smoker, said John Banzhaf. He is the public interest law professor at George Washington University who authored the concept of differential health insurance premiums for smokers and nonsmokers.

The Food and Drug Administration earlier this year said it intends to issue a proposal to include e-cigarettes in its “tobacco definition,” along with regular cigarettes and tobacco products. E-cigarettes contain a varying amount of nicotine, controlled by the user, and have turned into a billion-dollar industry.

Depending on the plan they choose, a surcharge could mean the Bautistas would be paying at least $900 a month for insurance.

The couple is saving nearly $4,000 a year since quitting, Bautista said. If they face a surcharge, those savings will go up in smoke.

Bautista said she hopes if e-cigarette smokers are subjected to the surcharge, there will be sufficient evidence proving a health risk.

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“While I am now technically a nonsmoker, am I going to be discriminated against because I still use the e-cigarettes, despite the fact that they put far fewer chemicals into my lungs?”


Most insurance plans, including Medicaid, cover smoking cessation programs, although in the past, that coverage has not been required in Florida. But the new law will require every plan offer a cessation program and smokers can avoid the surcharge if they enroll.

A report issued by the White House last week shows the average monthly premium in Florida could be about $300, so a smoker may pay $450 a month for insurance under the ACA. Parents of a child 18 or older who smokes and is on their insurance plan also will be responsible for that surcharge.

Banzhaf said Friday part of the reason the surcharge is important is to encourage smokers to quit.

“Even if the surcharge didn't cause smokers to quit, it's fairer to require those whose conduct causes the costs to bear them than to force the great majority of non-smoking employees to subsidize the habit,” Banzhaf said.

Current federal law allows employers and insurers to charge a surcharge up to 20 percent for smokers and their smoking spouses.

Workers who smoke can cost employers more than $12,000 annually, according to a court opinion Banzhaf cited. That loss is attributed to additional costs of health care, disability, absenteeism, and lost time for smoke breaks.

How fair?

Fort Myers resident Christina Gonzalez is concerned about nonsmokers, herself included, paying for medically needy smokers, whose health care is funded by taxpayers.

“I don’t have a problem with being charged more if I had an unhealthy habit, but I am seriously offended that our money is taken and redistributed in the form of Medicaid to people who have zero accountability” in taking steps to be healthy, Gonzalez said.

Medicaid charges more for smokers, Banzhaf said, so those costs will likely increase even more when the ACA is in place, because the ACA is going to force a lot of people into the program.

As for smokers on Medicare, they likely won’t be impacted by the surcharge because most Medicare plans exist outside of the ACA.

Opponents, including the American Lung Association, argue smoking is an addiction that can't be ended through punishment and smokers need insurance because of their health issues. Also, they say, there is no proof higher costs for insurance cause smokers to quit.

The surcharge likely won’t be in full effect the first year. Banzhaf said computer systems in many cases will not be able to provide the correct surcharge for the plans, and smokers may be charged as little as 10 percent the first year, with the 50 percent surcharge added in 2014.

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