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Tobacco use a pre-existing medical condition

| April 10, 2013

D.C. is moving ahead in creating its health exchange—the marketplace for individual and small group insurance plans required under the provisions of President Obama’s health care reform—and the board responsible for it yesterday voted to bar insurers from charging smokers and other tobacco users higher premiums.

Under the Affordable Care Act, insurers are allowed to charge up to 50 percent more in premiums for people who smoke. The decision stems from the reality that smokers face higher health risks, and many insurers across the country can already charge more for those who light up often—currently 46 states and D.C. allow insurers to charge higher premiums for smokers. Many private employers also charge a penalty, according to a story on the dcist website.

But various health policy experts—including organizations that have otherwise sided with the use of government power to stamp out smoking—have warned that the higher premiums could negate the broader goal of the law, which is to provide universal health insurance. Additionally, they say, the higher premiums would fall heavily on low-income residents.

“Tobacco use is a pre-existing medical condition and a central tenet of our health reform efforts is to open the health insurance market to millions of people who have been shut out due to their health,” said Dr. Mohammad Akhter, the chair of the Health Exchange Board and former director of the D.C. Department of Health. “Charging smokers significantly more for health insurance is in direct conflict with our efforts to help people quit smoking.”

According to the exchange board, one in five D.C. residents uses tobacco, and 30 percent of African American residents—who tend to post lower incomes than white residents—are smokers. Additionally, smoking rates are higher among those with lower educations: according to the CDC, close to half of all smokers in D.C. have less than a high school degree.

At its meeting on March 27, the board’s Standing Advisory Committee recommended doing away with the penalty. It’s decision was motivated in part by advocacy by the American Cancer Society, which said in a handout: “Charging smokers more for health insurance is an unproven way to address tobacco use when we have decades of success in several thoroughly tested, evidenced based ways to improve public health through raising the price of tobacco products, creating smoke-free venues and implementing tobacco use prevention and cessation programs.” Two of three insurance companies present at the meeting said they would have imposed the penalty.

Still, the move might fly in the face of what many non-smokers believe is wise. According to an October 2011 poll by Thomson Reuters, 58.5 percent of respondents say that smokers should have to pay more for health insurance. The percentage was obviously higher among non-smokers, but even 32 percent of smokers agreed that they should pay some sort of penalty for their habit.

California and Connecticut have similarly moved to eliminate the penalty for smokers in health exchanges, while Colorado and Alaska have kept it.