Ann Marie Marciarille:
PrawfsBlawg: Up In Smoke: [T]he ACA's much vaunted promise to end both pre-existing condition exclusions and individual underwriting of insurance risk…. There are some exceptions… use of tobacco products…. The ACA permits premiums to vary based on tobacco use by a factor of 1.5. And the premium supports available to low income individuals are not available for the tobacco use premium band bump.
What does this really mean for older low income tobacco users?… [I]nsurers could apply a different -- and considerably lower -- surcharge for tobacco use on younger smokers than on older smokers… could knock a substantial number of older smokers into a very familiar kind of uninsurability known as unaffordability… an un-subsidized tobacco premium surcharge of perhaps $4,000 a year…. (Of course, were you an older low income citizen intent on evading the individual mandate you could take up smoking and game yourself into the exceeds 8% of houshold income exemption for the individual mandate.)
All of this makes some actuarial sense…. All of this may not make the most public health sense, however. If higher unsubsidized premiums are designed to discourage tobacco use, there is little doubt that shorter term tobacco users have a higher success rate at quitting. Older smokers -- say a 57 year old male -- tend to be those with a pretty hard core addiction to nicotine, an addiction intensity not evenly distributed among the smoking population.