In December 2019, the United States adopted a law raising the federal minimum age of sale of all tobacco products to 21, effective immediately. Our estimates indicate that the probability that a smoker had insurance decreases by 3.4 percentage points (P<.01) relative to nonsmokers for a 10 percentage point increase in the size of the tobacco surcharge. 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. However, the Centers for Medicare and Medicaid Services has issued a subsequent rule that defines tobacco use as the use of any tobacco product within the last six months with a frequency of at least four times per week. County populations were pulled from the 2014 and 2018 American Community Survey annual county level estimates and aggregated up to the rating area level. 2018 Mar;37(3):473-481. doi: 10.1377/hlthaff.2017.1062. 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. Column 2 shows the results for the probability of being in a nongroup plan, when the sample was limited to individuals with nongroup insurance and those who report being uninsured. It was then decreased from 21 to 19 in 1963. The challenges and successes of each state's fight against tobacco use, and tobacco prevention efforts. The Office on Smoking and Health conducts and supports national and international surveys on tobacco use, smoking cessation, secondhand smoke exposure, and other tobacco-related topics among youth, adults and specific populations. [PMC free article] [PubMed] [CrossRef] [Google Scholar], 1 2020 Dec; 55(6): 983992. Joint Acknowledgment/Disclosure Statement: This study was funded by a grant from the American Cancer Society (RSGI1723401CPHPS). 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. The nationwide average pre-subsidy premium in 2020 is about $576 per month for health plans sold in the exchange. [4] On December 20, 2019, President Donald Trump (R) signed H.R. Employees at several companies are pushing back on employer wellness programs that require higher health insurance premiums for tobacco users. Standard errors, clustered at the state level are shown in parentheses. Trends over time in enrollment in nongroup health insurance plans by tobacco use in the United States. Before Click here to contact our editorial staff, and click here to report an error. The ACA requires that all health insurance plans provide tobacco cessation and lung cancer screening with no outofpocket costs. The two most recent waves of the CPSTUS in 201415 and 201819 were conducted after the ACA rating rules went into effect. Due to the sampling design of CPS, all households from CPSASEC can theoretically be linked to the CPSTUS in either January or May of 2015 or 2019. Our models test the effect of the surcharge on enrollment and do not provide evidence of higher enrollment among nonusers. Reasons for not enrolling in marketplace coverage. Tobacco use is the leading preventable cause of death in Georgia and is a modifiable risk factor for many chronic diseases, which costs the state more than 11,700 lives per year and nearly $3.2 billion in direct healthcare and indirect costs, such as lost wages. An official website of the United States government. Marketplace Premiums Rise Faster For Tobacco Users Because Of Subsidy Design. Duncan MS, Freiberg MS, Greevy RA, Kundu S, Vasan RS, Tindle HA. We examined the impact of state level tobacco surcharge policy on health insurance enrollment decisions among smokers. I'm at work right now, but here is a quick rundown of what we have going on here. 41% of respondents said this was the main reason they did not enroll, and 54% said it played a factor in their decision. Compliance Overview: Tobacco Surcharges Legal Rules April 30, 2019 By Lesa M. Votovich As employers continue to show more interest in adding wellness programs to their employee benefit plans, they must also be cognizant of any federal and/or state laws that could impact the components of these programs. 11 We know that compliance issues arise no matter the size of the company and no matter how long a law has been in effect. It is currently unclear what amount of incentive is permissible under these ADA rules. However, organizations like the American Cancer Society and the American Lung Association believe that higher health insurance premiums for tobacco users make health coverage less accessible to people using tobacco. The ePub format is best viewed in the iBooks reader. , If the program uses a medical test to detect nicotine or tobacco use, it also must comply with the ADA's rules for voluntary wellness plans. 26 More specifically, our results show that tobacco surcharges have a large negative impact on enrollment in nongroup plans sold on the ACA marketplaces among those without insurance through an employer or public program. Tech: Matt Latourelle Nathan Bingham Ryan Burch Kirsten Corrao Travis Eden Tate Kamish Margaret Kearney Joseph Sanchez. Minors are prohibited from buying alternative nicotine products, including e-cigarettes.6 Establishments are required to post signs stating that sales to minors are prohibited.6 Local tobacco laws While these rules may be frustrating to employers, ignoring them is not worth a lawsuit by the DOL. At incomes over 138% FPL, insurance eligibility is substantively similar across states. New Jersey law states: A PERSON WHO SELLS OR OFFERS A TOBACCO PRODUCT TO A PERSON UNDER 21 YEARS OF AGE SHALL PAY A PENALTY OF UP TO $1,000 AND MAY BE SUBJECT TO A LICENSE SUSPENSION OR REVOCATION. Under a law signed by Gov. **, Founder and President, Center for Health and Wellness Law, LLC. The $25 surcharge (per person, per pay) applies to employees and spouses covered under the Einstein health plan. State fixed effects were included in columns (2) and (4) include state fixed effects; however, they did not substantially affect the results. Tobacco use is the largest cause of preventable illness in the United States. All columns are derived from a single multinomial logit regression, and each column presents the relative risk ratios (RRR), comparing the risk of being in the insurance type of interest and being uninsured. There is an accommodation made for those it is unreasonably difficult to quit due to medical reasons. Keywords: In order to focus on health insurance coverage among individuals most likely to be affected by tobacco surcharges, we made several sample exclusions. The federal law gives insurers the right to add up to 50 percent to the cost of individual health care coverage. All plans offered on the marketplace adhere to the ACA tobacco surcharge restrictions; however, more than half of nongroup plans offered outside of the marketplaces are not ACA compliant. The most common options include (i) HSA, HRA or FSA contributions; (ii) a decrease in employee contributions toward medical coverage (often referred to as a tobacco surcharge); and (iii) cash, gift cards or entries into a prize drawing. This tax applies to cigars, snuff, chewing tobacco, and any other tobacco product except for cigarettes. The table presents relative risk ratios from a differenceindifference specification similar to the one presented in Table2 and including all income levels. Finally, we gathered data on tobacco surcharges from the CMS Health Insurance Exchange Public Use Files for 2015 and 2019. 18. Second, due to Medicaid expansions, eligibility for marketplace subsidies and Medicaid overlaps between 100% and 138% FPL in some states, but not others. In order to aggregate surcharge data to the state level, we first computed the median surcharge in each marketplace rating area by calculating the ratio between the plan premiums offered to tobacco and nontobacco users for a 45years old. [9][10] The tobacco age restriction remained at 19 until federal law raised it to 21 in December 2019. Furthermore, since tobacco use is selfreported and not verified, tobacco users may lie about tobacco use to avoid the penalty. Ballotpedia features 393,617 encyclopedic articles written and curated by our professional staff of editors, writers, and researchers. Smokers could find themselves burned by the Affordable Care Act. Tobacco products are mostly used by lower-income Americans than higher-income Americans. 1 2023 All rights reserved to InsureMeNow | Terms & Conditions | Privacy Policy. 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