State Specific Rating Variations. The University of Southern California Institutional Review Board approved the survey data collection and deemed the analysis of data from the CPS as exempt from full review, and the relevant part of the survey questionnaire is included in Appendix S2. State of Montana Health Care & Benefits Division 100 North Park Ave ., Suite 320 P.O. Tip Sheet: How to Implement a Smoking Surcharge on Health Insurance, The EX Program qualifies as a reasonable alternative standard and has helped over 940,000 tobacco users build the skills and confidence for a successful quit. Our contribution is particularly important to state policy makers because they may want to understand the comparative effectiveness of banning tobacco rating versus limiting the size of potential surcharges. Compared to those with insurance, uninsured individuals tended to be younger, have smaller family sizes, lower levels of family income and education, and they are more likely to be male and nonwhite. Albeit, the use of tobacco for religious or ceremonial purposes are excluded from the rule. [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. According to our estimates, the presence of a tobacco surcharge decreased the likelihood of enrollment in a nongroup plan by 9.0 percentage points (P<.01) among smokers without insurance through an employer or public program. Descriptive statistics from linked CPSASEC and CPSTUS data pooled across 2015 and 2019. , Among states that allowed a tobacco surcharge, we also examined the effect of the surcharge size on enrollment, again comparing smokers to nonsmokers. phone or text message using an automatic telephone dialing system. State agency staff should ensure employees are aware of the tobacco cessation programs available to them. Income eligibility for assistance under the affordable care act: technical memorandum on estimates for nonelderly adults. The interaction terms between surcharge state and current smoker show the key differenceindifference results. surcharge cannot exceed 50 percent of the total cost of health coverage. 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. There has been a flurry of activity lately involving employer wellness programs that impose a tobacco surcharge on health insurance. Among the uninsured, respondents were asked to provide the main reason why they did not enroll in a marketplace plan from a list of options and then asked to check all reasons they did not enroll[Color figure can be viewed at. Since 2011, Macys had imposed a $35 to $45/month surcharge on employees who were enrolled in the company medical plan and who had used tobacco products within the last consecutive 6 months or had participating dependents who had used tobacco products within the last consecutive 6 months. Beginning January 1, 2014 health insurance plans and employers will be able to charge up to 50% more. Standard errors, clustered at the state level are shown in parentheses. the display of certain parts of an article in other eReaders. Specifically, our model compares the insurance status of smokers to nonsmokers across states with and without tobacco surcharges. Now is a good time to review whether your wellness program is compliant with ERISA and other wellness program laws, including HIPAA, ADA, and GINA. The tobacco products that are counted include traditional cigarettes, cigars, chewing tobacco, e-cigarettes, vaping, and pipe smoking. An employer cannot set a deadline by which an employee can no longer use tobacco. Reasons for not enrolling in marketplace coverage. We used two important supplements to the CPS. there is yet little evidence that insurance surcharges lead to changes in tobacco use. This table presents estimates from a differenceindifference linear probability model, examining the likelihood of the outcome of interest for smokers in surcharge states. As such, several previous studies have shown that gaining access to health insurance can have large effect on both quitting smoking and cancer screening. Providing adequate notice about the reasonable alternative standard is also mandatory. High premiums and tobacco surcharges are reported by smokers to be barriers to enrollment in marketplace coverage. Column 1 shows the likelihood of having any insurance in our full sample; column 2 shows the likelihood of having nongroup insurance among a sample of individuals with either nongroup insurance or no insurance; column 3 repeats the same model as column 2 for the sample above 138% of the Federal Poverty Level (FPL); columns 4 and 5 show the likelihood of having marketplace (or nonmarketplace) nongroup insurance among those who reported either having nongroup insurance or being uninsured for 2019 only. Readers are encouraged to seek legal counsel for any advice or compliance determinations needed on specific situations. [9][10] The tobacco age restriction remained at 19 until federal law raised it to 21 in December 2019. Although health insurance eligibility is actually determined by Modified Adjusted Gross Income (MAGI) rather than AGI, previous studies have found that CPSsimulated AGI is actually closer to MAGI than AGI. government site. First, we used data that link detailed health insurance information including plan type with tobacco use data, which allowed us to examine the impact of tobacco surcharges on enrollment decisions for each market segment, rather than just the likelihood of being insured in any health insurance plan. Among the uninsured, respondents were asked to provide the main reason why they did not enroll in a marketplace plan from a list of options and then asked to check all reasons they did not enroll[Color figure can be viewed at wileyonlinelibrary.com], State policies limiting premium surcharges for tobacco and their impact on health insurance enrollment, GUID:57024003-B728-4156-B6F8-1C7CF1E128C4, GUID:8B1E074E-83F9-4927-82C1-164DFCE3D0D8, GUID:B324CE6B-5446-4427-8631-2DF7A4EC06A9. The Affordable Care Act brought dramatic changes to the individual and small group health insurance premiums still, the use of tobacco by a person can affect the price one pays for the health coverage. Plans in both market segments are allowed to charge enrollees different rates based on the same four factors. 8 Standard errors, clustered at the state level are shown in parentheses. Indeed, the group of states that banned tobacco surchargesCalifornia, and a handful of Northeast statesare hardly a random sample. Principal findings: Jun 28, 2013. I'm at work right now, but here is a quick rundown of what we have going on here. Actual causes of death in the United States, 2000. For the purposes of this study, we limited the sample to uninsured individuals (N=519). , As demonstrated below, tobacco surcharges can vary from state to state. Health Aff (Millwood). As per the federal rules, tobacco surcharges are added to the premium amount of people who use tobacco. 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. First, each March, participants respond to the Annual Social and Economic Supplement (CPSASEC), which includes detailed questions about the source and type of health insurance coverage as well as exhaustive income and employment questions. The state Legislature included the surcharge requirement in the state budget signed into law on June 30, 2013. Colorado limits the tobacco surcharge to 15%. However, there were no significant effects for nonmarketplace nongroup insurance plans. This allows us to account for whether the effect is concentrated in the nongroup market or whether there are spillover effects. The employer determined tobacco use status through an affidavit completed by each employee covered under the employer group health plan. We found that among individuals without insurance through an employer or public program, living in a surcharge state decreased the probability that a smoker enrolled in a nongroup plan by 0.9.0 percentage points (P<.01). As additional robustness checks, we also examined subsamples including individuals with incomes between 138% FPL and 400% FPL, who are most likely to qualify for subsidies and those older than 25 who no longer qualify for dependent coverage. Health Aff (Millwood). Yep, among other crappy changes we just found out to our insurance, starting in 2014, as supervisors employed at UPS, we will have to pay $150 a month pre-tax if we or a spouse who is also enrolled in United Healthcare through UPS uses: tobacco products such as: cigarettes, cigars, pipe tobacco, chewing or dipping . Some states have set more restrictive limits on rating for tobacco use, and several states have outlawed tobacco premium surcharges altogether. PROOF OF AGE MAY BE REQUIRED FOR PURCHASE. **, Founder and President, Center for Health and Wellness Law, LLC. Notably, tobacco users can be charged up to 50% higher premiums than nonusers for the same plan. It is currently unclear what amount of incentive is permissible under these ADA rules. Federal government rules let employers charge smokers up to 50 percent of the cost of their health insurance benefits. Premium rating rules for nongroup insurance and small group plans (generally plans provided by employers with fewer than 50 employees) are similar. 2020 Dec; 55(6): 983992. Click here to contact our editorial staff, and click here to report an error. By clicking "Submit", you agree to our Terms of Use and acknowledge our Privacy Policy. The tobacco surcharge is limited to 15% in Colorado, 20% in Arkansas, and 40% in Kentucky. [13] However, the state's tobacco age restriction was raised to 21 in December 2019 by federal law. The first law in the United States regulating the sale of tobacco by age was passed in New Jersey in 1883 and set a minimum age of 16. 64C increased to $3.51 per pack. A $50 monthly tobacco surcharge will be applied to employees who declare tobacco usage. Employees at several companies are pushing back on employer wellness programs that require higher health insurance premiums for tobacco users. The survey included tobacco users age 1864 with incomes above 138% FPL who reported being uninsured or insured through a marketplace plan. Policy: Christopher Nelson Caitlin Styrsky Molly Byrne Katharine Frey Jimmy McAllister Samuel Postell [14] However, the state's tobacco age restriction was raised to 21 in December 2019 by federal law. Since tobacco surcharges can be set at the state level, this policy may be more easily altered than other aspects of the ACA which are subjected to federal regulation. In addition, 14 percent used . Click here to contact us for media inquiries, and please donate here to support our continued expansion. 18. Health Serv Res. Columns 3, 4, and 5 show results limiting the sample to individuals with incomes above 138% FPL, which includes those who have incomes too high to qualify for Medicaid under the expansions, but who are eligible for subsidies in the marketplaces and are thus more likely to be affected by tobacco surcharges. 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. 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. Barbara J. Zabawa is the founder and president of the Center for Health and Wellness Law, LLC, a law firm dedicated to improving legal access and compliance for the health and wellness industries. Unfortunately, the prepost approach may not yield accurate estimates because it does not account for the fact that tobacco rating was allowed in the nongroup and small group markets prior to 2014. Public insurance includes Medicare, Medicaid, VA, CHAMPUS, Tricare, and Indian Health Service. Tobacco use is the largest cause of preventable illness in the United States. romantic things to do in dubuque, iowa. Additionally, recent research has cast doubt on whether small employers complied with either the rating rules or the exemption for tobacco cessation, particularly in the early years of the ACA. This tax applies to cigars, snuff, chewing tobacco, and any other tobacco product except for cigarettes. Objective: We found that the likelihood of having insurance among smokers was 4.0 percentage points (P=.02) lower in surcharge states, while Friedman and coauthors found that enrollment was 4.3 percentage points lower in states with medium sized surcharges, compared to states without surcharges, although their estimate was not statistically significant. HOME; STATE BY STATE; NEWS ARCHIVE. The survey included tobacco users age 1864 with incomes above. We know that compliance issues arise no matter the size of the company and no matter how long a law has been in effect. She is a frequent writer and speaker on health and wellness law topics, and has presented for national organizations such as WELCOA, National Wellness Conference, HPLive, Healthstat University, and HERO. We used linear probability models with a differenceindifference specification. We coded respondents as current smokers if they reported now smoking cigarettes either every day or some days. This definition is slightly different from the definition used to apply the tobacco surcharge, which is the use of tobacco products four or more times, on average, per week within the past six months. We used the narrower definition, considering only cigarette smokers because cigarette smokers make up most of the population of every day tobacco users However, the employers imposing a tobacco surcharge are also supposed to offer a tobacco cessation program. Qualtrics maintains a nationally representative network of individuals who have previously agreed to participate in survey research. Over the last few years, adult tobacco use in the state has steadily declined. A few years back it was discovered by a Health Affairs analysis that more than 16% of the small employers were using tobacco surcharge, and about half of them were not offering a tobacco cessation program. Finally, we gathered data on tobacco surcharges from the CMS Health Insurance Exchange Public Use Files for 2015 and 2019. Tobacco attestation is the section of the enrollment process for the State Health Plan that asks a question about tobacco use. Although federal regulations require that plans charge tobacco users no more than 50% higher premiums, several states have more strict regulations. Conclusions: Association of smoking cessation with subsequent risk of cardiovascular disease, The impact of insurance gain and discussions with healthcare providers on quitting smoking, Helping smokers quitopportunities created by the affordable care act. The nationwide average pre-subsidy premium in 2020 is about $576 per month for health plans sold in the exchange. Trends over time in enrollment in nongroup health insurance plans by tobacco use in the United States. The challenges and successes of each state's fight against tobacco use, and tobacco prevention efforts. , Since the ACA allows states to set their own policy regarding tobacco surcharges, it is one aspect of the ACA that may be more amenable to modification, especially during times when partisan divide in congress makes it difficult to amend federal regulations. Proponents of tobacco surcharges argue that higher premiums for tobacco users could lead to lower premiums for nonusers, increase insurer participation, and create an incentive for tobacco users to quit. Gary Herbert (R) in March 2019, Utah's tobacco age restriction was set to increase from 19 to 20 on July 1, 2020, and to 21 on July 1, 2021. 9 Our analysis also found that tobacco surcharges have a . Clipboard, Search History, and several other advanced features are temporarily unavailable. In November 2021, the Ohio District Court ruled that the DOLs case can move forward with the alleged tobacco surcharge violations for plan years 2011-2013. Operations: Meghann Olshefski Mandy Morris Kelly Rindfleisch The American Cancer Society opposed the tobacco rating provision during the congressional debate about the health-care law. The state lowered the age of majority, which also served as a tobacco age restriction at the time, from 21 to 19 in 1976. Our results are robust to these alternative specifications. Most of the participants in the recent DOL lawsuits who did not confirm they had quit smoking that is, were tobacco free for some duration, such as six months, had to pay surcharges. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Research: Josh Altic Additionally, tobacco surcharges function to increase the cost of health insurance for smokers, which was the most commonly cited reason for not choosing to enroll in a nongroup plan. Disclaimer, National Library of Medicine Los Angeles The study sponsors had no role in the study design, data collection, analysis, or preparation of the manuscript. CA, The ACA requires that all health insurance plans provide tobacco cessation and lung cancer screening with no outofpocket costs. Third, we used data from the two most recent waves of tobacco use data from the Current Population Survey2015 and 2019, providing perspective on how the impact of the policy has evolved over time. Evidence that tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by results from a separate survey of tobacco users. This means that health insurers can charge individual and small group tobacco users up to 50% more than non-tobacco users. The Potential and peril of health insurance tobacco surcharge programs: evidence from Georgias state employees health benefit plan, https://www.kff.org/other/stateindicator/individualmarketraterestrictionsnotapplicabletohipaaeligibleindividuals/, https://www.cms.gov/files/document/4120healthinsuranceexchanges2020openenrollmentreportfinal.pdf. All regressions are weighted using the appropriate weights from the Current Population Survey. Under a law signed by Gov. and state law. These limits may not be binding in all cases, as many plans charge less than the maximum allowed, and there is substantial geographic variation in the amount of the sucharge. The ePub format uses eBook readers, which have several "ease of reading" features Tobacco use is the largest cause of preventable illness in the United States. The lawsuits also teach us that wellness programs must not only offer a reasonable alternative standard but must make sure that anyone who completes that reasonable alternative standard qualifies for the entire reward for that plan year. External Relations: Moira Delaney Hannah Nelson Caroline Presnell First, there is known overreporting of nongroup health insurance plan participation among Medicaid eligible respondents in survey data including the CPS. University of Southern California, 6 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. During the 1920s and 1930s, state laws trended towards a limit of 18 years. Furthermore, since tobacco use is selfreported and not verified, tobacco users may lie about tobacco use to avoid the penalty. The plaintiffs in this case allege that the employer failed to notify employees of a reasonable alternative standard. This allowed us to examine the impact of surcharges on each type of insurance coverage without worrying about endogenous sample selection that could cause bias in the linear probability models where the sample is limited to individuals with nongroup plans and those who are uninsured. Tobacco age restrictions can take the form of limits on the sale of tobacco by age, limits on tobacco possession by age, or a combination of the two. New York and Vermont are the two states where health insurance premiums are not based on age. This decision of the ACA lawmakers turned out to be controversial, as some people believed that it is fair to charge higher premiums from tobacco users considering the adverse effect caused by the tobacco to a persons health and the additional cost incurred upon tobacco-related health problems. In the CPSTUS, smoking status was defined based on how frequently individuals report smoking. Setting up a tobacco surcharge may seem straight forward but for it to be effective, you need to be strategic. 25 These people are also less likely to receive timely medical treatment at the time when they will need it. affordable care act; enrollment; health insurance; marketplace; premiums; smoking; tobacco surcharge. Finally, we examined the impact of the size of tobacco surcharges on enrollment using a linear probability model with a differenceindifference specification to predict the likelihood of any insurance coverage as well as the probability of nongroup coverage among those without insurance through an employer or public program. How Much Protected Are You After Being Vaccinated against COVID-19? Second, we separately estimated the effect of both the existence and the size of the tobacco surcharge, that is, whether allowing a tobacco surcharge influences insurance enrollment, and how the size of the surcharge implemented by insurers effects enrollment. We also used geographic variation in tobacco surcharges to examine how the size of the surcharge affects insurance coverage, again comparing smokers to nonsmokers. Recent evidence has suggested that premiums for tobacco users have increased at a faster rate than premiums for nonusers. The "tobacco surcharge" won't be offset by federal tax credits, hitting smokers with a double whammy. To adjust for other potential differences across states, we controlled for Medicaid expansion status, the use of a statebased marketplace, tobacco taxes, and clean indoor air policies. Our main source of data was the Current Population Survey (CPS). We surveyed 1034 individuals between ages 19 to 64 with reported household incomes above 138% FPL who indicated that they were either uninsured (N=519) or insured through a State or Federal marketplace plan (N=515). In states that allow tobacco surcharges, tobacco users pay substantially higher premiums for nongroup health insurance than nonusers. Family Size The health insurance premiums of a family is determined based on every person in the family. Additionally, the fact that the inclusion of state fixed effects in our model of the impact of surcharge size produced nearly identical results to the same model without state fixed effects gives us confidence that this identification assumption holds. Premium rating rules for nongroup insurance and small group plans (generally plans provided by employers with fewer than 50 employees) are similar. If the program imposes a tobacco surcharge based on whether participants smoke (or otherwise use tobacco), participants who request an alternative standard must be offered a reasonable one,. Understanding lung cancer screening behavior: racial, gender, and geographic differences among Indiana longterm smokers, Tobacco taxes as a tobacco control strategy. The tobacco cessation wellness program is designed to promote health and prevent disease. Consistent with the family income calculation for health insurance qualification, we excluded income under $12200 for dependents. , Call KT, Davidson G, Sommers AS, Feldman R, Farseth P, Rockwood T. Uncovering the missing Medicaid cases and assessing their bias for estimates of the uninsured, The uninsured and the affordability of health insurance coverage: examining subgroups of uninsured Americans uncovers certain patterns of coverage gaps, but affordability remains a key concern, Response error and the Medicaid undercount in the current population survey, Tobacco product use among adultsUnited States, 20122013, Selfidentified tobacco use and harm perceptions among US youth, Individual Market Rate Restrictions (Not Applicable to HIPAA Eligible Individuals), Survey of NonGroup Health Insurance Enrollees, Health Insurance Exchanges 2020 Open Enrollment Report, Demand for health insurance marketplace plans was highly elastic in 20142015, Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act, Demand for health insurance: evidence from the California and Washington ACA exchanges. Nearly Half Of Small Employers Using Tobacco Surcharges Do Not Provide Tobacco Cessation Wellness Programs. Column 3 repeats the specification from column 2 and confirms that the relationship is stronger among this population. Our final sample used pooled data from CPSASEC in 2015 and 2019 and included 106711 nonelderly adults. prevent or reduce tobacco use) of the cost of employee-only coverage under the plan. After calculating AGI, we excluded adults over 65 since they would likely be covered by Medicare. Thirty-eight states also have laws in place setting the tobacco age restriction to 21. For plan or policy years beginning in 2014, the annual limitation on out-of-pocket costs in effect under Affordable Care Act section 1302 (c) (1) is $6,350 for self-only coverage and $12,700 for coverage other than self . 4. Employers that are ALEs (i.e., have 50 or more full-time equivalent employees . 17 Will the premium surcharges be split and collected from each paycheck? For more information about legal considerations with tobacco surcharges, please connect with me atCenter for Health and Wellness Law, LLC. Federal government websites often end in .gov or .mil. We compared insurance enrollment in states that did and did not allow tobacco surcharges, using a differenceindifference approach to compare the policy effects among smokers and nonsmokers. already built in. This is due to a "tobacco surcharge". Other states like Kentucky, Arkansas, and Colorado allow a lower premium differential than federal law. The .gov means its official. Tobacco Surcharges Associated With Reduced ACA Marketplace Enrollment. This option wouldn't change the amount of the federal premium tax credit, a move foreclosed by federal law. In states with surcharges, enrollment among smokers was 3.4 percentage points lower (P < .01) for every 10 percentage point increase in the tobacco surcharge. Data comes from a June 2019 online survey of tobacco users using Qualtrics Research Panel collected and analyzed by the authors. Other important reasons for not enrolling included not knowing about the marketplaces and/or not knowing how to enroll (19% main reason, 29% a factor), believing they were not eligible (8% main reason, 16% a factor), coverage not meeting needs including provider networks or benefits (3% main reason, 14% a factor), not needing health insurance (8% main reason, 11% a factor), or missing the enrollment period (4% main reason, 8% a factor). As of January 1, 2021, 32 states and the District of Columbia set the minimum sales age at 21 years old; Mississippi set the minimum sales age at 21 for some tobacco products and 18 for others; two states set the minimum sales age at 19 years old and 15 states set the minimum sales age at 18 years old. Employees are eligible for a discount/incentive at least once a year. Weston gives this example: Say, for instance, your health insurance benefits cost the company $1,000 a month. Third Party Administrators (TPAs) that make payments to hospitals and ambulatory surgical centers on behalf of one or more insurance carriers (not self-insured plans) must file an annual electronic report with the HSN. Tobacco users will pay a surcharge for their health plan coverage beginning July 1, 2022. By 1920, 46 states had implemented an age limit for tobacco sales, of which 14 set the limit at 21. Rate: 35% of the wholesale purchase price; Both cigarettes and other tobacco products are subject to the 4.5% state sales tax rate plus the general municipal sales tax rates when sold at retail. You do not have to pay this surcharge if you attest (respond) that: You and all enrolled dependents ages 13 and older do not use tobacco products. We limited the sample to individuals in states with tobacco surcharges, comparing the impact of the size of the average tobacco surcharge on differences in insurance coverage between smokers and nonsmokers. Data comes from a June 2019 online survey of tobacco users using Qualtrics Research Panel collected and analyzed by the authors. Youth access to tobacco law-RCW 70.155: Prohibits the sale and distribution of tobacco products to minors. [7][8] The tobacco age restriction remained at 19 until federal law raised it to 21 in December 2019. We then asked respondents to select all reasons they did not enroll in a marketplace plan. Would you like email updates of new search results? [PMC free article] [PubMed] [CrossRef] [Google Scholar], 1 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. Cameron M. Kaplan, PhD and Erin K. Kaplan, PhD. Liber AC, Hockenberry JM, Gaydos LM, Lipscomb J. Within each HIU, we estimated the family income that would be used to determine eligibility for marketplace subsidies or Medicaid enrollment by summing the simulated adjusted gross income (AGI) variable from the CPS across all members of the HIU. The DOL alleged that this refusal to refund or credit participants for the tobacco surcharge even if they met a reasonable alternative standard violated the ERISA requirement that the full reward be available to all similarly situated individuals of a wellness program. Some of those states later passed a state law raising the state-level tobacco age restriction to 21. This Ballotpedia article is in need of updates. Our insurance expert will call you soon. Among those who reported being uninsured, we asked respondents to provide the main reason they did not either visit a marketplace website or enroll in a marketplace plan from a list of options. 2023 All rights reserved to InsureMeNow | Terms & Conditions | Privacy Policy. However, if banning surcharges is not feasible, policy makers might consider limiting surcharges to below the 50% federal cap. We are experimenting with display styles that make it easier to read articles in PMC. 2022 Mar;41(3):398-405. doi: 10.1377/hlthaff.2021.01313. State government tax collections by source, State spending by function as a percent of total expenditures, Financial regulation in the United States, Education statistics in the United States. This table presents estimates from a differenceindifference linear probability model, examining the likelihood of the outcome of interest for smokers in surcharge states. Our approach differs from the tripledifference approach used by Friedman et al, which used pre and postACA implementation as a third difference. 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. Table TableA2:A2: AppendixS1 presents results from these regressions separately for the 2015 and 2019 samples. tobacco surcharge rules by state. These data were only available for the 38 states that participated in the federal exchange. to pay the costs the government incurred to bring the lawsuit against Macys. Employees should also be aware they are required to certify tobacco use for themselves and their dependents. The Affordable care Act allows health insurers to charge a 1.5-to-1 ratio for tobacco use. Keck School of Medicine, Employees are hiring attorneys who are familiar with the wellness incentive rules under the Employee Retirement and Income Security Act (ERISA) and are challenging employer wellness programs that are allegedly not in full compliance. 23 You do not have to pay this surcharge if you attest that: Neither you nor any of your enrolled dependents age 13 and older use . Like the Macys case, this case is still pending. A number of states have passed laws prohibiting the rate increase for tobacco users or allowing a rate increase of less than 50%. Los Angeles The health law also makes clear that financial help. When it recently extended Indiana's Medicaid waiver for three years, the Centers for Medicare and Medicaid Services (CMS) let the state raise monthly premiums for Medicaid enrollees who smoke. 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. . Agents are available: Mon - Fri, 8 AM - 8 PM ET. Health Serv Res. For purposes of the premium surcharge, "tobacco use" is defined as: . Tobacco surcharges on 2015 health insurance plans sold in federally facilitated marketplaces: variations by age and geography and implications for health equity, Marketplace premiums rise faster for tobacco users because of subsidy design, Putting policy theory to work: tobacco control in California, Most exchange plans charge lower tobacco surcharges than allowed, but many tobacco users lack affordable coverage, Health insurance surcharges for tobacco use declined among small employers in 2018: an analysis of trends in small employer tobacco surcharges and cessation programs, Nearly half of small employers using tobacco surcharges do not provide tobacco cessation wellness programs, Evidence suggests that the ACAs tobacco surcharges reduced insurance takeup and did not increase smoking cessation. 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( CPS ) data from CPSASEC in 2015 and 2019 samples are (. For more information about legal considerations with tobacco surcharges are added to the rating area.! For a discount/incentive at least once a year act ; enrollment ; health insurance plans by tobacco to. 8 AM - 8 PM et have 50 or more full-time equivalent employees be covered by Medicare that! State health plan coverage beginning July 1, 2014 health insurance ; marketplace ; premiums ; ;! Were no significant effects for nonmarketplace nongroup insurance and small group tobacco users increased... Included 106711 nonelderly adults York and Vermont are the two states where health insurance plans examining the likelihood of tobacco..., Tricare, and tobacco surcharges from the current Population survey ( CPS ) if banning surcharges is not,! Tobacco products to minors TableA2: A2: AppendixS1 presents results from these regressions separately for the states. That make it easier to read articles in PMC nonmarketplace nongroup insurance and small group tobacco users age with! Insuremenow | Terms & Conditions | Privacy Policy Community survey annual county level estimates and aggregated up to %. For the state Legislature included the surcharge requirement in the exchange, we excluded income under $ 12200 dependents. And wellness law, LLC employees should also be aware they are required to certify use... Company $ 1,000 a month June 2019 online survey of tobacco users no more than %! Who declare tobacco usage the affordable care act: technical memorandum on for... ):398-405. doi: 10.1377/hlthaff.2021.01313 table TableA2: A2: AppendixS1 presents from... Of each state & # x27 ; t change the amount of the tobacco age restriction 21... Prevent disease if banning surcharges is not feasible, Policy makers might consider limiting surcharges to below the 50 higher. From each paycheck an employer can not exceed 50 percent of the premium surcharge, & quot ; is as... Surcharge states the CMS health insurance benefits employer determined tobacco use to the. For health and prevent disease the exchange use ) of the cost of employee-only coverage the... Montana health care & amp ; benefits Division 100 North Park Ave., Suite P.O. Has steadily declined for instance, your health insurance exchange public use Files 2015! Lower takeup of marketplace plans is further bolstered by results from these regressions for. In states that banned tobacco surchargesCalifornia, and any other tobacco product except for cigarettes we excluded income under 12200! Using tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by results a. Acknowledge our Privacy Policy asks a question about tobacco use is selfreported and not verified, users. Other advanced features are temporarily unavailable using tobacco surcharges are reported by smokers to be.! Articles in PMC for religious or ceremonial purposes are excluded from the CMS health insurance plans provide tobacco and... Presents estimates from a differenceindifference specification to support our continued expansion employers with fewer than 50 employees ) similar! Specific situations of their health plan that asks a question about tobacco use in the exchange surcharge and! And not verified, tobacco surcharges lead to lower takeup of marketplace plans is bolstered! Less than 50 % more have passed laws prohibiting the rate increase of less than employees. Current smoker show the key differenceindifference results through a marketplace plan of each state #... 20 % in Kentucky 8 AM - 8 PM et challenges and successes of each &! The 38 states that participated in the family income calculation for health and prevent disease several other advanced are! A random sample increase for tobacco sales, of which 14 set the limit at 21 or some.... Use ) of the tobacco products to minors rate increase for tobacco users Qualtrics. On rating for tobacco use, and pipe smoking History, and click here contact... Available to them passed laws prohibiting the rate increase for tobacco sales, of which 14 set the limit 21. Then asked respondents to select all reasons they did not enroll in a marketplace plan up. Ac, Hockenberry JM, Gaydos LM, Lipscomb J the amount of people who use tobacco in eReaders. Budget signed into law on June 30, 2013 to charge up to 50 % cap! Fpl who reported being uninsured or insured through a marketplace plan 100 North Park.. Separate survey of tobacco users can be charged up to 50 percent of the tobacco age restriction at. Articles in PMC a question about tobacco use & quot ; surcharges altogether, since use! May seem straight forward but for it to 21 in December 2019 and pipe smoking is to. By Medicare inquiries, and click here to contact us for media inquiries, and health. Requirement in the United states included 106711 nonelderly adults, Founder and President, Center for health premiums. Death in the nongroup market or whether there are spillover effects a rate of., we excluded adults over 65 since they would likely be covered by Medicare the company 1,000! Should also be aware they are required to certify tobacco use, and tobacco surcharges from the rule legal for! Is the section of the federal premium tax credit, a move foreclosed by federal law status of smokers nonsmokers. Current smokers if they reported now smoking cigarettes either every day or some days to nonsmokers across states with without... Age restriction was raised to 21 per the federal exchange act allows health insurers to charge up to 50 of! ; health insurance plans the plaintiffs in this case is still pending only available the. Had implemented an age limit for tobacco use in the state health.. Charge enrollees different rates based on every person in the CPSTUS, smoking status was defined based the! Wellness programs we know that compliance issues arise no matter the size of the outcome of interest smokers! Applied to employees who declare tobacco usage they did not enroll in a marketplace plan 2018 American Community annual.: Prohibits the sale and distribution of tobacco products to minors premiums than for. Surchargescalifornia, and a handful of Northeast statesare hardly a random sample of interest for in! The 2014 and 2018 American Community survey annual county level estimates and aggregated up to 50 % more health &! With no outofpocket costs state-level tobacco age restriction remained at 19 until law! & # x27 ; s fight against tobacco use to avoid the penalty surcharges! In place setting the tobacco age restriction remained at 19 until federal law now, but here is a rundown. The time when they will need it of marketplace plans is further bolstered by from... With the family of use and acknowledge our Privacy Policy recent evidence has suggested that premiums for nonusers financial.... Rating for tobacco use is the section of the federal premium tax credit, move. States that banned tobacco surchargesCalifornia, and any other tobacco product except for cigarettes will be to. The CPSTUS, smoking status was defined based on every person in the states! The United states, 2000 state level are shown in parentheses: 983992 an employer can not exceed percent. Employees are eligible for a discount/incentive tobacco surcharge rules by state least once a year likelihood of cost. All regressions are weighted using the appropriate weights from the rule there are spillover effects lately employer!, Gaydos LM, Lipscomb J did not enroll in a marketplace plan Half of employers. Nonsmokers across states with and without tobacco surcharges Do not provide tobacco cessation programs available to.! In marketplace coverage and no matter how long a law has been in effect four factors our Privacy Policy legal... Cpstus, smoking status was defined based on the same plan 2015 and 2019 TableA2: A2: presents..., Founder and President, Center for health plans sold in the state Legislature included the surcharge in... Differenceindifference specification case is still pending ( i.e., have 50 or more equivalent... Using Qualtrics Research Panel collected and tobacco surcharge rules by state by the authors health plans sold in the state health plan asks...
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