Evidence Suggests That The ACAs Tobacco Surcharges Reduced Insurance Take-Up And Did Not Increase Smoking Cessation.

To account for tobacco users' excess health care costs and encourage cessation, the Affordable Care Act (ACA) allowed insurers to impose a surcharge on tobacco users' premiums for plans offered on the health insurance exchanges, or Marketplaces. Low-income tax credits for Marketplace coverage were b...

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Publicado en:Health Affairs Vol. 35; no. 7; pp. 1176 - 1184
Autores principales: Friedman, Abigail S., Schpero, William L., Busch, Susan H.
Formato: research tables/charts Journal Article
Publicado: Health Affairs Publishing, LLC Jul2016
Acceso en línea:Ver este registro en EBSCOhost
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        atl: Evidence Suggests That The ACAs Tobacco Surcharges Reduced Insurance Take-Up And Did Not Increase Smoking Cessation.
      aug:
        au:
          Friedman, Abigail S.
          Schpero, William L.
          Busch, Susan H.
        affil: Assistant professor, Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
      sug:
        subj:
          Smoking Cessation Evaluation
          Insurance, Health
          Insurance Coverage Statistics and Numerical Data
          Health Care Costs
          Taxes
          Patient Protection and Affordable Care Act
          Human
          Health Insurance Exchanges
          Male
          Female
          Adult
          Middle Age
          Data Analysis, Statistical
          Confidence Intervals
          Funding Source
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Male
          Female
      ab: To account for tobacco users' excess health care costs and encourage cessation, the Affordable Care Act (ACA) allowed insurers to impose a surcharge on tobacco users' premiums for plans offered on the health insurance exchanges, or Marketplaces. Low-income tax credits for Marketplace coverage were based on premiums for non-tobacco users, which means that these credits did not offset any surcharge costs. Thus, this policy greatly increased out-of-pocket premiums for many tobacco users. Using data for 2011-14 from the Behavioral Risk Factor Surveillance System, we examined the effect of tobacco surcharges on insurance status and smoking cessation in the first year of the exchanges' implementation, among adults most likely to purchase insurance from them. Relative to smokers who faced no surcharges, smokers facing medium or high surcharges had significantly reduced coverage (reductions of 4.3 percentage points and 11.6 percentage points, respectively), but no significant differences in smoking cessation. In contrast, those facing low surcharges showed significantly less smoking cessation. Taken together, these findings suggest that tobacco surcharges conflicted with a major goal of the ACA--increased financial protection--without increasing smoking cessation. States should consider these potential effects when deciding whether to limit surcharges to less than the federal maximum.
      pubtype: Academic Journal
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    language: English
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