title: Most exchange plans charge lower tobacco surcharges than allowed, but many tobacco users lack affordable coverage.
abstract: Beginning in 2014, federal guidelines for health plans sold to people in the individual market allow insurers to charge tobacco users up to 50 percent more for premiums, compared to nonusers. We examined variations in tobacco surcharges for plans offered through the state and federal health insurance exchanges, or Marketplaces. The plan with the median surcharge had only 10 percent higher premiums for tobacco users compared to nonusers, and nine in ten plans charged a lower surcharge than allowed. Even with such lower-than-allowed surcharges, tobacco users lacked affordable coverage-defined as access to at least one plan with premiums of less than 8 percent of income after subsidies-in more states than did nonusers. Higher premiums could encourage tobacco users to opt out of coverage. Our results also suggest that the variation in tobacco surcharges may result in the sorting of tobacco users and nonusers into different plans.
authors.affiliation: Cameron M. Kaplan (ckaplan@uthsc.edu) is an assistant professor of preventive medicine at the University of Tennessee Health Science Center, in Memphis.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Kaplan
authors.affiliation: Ilana Graetz is an assistant professor of preventive medicine at the University of Tennessee Health Science Center.
authors.forename: Ilana
authors.initials: I
authors.lastname: Graetz
authors.affiliation: Teresa M. Waters is a professor of preventive medicine at the University of Tennessee Health Science Center.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Waters
mesh_terms: D000328:Adult; D005249:Fees and Charges; D062265:Health Insurance Exchanges / Q000191:economics*; D006801:Humans; D007182:Income; D007341:Insurance; D007343:Insurance Carriers / Q000191:economics; D019458:Insurance Coverage / Q000191:economics; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000331:legislation & jurisprudence; D064424:Tobacco Use / Q000191:economics*; D014481:United States; D055815:Young Adult
keywords: Cost of Health Care; Health Reform; Insurance Coverage < Insurance; Insurance Market < Insurance; Tobacco/Smoking