Although the Affordable Care Act (ACA) eliminated some of the barriers to obtaining health insurance coverage, not all Americans have access to affordable coverage. Low-income smokers in particular face challenges when shopping for insurance that meets their health needs.
Smokers face a double jeopardy when it comes to purchasing insurance. Under the ACA, insurance companies can charge smokers up to 50 percent more for health insurance premiums. While the ACA provides subsidies or tax credits for many people with low incomes, the premium surcharge for smokers is not adjusted based on income.
In addition, smokers who are below 100 percent of the poverty level fall in the “coverage gap” in states that have not expanded Medicaid. In this coverage gap, they must pay full price for health insurance premiums in the marketplace, in addition to the smoking surcharge.
The smoking surcharge was created to allow insurance companies to recover costs incurred by smokers, but it has the unintended consequence of pricing many low-income smokers out of the market altogether.
As someone who studies health disparities and as a clinician who has led smoking cessation groups, I see a troubling trend. Many smokers cannot afford insurance that covers the costs of smoking cessation programs.
Smoking is one of the hardest habits to quit, often requiring many attempts before someone quits successfully. Almost everyone who smokes, rich or poor, needs help doing so, and they need support to help pay for the health care they need. The health care law should help smokers quit smoking and seek needed health care, but my research indicates that this may not occur due to the high costs of insurance for smokers.
Lower incomes and higher health care needs
Since smokers tend to have lower incomes than nonsmokers, the costs associated with coverage mean low-income smokers are restricted in their health insurance options. They may choose a plan with fewer upfront monthly costs, which can end up costing more in the year if they have high health care needs.
Or, they may choose to remain uninsured. Of the uninsured adults in the United States, 37 percent are smokers, even though smokers account for only 17 percent of the total U.S. population.
In addition to the high cost of coverage, smokers often have more chronic health needs and greater health care use compared to nonsmokers. So, while low-premium insurance plans may be in a suitable monthly price range for low-income smokers, these plans miss the mark in providing adequate coverage. And they fail to ensure low costs throughout the year as smokers use care.