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Will smokers be unable to afford insurance under the ACA?

  • By
  • contributor
  • May 1, 2013

Q. I’ve heard that under the ACA, smokers will have to pay 50 percent more for insurance – and that, even if they qualify for a tax credit, the subsidy will not cover the 50 percent “premium surcharge.” Does this mean that, under the ACA, smokers won’t be able to afford healthcare?

A. In the end, most smokers should be able to get health insurance.

First, in the U.S. most adults who smoke are poor: 39 percent live below the poverty level. Many more live below 133 percent of the poverty level. As states expand Medicaid, they will become eligible for the program. Since Medicaid charges no premiums, they will not pay a premium surcharge.

Secondly, it is up to individuals states to decide whether they will let insurers charge smokers more. By early April of 2013, Rhode Island, Vermont, Massachusetts and D.C. had voted to eliminate smoking premiums in their health care exchanges. The American Cancer Society, which is opposed to the surcharge, is working to persuade other states to ban it. (The ACS explains: “We’re anti-smoking, not anti-smoker.”)

Third, workers covered on the job will be able to avoid tobacco penalties by joining smoking cessation programs.