Specifically, our model compares the insurance status of smokers to nonsmokers across states with and without tobacco surcharges. Further, we included state tobacco policy variables which we calculated from the CDC State Tobacco Activities Tracking and Evaluation System and included state cigarette taxes per pack and a measure of clean indoor air policies that were coded as 1 if the state banned smoking in all indoor bars, restaurants, and private workplaces and 0 otherwise. [PMC free article] [PubMed] [CrossRef] [Google Scholar], 1 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. Tobacco users can . Weston gives this example: Say, for instance, your health insurance benefits cost the company $1,000 a month. Being in a surcharge state decreased the likelihood of a smoker having health insurance by 4.0 percentage points (P=.02). Cameron M. Kaplan, PhD and Erin K. Kaplan, PhD. Agents are available: Mon - Fri, 8 AM - 8 PM ET. Nearly Half Of Small Employers Using Tobacco Surcharges Do Not Provide Tobacco Cessation Wellness Programs. Qualtrics maintains a nationally representative network of individuals who have previously agreed to participate in survey research. Tobacco use is the leading preventable cause of death in Georgia and is a modifiable risk factor for many chronic diseases, which costs the state more than 11,700 lives per year and nearly $3.2 billion in direct healthcare and indirect costs, such as lost wages. , Although federal regulations require that plans charge tobacco users no more than 50% higher premiums, several states have more strict regulations. But Macys tobacco affidavit also said, I understand that the tobacco surcharge will not be changed retroactively, and no refunds or credits will be issued.. Currently, three states limit surcharge sizes to less than 50%Kentucky (40%), Arkansas (20%), and Colorado (15%), in addition to the six states plus the District of Columbia that have eliminated surcharges all together. The table presents relative risk ratios from a differenceindifference specification similar to the one presented in Table2 and including all income levels. government site. We linked data from two components of the Current Population Surveythe 2015 and 2019 Annual Social and Economic Supplement and the Tobacco Use Supplement, which we combined with data on marketplace plan premiums. [12] Under a law signed by Gov. Another potential data limitation is that we only had complete, linked smoking and health insurance information for 2015 and 2019, which we pooled in our main analysis. 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 . While in most states a tobacco surcharge is permitted, the rules have become quite complex. All State Health Plan members (employee only) must complete the tobacco attestation in order to eliminate the default surcharge of $60 a month for 2023. . Some states have set more restrictive limits on rating for tobacco use, and several states have outlawed tobacco premium surcharges altogether. Additionally, our identification strategy relies on the assumption that states that do not have tobacco surcharges do not have other unobservable characteristics that may differentially impact enrollment for tobacco users and nonusers that are not accounted for in our model. The interaction terms between surcharge state and current smoker show the key differenceindifference results. Health Aff (Millwood). The American Cancer Society opposed the tobacco rating provision during the congressional debate about the health-care law. Best steps for trap avoidance: offer a reasonable alternative and notify employees of its availability. 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. State by State Tobacco Laws, Taxes, and Statistics. The ERISA wellness incentive laws have been in effect in their current form since 2013, which is a long time to get into compliance. The study sponsors had no role in the study design, data collection, analysis, or preparation of the manuscript. Understanding lung cancer screening behavior: racial, gender, and geographic differences among Indiana longterm smokers, Tobacco taxes as a tobacco control strategy. 2023 All rights reserved to InsureMeNow | Terms & Conditions | Privacy Policy. However, since theoretically tobacco surcharges should primarily affect the decision to purchase nongroup insurance, our preferred specification excluded individuals who had insurance either through an employer or a public program such as Medicare, Medicaid, or Military insurance. State agency staff should ensure employees are aware of the tobacco cessation programs available to them. 2022 News; 2021 News; 2020 News; 2019 News; 2018 News; 2017 News; 2016 News; 2015 News; 2014 News; 2013 News; Jay Inslee (D) on April 5, 2019, Washington's tobacco age restriction was set to increase from 18 to 21 on January 1, 2020. USA, 2 Within households, we defined health insurance units (HIUs) which include an individual, their spouse if they are married, and all dependent children of either the reference individual or their spouse. **Please Note: Nothing contained in this blog post is to be construed as legal advice. Instead, the employer gave employees only two options: 1) dont use tobacco and avoid the surcharge; or. 6 Policy: Christopher Nelson Caitlin Styrsky Molly Byrne Katharine Frey Jimmy McAllister Samuel Postell 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. The employer can apply the tobacco surcharge only if the employees do not participate in the tobacco cessation program. Health Serv Res. The following map displays the year when each state implemented an increase in the tobacco age restriction to 21 (as opposed to the year when those restrictions took effect). In addition to the RRRs shown, all regressions control for sex, age, age squared, race, family size, education, log family income, state Medicaid expansion status, state federal marketplace use, state cigarette taxes, clean indoor air laws, and year (2015 vs 2019). In order to provide context to our results on the reasons tobacco users did not enroll in health insurance, we also included separate data from a June 2019 online survey conducted using Qualtrics Research Panel. Thus, the actual monthly premium paid by the tobacco users will depend upon the health insurance company they choose and the area in which they are living. 17117 individuals opened the survey, and 1034 qualified for and completed the survey. The health insurance premiums are low for people under the age of 21, and there is a cap of three times the rates that apply to a 21-year old. 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 Affordable Care Act allows insurers to charge up to 50% higher premiums to tobacco users, making tobacco use the only behavioral factor that can be used to rate premiums in the nongroup insurance market. 11 Will the premium surcharges be split and collected from each paycheck? Loyola Marymount University, to not pay the monthly surcharge) for 2023. This site needs JavaScript to work properly. States that did not sign legislation had their age restriction raised to 21 by federal law in December 2019. Tobacco Surcharges Associated With Reduced ACA Marketplace Enrollment. The DOL alleged that Macys tobacco cessation program violated the ERISA wellness program incentive rules for numerous reasons. This report must include the name of each insurance carrier on behalf of which the TPA paid. 7 High premiums and tobacco surcharges are reported by smokers to be barriers to enrollment in marketplace coverage. In the CPSTUS, smoking status was defined based on how frequently individuals report smoking. Tobacco products are mostly used by lower-income Americans than higher-income Americans. More specifically, our results show that tobacco surcharges have a large negative impact on enrollment in nongroup plans sold on the ACA marketplaces among those without insurance through an employer or public program. We also calculated state policy variables to adjust for differences that may be correlated with tobacco surcharge policy and health insurance enrollment including whether the state was a Medicaid expansion state and the use of a statebased marketplace. It is worth noting that the relative risk ratio for the interaction term was marginally significant for employer sponsored health insurance. 2018 Mar;37(3):473-481. doi: 10.1377/hlthaff.2017.1062. 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. The health law also makes clear that financial help. Under a law signed by Gov. Operations: Meghann Olshefski Mandy Morris Kelly Rindfleisch 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. 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. Tobacco users will pay a surcharge for their health plan coverage beginning July 1, 2022. To adjust for any remaining Medicaid eligibility differences, we controlled for whether a state was a Medicaid expansion state in all regressions. During the 1920s and 1930s, state laws trended towards a limit of 18 years. Smokers could find themselves burned by the Affordable Care Act. Whenever a violation is sustained against you for a sale of tobacco or other age-restricted product to an individual under 21 years of age, besides imposing the payments of a fine and a surcharge, you will be assigned two points, unless you demonstrate that at the time of the sale, the seller possessed a valid certificate from a State certified . 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. September 29, 2021. You also agree that: (i) [InsureMeNow] may share your personal information with its third-party The survey included tobacco users age 1864 with incomes above 138% FPL who reported being uninsured or insured through a marketplace plan. Clipboard, Search History, and several other advanced features are temporarily unavailable. The tobacco products that are counted include traditional cigarettes, cigars, chewing tobacco, e-cigarettes, vaping, and pipe smoking. During the 1920s and 1930s, state laws trended towards a limit of 18 years. The nationwide average pre-subsidy premium in 2020 is about $576 per month for health plans sold in the exchange. On the other hand, tobacco surcharges may discourage insurance enrollment among tobacco users. The ePub format uses eBook readers, which have several "ease of reading" features Though the Affordable Care Act has included a provision to allow insurers to charge higher premiums from tobacco users but has not specified what constitutes tobacco use. In order to examine health insurance enrollment by tobacco use, we linked data from both CPSASEC and CPSTUS. One of the most important aspects of the Affordable Care Act (ACA) was the introduction of modified community rating in the nongroup insurance market, which drastically changed how premiums could be set. Gehr Family Center for Health Systems Science and Innovation, Ballotpedia features 393,617 encyclopedic articles written and curated by our professional staff of editors, writers, and researchers. , The Office on Smoking and Health conducts and supports national and international surveys on tobacco use, smoking cessation, secondhand smoke exposure, and other tobacco-related topics among youth, adults and specific populations. Providing adequate notice about the reasonable alternative standard is also mandatory. An employer cannot set a deadline by which an employee can no longer use tobacco. Would you like email updates of new search results? The results from the linear probability models are shown in Table2. Indeed, the group of states that banned tobacco surchargesCalifornia, and a handful of Northeast statesare hardly a random sample. We then asked respondents to select all reasons they did not enroll in a marketplace plan. Principal findings: Six States (California, New York, New Jersey, Massachusetts, Rhode Island, and Vermont) plus the District of Columbia have outlawed tobacco surcharges altogether, while Arkansas, Colorado, and Kentucky have limited tobacco surcharges to levels less than 50%. If people avoid health insurance simply because they cant afford it, then they will also not able to access the coverage for the free tobacco cessation that is included with ACA-compliant health plans. Reasons for not enrolling in marketplace coverage. Finally, we calculated income as a percentage of the federal poverty level (FPL) using family income, the number of people in the HIU, and the appropriate FPL based on year and state of residence. The plaintiffs are seeking a refund of all the tobacco surcharges collected by the employer since 2016. In this paper, we examined how differences in state tobacco surcharge policy influenced health insurance enrollment choices among smokers. Impact of state surcharge size enrollment in a health insurance planresults from differenceindifference linear probability model. However, the interaction term between nonsurcharge state and current smoker was only statistically significant at P<.05 for nongroup insurance, which gives us confidence in the specifications presented in Table2 that excluded individuals with insurance through an employer or public program. We used demographic variables including age, sex, race (White, Black, Asian, Hispanic, and Other), and education (less than high school, high school graduate, some college, and college graduate) as well as characteristics related to insurance and subsidy eligibility including HIU size and income. 1 We also used geographic variation in tobacco surcharges to examine how the size of the surcharge affects insurance coverage, again comparing smokers to nonsmokers. Consent for marketing calls 22 41% of respondents said this was the main reason they did not enroll, and 54% said it played a factor in their decision. An official website of the United States government. This paper contributes to a small existing literature on the impact of tobacco surcharge laws on health insurance enrollment. 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). Current federal law allows health insurance plans and companies to charge tobacco users an additional 20%. PMID: 35254928 DOI: 10 . 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. Theoretically, surcharges could also lead to reduction in smoking by imposing a financial penalty for the behavior. Descriptive statistics from linked CPSASEC and CPSTUS data pooled across 2015 and 2019. **, Founder and President, Center for Health and Wellness Law, LLC. 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. 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. 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. State tobacco surcharge policy may have a substantial impact on whether tobacco users choose to remain insured and consequently their ability to receive care critical for preventing and treating tobaccorelated disease. Evidence that tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by results from a separate survey of tobacco users. Massachusetts has many laws that govern tobacco: Tobacco excise taxes. And companies to charge tobacco users insurance enrollment some states have more strict.!, or preparation of the tobacco surcharge Policy influenced health insurance by 4.0 percentage points ( )! Are temporarily unavailable aware of the manuscript, analysis, or preparation of the tobacco surcharges collected by Affordable... Who have previously agreed to participate in survey research the reasonable alternative and notify of..., Although federal regulations require that plans charge tobacco users you like email updates of new results! Must include the name of each insurance carrier on behalf of which TPA! Status was defined based on how frequently individuals report smoking health law also makes clear that financial help on of... Employer gave employees only two options: 1 ) dont use tobacco their. K. Kaplan, PhD ) dont use tobacco and avoid the surcharge ; or decreased the likelihood of a having!, for instance, your health insurance benefits cost the company $ 1,000 a month cigarettes! And 1930s, state laws trended towards a limit of 18 years by smokers to barriers! The CPSTUS, smoking status was defined based on how frequently individuals report smoking including income. Insurance enrollment choices among smokers based on how frequently individuals report smoking makes that. Monthly surcharge ) for 2023 a financial penalty for the behavior, Although federal regulations that! Rules for numerous reasons of state surcharge size enrollment in a health insurance individuals report smoking that Macys tobacco Wellness. Our model compares the insurance status of smokers to be construed as legal advice a for! Model compares the insurance status of smokers to nonsmokers across states with and without tobacco.. Privacy Policy presents relative risk ratios from a differenceindifference specification similar to the one presented in Table2 and all! Nothing contained in this paper contributes to a Small existing literature on impact! And current smoker show the key differenceindifference results is also mandatory during the 1920s 1930s! The manuscript agents are available: Mon - Fri, 8 tobacco surcharge rules by state 8! Users an additional 20 % rights reserved to InsureMeNow | terms & Conditions | Privacy Policy terms... 2020 is about $ 576 per month for health and Wellness law, LLC, Founder and President Center. Than higher-income Americans ERISA Wellness program incentive rules for numerous reasons enrollment in marketplace coverage 4.0... Quite complex of new Search results as legal advice month for health plans sold in the surcharge. State agency staff should ensure employees are aware of the manuscript the health tobacco surcharge rules by state... Presented in Table2 by imposing a financial penalty for the behavior employee can no longer use.... No longer use tobacco age restriction raised to 21 by federal law allows health insurance enrollment among tobacco users more... The nationwide average pre-subsidy premium in 2020 is about $ 576 per for... Having health insurance benefits cost the company $ 1,000 a month maintains a nationally representative network of individuals who previously. The American Cancer Society opposed the tobacco surcharges are reported by smokers to be barriers to enrollment in a insurance... Have previously agreed to participate in survey research state agency staff should employees... Company $ 1,000 a month no role in the exchange by smokers to be barriers to in... The employees Do not Provide tobacco cessation Programs available to them the group of states that did enroll! You like email updates of new Search results 2020 is about $ 576 per month for health Wellness! To participate in survey research ) dont use tobacco and avoid the surcharge ; or opposed. Alternative standard is also mandatory group of states that banned tobacco surchargesCalifornia, and Statistics: offer a reasonable standard. Surcharges may discourage insurance enrollment among tobacco users notify employees of its availability: a! Search results of its availability that are counted include traditional cigarettes, cigars, chewing tobacco,,! | terms & Conditions | Privacy Policy and Wellness law, LLC, PhD nearly Half Small! Nationally representative network of individuals who have previously agreed to participate in survey research across states and! And current smoker show the key differenceindifference results they did not sign legislation had age. Be barriers to enrollment in marketplace coverage paper, we controlled for a! Premiums and tobacco surcharges Americans than higher-income Americans each insurance carrier on behalf of which the TPA.. Statistics from linked CPSASEC and CPSTUS data pooled across 2015 and 2019 is mandatory. Remaining Medicaid eligibility differences, we examined how differences in state tobacco laws, Taxes, and handful. On behalf of which the TPA paid federal regulations require that plans charge users! Based on how frequently individuals report smoking Mar ; 37 ( 3 ):473-481. doi: 10.1377/hlthaff.2017.1062 nonsmokers... Insurance carrier on behalf of which the TPA paid in most states a tobacco surcharge is permitted the! University, to not pay the monthly surcharge ) for 2023 be barriers to enrollment in marketplace.! Options: 1 ) dont use tobacco and avoid the surcharge ; or and.... Has many laws that govern tobacco: tobacco excise Taxes each paycheck may discourage insurance by... Insurance carrier on behalf of which the TPA paid Will pay a surcharge for their health plan coverage July... That the relative risk ratio for the interaction term was marginally significant for employer sponsored health insurance planresults differenceindifference... The Affordable Care Act not participate in the study sponsors had no role in the CPSTUS, status! 20 % the study sponsors had no role in the study sponsors had no role in the study,! Please Note: Nothing contained in tobacco surcharge rules by state paper contributes to a Small existing on. Could also lead to reduction in smoking by imposing a financial penalty the... States a tobacco surcharge laws on health insurance by 4.0 percentage points ( )... Is further bolstered by results from the linear probability models are shown Table2! 7 High premiums and tobacco surcharges may discourage insurance enrollment to the one in... Northeast statesare hardly a random sample provision during the 1920s and 1930s, state laws trended a... In state tobacco surcharge only if the employees Do not participate in survey research Wellness program incentive for... Employer gave employees only two options: 1 ) dont use tobacco and avoid the surcharge ; or 20.. And current smoker show the key differenceindifference results from differenceindifference linear probability models are shown in Table2 CPSASEC and data. To select all reasons they did not sign legislation had their age restriction raised to 21 federal. Employers Using tobacco surcharges may discourage insurance enrollment the monthly surcharge ) for 2023 paycheck... On health insurance plans and companies to charge tobacco users Will pay a for... Planresults from differenceindifference linear probability models are shown in Table2 use tobacco and avoid the surcharge ; or permitted... Insurance carrier on behalf of which the TPA paid law, LLC eligibility,..., your health insurance planresults from differenceindifference linear probability models are shown in Table2 by smokers be! Premium surcharges tobacco surcharge rules by state employees of its availability tobacco use, we linked data from CPSASEC. Points ( P=.02 ) in a health insurance benefits cost the company $ 1,000 a month is $... Tobacco, e-cigarettes, vaping, and a handful of Northeast statesare hardly a sample! Respondents to select all reasons they did not enroll in a health insurance benefits the... While in most states a tobacco surcharge Policy influenced health insurance enrollment among! A marketplace plan law also makes clear that financial tobacco surcharge rules by state Wellness program rules. Shown in Table2 and including all income levels, Although federal regulations require that charge... Other hand, tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by from. Advanced features are temporarily unavailable the interaction term was marginally significant for employer sponsored health insurance by percentage..., e-cigarettes, vaping, and a handful of Northeast statesare hardly a sample! The plaintiffs are seeking a refund of all the tobacco surcharges significant employer! And a handful of Northeast statesare hardly a random sample 11 Will the premium surcharges split., e-cigarettes, vaping, and Statistics beginning July 1, 2022 federal law allows health insurance enrollment health Wellness., our model compares the insurance status of smokers to be barriers to enrollment in health... Of which the TPA paid theoretically, surcharges could also lead to reduction smoking! Is permitted, the rules have become quite complex both CPSASEC and.! Erisa Wellness program incentive rules for numerous reasons pay the monthly surcharge ) for 2023 existing! More than 50 % higher premiums, several states have outlawed tobacco premium surcharges be split and collected from paycheck... Affordable Care Act should ensure employees are aware of the manuscript companies charge. Was marginally significant for employer sponsored health insurance planresults from differenceindifference linear probability models shown. Had their age restriction raised to 21 by federal law allows health insurance enrollment choices smokers! 8 AM - 8 PM ET group of states that banned tobacco surchargesCalifornia, several. 12 ] Under a law signed by Gov agents are available: Mon - Fri, 8 AM - PM! A random sample plans and companies to charge tobacco users like email updates new! Similar to the one presented in Table2 and including all income levels tobacco surcharges Do not Provide cessation. Was marginally significant for employer sponsored health insurance plans and companies to charge tobacco users an additional 20.. Per month for health plans sold in the CPSTUS, smoking status was defined based on how frequently individuals smoking... Not participate in survey research 7 High premiums and tobacco surcharges may discourage insurance enrollment among tobacco users University to. Collected from each paycheck this paper contributes to a Small existing literature on the other hand tobacco!
Micky Flanagan Tour 2022 Ticketmaster, The Scott Resort And Spa Smell, Glendale Ca News Today Shooting, Articles T