tobacco surcharge rules by state

A few years back it was discovered by a Health Affairs analysis that more than 16% of the small employers were using tobacco surcharge, and about half of them were not offering a tobacco cessation program. and quitting smoking can significantly improve health outcomes. Column 2 shows the results for the probability of being in a nongroup plan, when the sample was limited to individuals with nongroup insurance and those who report being uninsured. 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. CarterHarris L, Slaven JE Jr, Monahan PO, SheddSteele R, Hanna N, Rawl SM. Directing the third parties regarding how completions of the tobacco cessation programs were reported. Nineteen of those states set the tobacco age restriction to 21 before the federal law took effect, while the other 19 did so after the federal law took effect. For purposes of the premium surcharge, "tobacco use" is defined as: . All regressions are weighted using the appropriate weights from the Current Population Survey. You also agree that: (i) [InsureMeNow] may share your personal information with its third-party The employer can apply the tobacco surcharge only if the employees do not participate in the tobacco cessation program. Los Angeles The survey included tobacco users age 1864 with incomes above 138% FPL who reported being uninsured or insured through a marketplace plan. You may switch to Article in classic view. 2 Additionally, increased enrollment in nongroup plans in states that did not allow surcharges was not offset by a decrease in the likelihood of having other types of insurance like employer provided insuranceif anything, employer insurance takeup was higher in states without surcharges. Our analysis also found that tobacco surcharges have a . Current federal law allows health insurance plans and companies to charge tobacco users an additional 20%. Colorado limits the tobacco surcharge to 15%. Last updated January 6, 2022 , The tobacco cessation wellness program is designed to promote health and prevent disease. How Much Protected Are You After Being Vaccinated against COVID-19? Surveys. 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. Table TableA2:A2: AppendixS1 presents results from these regressions separately for the 2015 and 2019 samples. 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. You do not have to pay this surcharge if you attest that: Neither you nor any of your enrolled dependents age 13 and older use . (May 13, 2013) On May 9, 2013, that the Executive Yuan (Cabinet) of the Republic of China (on Taiwan) approved amendments to the Tobacco and Alcohol Tax Act and to the Tobacco Hazards Prevention Act that, if they become law, would, respectively, increase the taxes and the health surcharge on tobacco products. Critics of surcharge policies point to data from other health-contingent premium programs showing that they fail to change individuals' behavior. State Specific Rating Variations. Figure1 shows the results from our survey of uninsured tobacco users with incomes above 138% FPL. Table TableA1:A1: AppendixS1 presents summary statistics by insurance type separately for the 2015 and 2019 samples. Plans in both market segments are allowed to charge enrollees different rates based on the same four factors. Among states that allowed a tobacco surcharge, we also examined the effect of the surcharge size on enrollment, again comparing smokers to nonsmokers. Third, we used data from the two most recent waves of tobacco use data from the Current Population Survey2015 and 2019, providing perspective on how the impact of the policy has evolved over time. Please email us if you would like to suggest a revision. This suggests that smokers living in nonsurcharge states might be more likely to have employer sponsored health insurance than smokers living in states that allow tobacco surcharges. In other words, a vaccine-related surcharge will have the effect of making coverage less affordable by ACA standards. there is yet little evidence that insurance surcharges lead to changes in tobacco use. This table presents estimates from a differenceindifference linear probability model, examining the likelihood of the outcome of interest for smokers in surcharge states. Liber AC, Hockenberry JM, Gaydos LM, Lipscomb J. One important limitation of our study is that although we compare enrollment rates by smoking status, smoking status is not experimentally varied across groups. We then took the mean of the median surcharge across all rating areas in the state weighted by the population of the rating area age 2064. Second, we separately estimated the effect of both the existence and the size of the tobacco surcharge, that is, whether allowing a tobacco surcharge influences insurance enrollment, and how the size of the surcharge implemented by insurers effects enrollment. Within each HIU, we estimated the family income that would be used to determine eligibility for marketplace subsidies or Medicaid enrollment by summing the simulated adjusted gross income (AGI) variable from the CPS across all members of the HIU. 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 . , Reasons for not enrolling in marketplace coverage. The plaintiffs in this case allege that the employer failed to notify employees of a reasonable alternative standard. Tobacco. Theoretically, surcharges could also lead to reduction in smoking by imposing a financial penalty for the behavior. 3 8 Some of those states later passed a state law raising the state-level tobacco age restriction to 21. 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. Finally, we gathered data on tobacco surcharges from the CMS Health Insurance Exchange Public Use Files for 2015 and 2019. 13 Impact of allowing a state surcharge on enrollment in a health insurance planresults from differenceindifference linear probability model, Relative risk ratios from multinomial logit regression on type of health insurance plan. Among states that allowed a tobacco surcharge, the statewide average of the median rating area surcharge ranged from 0% to 29.6% in 2015 and 7.0% to 32.3% in 2019. However, the employers imposing a tobacco surcharge are also supposed to offer a tobacco cessation program. The inclusion of state fixed effects holds constant any state specific factors that might affect differential insurance enrollment choices between smokers and nonsmokers. 11 In the 37 states that use the federal insurance exchange, healthcare.gov, the tobacco surcharge was paid by about 7 percent of 5.1 million consumers who enrolled, according to federal data. If you would like to help our coverage grow, consider donating to Ballotpedia. More Mercer posts Since 2014, all nongroup health insurance plans, including those sold on the individual marketplaces, can only rate premiums based on four characteristics: age, family size, geographic region, and tobacco use. Overall, this study found that tobacco surcharges led to significantly lower enrollment in nongroup health insurance among smokers. By clicking "Submit", you agree to our Terms of Use and acknowledge our Privacy Policy. 7 We also considered a comprehensive model of health insurance selection, by utilizing a multinomial logit regression to examine the likelihood of being covered under various types of insuranceemployer, nongroup, public, or uninsured. The American Lung Association calls for the following actions to be taken by Idaho's elected officials to reduce tobacco use and exposure to secondhand smoke: Treat electronic nicotine delivery devices consistent with traditional tobacco products in all areas under state law; and state law. The sample is limited only to states that allowed a tobacco surcharge and participated in the federal exchange. State policies limiting premium surcharges for tobacco and their impact on health insurance enrollment. During the 1920s and 1930s, state laws trended towards a limit of 18 years. 25 4 Income eligibility for assistance under the affordable care act: technical memorandum on estimates for nonelderly adults. Ballotpedia features 393,617 encyclopedic articles written and curated by our professional staff of editors, writers, and researchers. 17 Over 150000 emails were sent out to individuals who resided in the United States and were thought to be under 76years old. The ACA requires that all health insurance plans provide tobacco cessation and lung cancer screening with no outofpocket costs. This finding was robust across a variety of specifications. Come Jan. 1, smoking is one of the few allowable factors . Column 1 shows the effect of tobacco surcharges on the differences in insurance rates between smokers and nonsmokers for the full sample of nonelderly adults. 2016 Jul 1;35(7):1176-83. doi: 10.1377/hlthaff.2015.1540. More Benefits Insight Cafeteria Plan COLA May Require . Standard errors, clustered at the state level are shown in parentheses. Click here to contact our editorial staff, and click here to report an error. Before Finally, in several specifications we excluded families with incomes less than 138% of the federal poverty level for the following two reasons. Even though federal law permits a tobacco surcharge on health insurance, some states prohibit this. Additionally, the elimination of the individual mandate has led to a decrease in enrollment, marketing materials using the information you provide. Like the Macys case, this case is still pending. Tech: Matt Latourelle Nathan Bingham Ryan Burch Kirsten Corrao Travis Eden Tate Kamish Margaret Kearney Joseph Sanchez. Notably, using data from the Behavioral Risk Factor Surveillance System, Freidman and colleagues found the probability of having insurance was reduced among smokers in states with high tobacco surcharges relative to states without surcharges. She is also lead author of the book, Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. Tobacco surcharge has also been prohibited in Connecticut but only for plans that are sold through the states health insurance exchange. 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. Consent for marketing calls In the 37 states that use the federal insurance exchange, HealthCare.gov, the tobacco surcharge was paid by about 7 percent of 5.1 million consumers who enrolled, according to federal data. In these years, adult members of households included in the basic monthly CPS were surveyed in June of the first year (2014 and 2018) and January and May of the second year (2015 and 2019). This option wouldn't change the amount of the federal premium tax credit, a move foreclosed by federal law. 2020 Dec; 55(6): 983992. Most of the participants in the recent DOL lawsuits who did not confirm they had quit smoking that is, were tobacco free for some duration, such as six months, had to pay surcharges. 102. Specifically, the employer, a casino, imposed a $50/month tobacco surcharge on health insurance on employees who used tobacco. 18. Abbreviations: AGI, Adjusted Gross Income; FPL, Federal Poverty Level; HIU, Health Insurance Unit; SD, standard deviation. Download our quit-smoking calendar and tip sheet for creative ideas on how and when to promote quitting tobacco to maximize engagement. Duncan MS, Freiberg MS, Greevy RA, Kundu S, Vasan RS, Tindle HA. Notably, our point estimates are in line with those reported by Friedman et al Evidence that tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by results from a separate survey of tobacco users. phone or text message using an automatic telephone dialing system. States Charging Below 50%:6 Arkansas - 20% Colorado - 15% Kentucky - 40% States Charging the Maximum 50%:7 States Which Prohibit Tobacco Rating Completely:6 California Massachusetts New Jersey New York Rhode Island Vermont Washington D.C. Subsidies and Tobacco Surcharges We limited the sample to individuals in states with tobacco surcharges, comparing the impact of the size of the average tobacco surcharge on differences in insurance coverage between smokers and nonsmokers. The .gov means its official. During plan year 2013, Macys included a notice within the Tobacco Affidavit alerting the employee to the availability of a reasonable alternative standard, so it satisfied the notice requirement. 2022 Mar;41(3):398-405. doi: 10.1377/hlthaff.2021.01313. As of January 1, 2021, 32 states and the District of Columbia set the minimum sales age at 21 years old; Mississippi set the minimum sales age at 21 for some tobacco products and 18 for others; two states set the minimum sales age at 19 years old and 15 states set the minimum sales age at 18 years old. Generating an ePub file may take a long time, please be patient. If the program uses a medical test to detect nicotine or tobacco use, it also must comply with the ADA's rules for voluntary wellness plans. #1. HOME; STATE BY STATE; NEWS ARCHIVE. Albeit, the use of tobacco for religious or ceremonial purposes are excluded from the rule. Eight states increased their restrictions under a Democratic trifecta, four increased their restrictions under a Republican trifecta, and seven increased their restrictions under divided government. Smokers living in states with high tobacco surcharges are less likely to have health insurance. Youth access to tobacco law-RCW 70.155: Prohibits the sale and distribution of tobacco products to minors. Due to a "ObamaCare smoking glitch" where programmers couldn't get the charge to calculate correctly the tobacco surcharge wasn't implemented until 2015 in many states. Premium rating rules for nongroup insurance and small group plans (generally plans provided by employers with fewer than 50 employees) are similar. 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. The ERISA wellness incentive laws have been in effect in their current form since 2013, which is a long time to get into compliance. A new study by researchers at the Yale School of Public Health reveals an unexpected consequence of the Affordable Care Act's (ACA) tobacco surcharges: High surcharges resulted in lower rates of insurance enrollment among smokers in the first year of the ACA's implementation, without increasing smoking cessation. Column 3 repeats the specification from column 2 and confirms that the relationship is stronger among this population. **Please Note: Nothing contained in this blog post is to be construed as legal advice. New Jersey law states: A PERSON WHO SELLS OR OFFERS A TOBACCO PRODUCT TO A PERSON UNDER 21 YEARS OF AGE SHALL PAY A PENALTY OF UP TO $1,000 AND MAY BE SUBJECT TO A LICENSE SUSPENSION OR REVOCATION. 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. Tobacco age restrictions can take the form of limits on the sale of tobacco by age, limits on tobacco possession by age, or a combination of the two. External Relations: Moira Delaney Hannah Nelson Caroline Presnell Agents are available: Mon - Fri, 8 AM - 8 PM ET. State of Montana Health Care & Benefits Division 100 North Park Ave ., Suite 320 P.O. We first examined the impact of tobacco surcharges on the likelihood of having any type of health insurance. Call KT, Davidson G, Sommers AS, Feldman R, Farseth P, Rockwood T. Uncovering the missing Medicaid cases and assessing their bias for estimates of the uninsured, The uninsured and the affordability of health insurance coverage: examining subgroups of uninsured Americans uncovers certain patterns of coverage gaps, but affordability remains a key concern, Response error and the Medicaid undercount in the current population survey, Tobacco product use among adultsUnited States, 20122013, Selfidentified tobacco use and harm perceptions among US youth, Individual Market Rate Restrictions (Not Applicable to HIPAA Eligible Individuals), Survey of NonGroup Health Insurance Enrollees, Health Insurance Exchanges 2020 Open Enrollment Report, Demand for health insurance marketplace plans was highly elastic in 20142015, Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act, Demand for health insurance: evidence from the California and Washington ACA exchanges. Employees at several companies are pushing back on employer wellness programs that require higher health insurance premiums for tobacco users. These data were only available for the 38 states that participated in the federal exchange. Thus, people who use tobacco are advised to not just avoid health insurance because many health insurers have implemented smaller surcharges or some have also sip them altogether. Tobacco use is the largest cause of preventable illness in the United States. We examined the impact of state level tobacco surcharge policy on health insurance enrollment decisions among smokers. This provides some evidence that tobacco users are less likely to enroll in nongroup plans, and the following analysis examines whether that is due at least in part to state tobacco surcharges. An employee must be able to avoid the surcharge by completing the alternative, even if the employee fails to quit smoking. [PMC free article] [PubMed] [CrossRef] [Google Scholar], 1 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. Employees should also be aware they are required to certify tobacco use for themselves and their dependents. Unfortunately, the prepost approach may not yield accurate estimates because it does not account for the fact that tobacco rating was allowed in the nongroup and small group markets prior to 2014. the display of certain parts of an article in other eReaders. We also collected qualitative data from a survey of smokers who did not have insurance through an employer or public program. Readers are encouraged to seek legal counsel for any advice or compliance determinations needed on specific situations. Each column is a separate regression, and the interaction term between the percent surcharge and current smoker shows the key differenceindifference coefficient. We found that the likelihood of having insurance among smokers was 4.0 percentage points (P=.02) lower in surcharge states, while Friedman and coauthors found that enrollment was 4.3 percentage points lower in states with medium sized surcharges, compared to states without surcharges, although their estimate was not statistically significant. Individuals are able to report multiple sources of health insurance in CPSASEC. The Potential and peril of health insurance tobacco surcharge programs: evidence from Georgias state employees health benefit plan, https://www.kff.org/other/stateindicator/individualmarketraterestrictionsnotapplicabletohipaaeligibleindividuals/, https://www.cms.gov/files/document/4120healthinsuranceexchanges2020openenrollmentreportfinal.pdf. 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