A majority of Americans thinks it's OK to charge higher health insurance rates to smokers, but not to overweight people, according to a Gallup poll released this week.
That may have something to do with the fact that a majority of Americans are indeed overweight, while only 1 in 5 adults are smokers. But the attitude has implications for health plan policy designs going forward, especially in the Affordable Care Act era.
The federal health care overhaul gives states the option of allowing insurers that participate in the online health care exchanges to charge higher premiums to smokers -- up to 50 percent higher than the standard rate. At least five states and Washington, D.C., have said they won't allow insurers to charge higher rates to smokers. Pennsylvania is not one of them.
The eight insurers interested in selling polices in Pennsylvania come October -- Highmark, Capital BlueCross, Independence Blue Cross, Blue Cross of Northeastern Pennsylvania, UPMC Health Plan, Geisinger Health System, Aetna Inc. and HealthAmerica -- can charge more to smokers, a move meant to account for the increased risk and expense of covering smokers' health claims.
But it's a move opposed by some odd bedfellows, such as the county's top cigarette makers as well as the American Cancer Society. Advocates for the poor and minorities also say the smokers' surcharge is unfair, as it disproportionately will affect those populations since they are more likely to smoke and less likely to have employer-provided health insurance.
And higher premiums could discourage smokers from buying insurance -- the opposite of the intended effect of the exchanges. (Pennsylvania's smoking rate is slightly higher than the national average).
"We don't want to create more barriers to quitting," said Dianne Phillips, state policy director for the cancer society's Cancer Action Network. "Making it more expensive [might] put that insurance coverage out of their reach."
The surcharge singles out smokers in a punitive way, Ms. Phillips added.
"We're anti-smoking, but we're not anti-smoker," she said
Insurers say that the extra charges make sense from a risk-management standpoint.
"Smoking is proven to damage health in many significant ways and to be very costly to the health system," said Janice Maszle, Highmark spokeswoman. "That's why the Affordable Care Act allows smokers to be surcharged, and Highmark Health Services plans to make use of the tobacco rating factor in the law in order to help contain the higher cost of smokers."
Smokers will more or less be on the honor system when buying the insurance policies -- there's no blood test to determine whether an applicant is indeed a regular smoker. However, if the insurance company later finds out that an applicant is a smoker but lied about it on the application, it can retroactively apply the extra premium and continue to charge it going forward.
It can't cancel the policy, though.
According to the Gallup poll, 58 percent of those surveyed would be in favor of charging higher insurance rates to smokers, but only 41 percent would agree the overweight should be charged more.
Among those who had smoked a cigarette within a week of being surveyed, only 28 percent thought higher premiums for smokers were OK. Meanwhile, 65 percent of non-smokers are on board.
The Affordable Care Act does not allow insurers to charge higher premiums to overweight customers.
Washington, D.C., California, Massachusetts, New Jersey, New York, Rhode Island and Vermont have all outlawed higher health care premiums for smokers buying policies through the exchanges, according to the Department of Health and Human Services.
Bill Toland: firstname.lastname@example.org or 412-263-2625.