Starting in 2014, the Affordable Care Act (ACA or Obamacare) will prohibit insurance companies from discriminating against people with pre-existing health conditions. Although ACA guarantees access to the chronically unwell, including those who are overweight, or have a condition like diabetes, it will allow insurers to charge up to 50% higher rates to smokers, because smoking is considered an optional behavior, not an illness. As a result, millions of smokers may find that health insurance is just too expensive.

To be clear, under present law insurance companies already charge smokers more and are even allowed to deny them coverage altogether because of their higher rates of serious illness like cancer and heart disease. The premium, which rises with a smoker’s age, was in part the result of a lobbying campaign by anti-smoking health advocates, and constituted a compromise solution.

Now, however, some are questioning whether the ACA is too burdensome on smokers, especially since smokers tend to be lower-income and to work in jobs without insurance benefits. For example, a 55-year-old smoker could pay a smoking premium of as much as $4,250 a year, while a 60-year-old could pay up to $5,100.

“The effect of the smoking (penalty) allowed under the law would be that lower-income smokers could not afford health insurance,” said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan think tank that shed light on the issue with a study released last June about the potential impact in California.

“We don’t want to create barriers for people to get health care coverage,” argued California state Assemblyman Richard Pan, who is backing a law that would limit insurers’ ability to charge smokers more in California. The ACA allows states to limit or change the smoking penalty. “We want people who are smoking to get smoking cessation treatment,” said Pan, a Sacramento area pediatrician.

Supporters of the smoking premium say it will be a boon to all. “Properly understood, this provision could save businesses $12,000 annually for each smoker they now employ, help the great majority of smokers who already want to quit to finally do so, and restore to the American economy more than the total cost of Obamacare,” argues Prof. John Banzhaf, a law professor at the George Washington University Law School and longtime anti-smoking activist.

-Matt Bewig

To Learn More:

Penalty Could Keep Smokers out of Health Overhaul (by Ricardo Alonso-Zaldivar, Associated Press)

Media Myths About Obamacare Smoker 50% Surcharges Abound (by  John Banzhaf, Action on Smoking and Health)