More Obamacare Stupidity: Insurances Exchanges Can't Charge More for Smokers

The board charged with implementing federal health care reforms in the District has voted to prohibit insurance companies from charging higher premiums to cigarette smokers, adding the city to a handful of states rejecting such surcharges because of the effect they have on poor families who are more likely to smoke.

The D.C. Health Benefit Exchange executive board voted Monday to join Rhode Island, Vermont and Massachusetts in eliminating smoking premiums in their health care exchanges.

Dr. Mohammad N. Akhter, chairman of the city’s health exchange board, said the costs of the surcharge could be prohibitive for poor families. The Affordable Care Act allows states to impose up to a 50 percent surcharge for people who have used tobacco at least four times a week over the last six months.

A June 2012 study by the Institute for Health Policy Solutions estimated that the largest effect would be on older couples whose earnings were at 150 percent of the federal poverty line. If subjected to the maximum surcharge, a couple older than 60 years old who both smoke would face a premium equaling 48 percent of their total income and 143 percent of their income above the poverty level.

“That’s basically unaffordable,” Dr. Akhter said.

An estimated 20.8 percent of D.C. adults smoke regularly, compared to a national median of 21.2 percent, according to 2011 statistics from the Centers for Disease Control and Prevention. But smoking rates among black residents in the District were much higher, at 30.8 percent.

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