26 We also used geographic variation in tobacco surcharges to examine how the size of the surcharge affects insurance coverage, again comparing smokers to nonsmokers. 83 votes, 182 comments. By limiting the sample respondents in states with tobacco surcharges, we were able to estimate the effect of the size of the surcharge on insurance enrollment. Some states have set more restrictive limits on rating for tobacco use, and several states have outlawed tobacco premium surcharges altogether. This option wouldn't change the amount of the federal premium tax credit, a move foreclosed by federal law. You may switch to Article in classic view. Participants overwhelmingly reported that cost of health insurance was a major reason for either not visiting their state's health insurance marketplace website or not purchasing a plan. Additionally, tobacco surcharges function to increase the cost of health insurance for smokers, which was the most commonly cited reason for not choosing to enroll in a nongroup plan. Notably, smoking rates were higher among those without health insurance than those with nongroup coverage. The challenges and successes of each state's fight against tobacco use, and tobacco prevention efforts. Tobacco use is the largest cause of preventable illness in the United States. A $25 tobacco use premium surcharge is required in addition to your medical plan premium if you or a dependent (age 13 and older) enrolled on your PEBB medical uses a tobacco product. An employer cannot set a deadline by which an employee can no longer use tobacco. We examined the impact of state level tobacco surcharge policy on health insurance enrollment decisions among smokers. Another potential consideration is the effect of tobacco surcharges on nonusers. Members Currently Paying the Tobacco Surcharge: If a member is currently paying the tobacco surcharge and does not make an active election during Open Enrollment, the current enrollment will default to the new Plan Year and the member will continue to pay the tobacco surcharge. The University of Southern California Institutional Review Board approved the survey data collection and deemed the analysis of data from the CPS as exempt from full review, and the relevant part of the survey questionnaire is included in Appendix S2. Modification in the tobacco surcharge has been prohibited in some of the states. All columns are derived from a single multinomial logit regression, and each column presents the relative risk ratios (RRR), comparing the risk of being in the insurance type of interest and being uninsured. Standard errors, clustered at the state level are shown in parentheses. Health Aff (Millwood). affordable care act, enrollment, health insurance, marketplace, premiums, smoking, tobacco surcharge, Reasons for not enrolling in marketplace coverage. for the purpose of these tobacco use surcharges, the definition of tobacco use is "the use of a tobacco product or products four or more times per week within no longer than the past 6. See this image and copyright information in PMC. 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. State fixed effects were included in columns (2) and (4) include state fixed effects; however, they did not substantially affect the results. 41% of respondents said this was the main reason they did not enroll, and 54% said it played a factor in their decision. Keck School of Medicine, Ballotpedia features 393,617 encyclopedic articles written and curated by our professional staff of editors, writers, and researchers. As of July 1, 2013, the excise tax imposed on cigarettes under M.G.L. State government tax collections by source, State spending by function as a percent of total expenditures, Financial regulation in the United States, Education statistics in the United States. Finally, we gathered data on tobacco surcharges from the CMS Health Insurance Exchange Public Use Files for 2015 and 2019. Agents are available: Mon - Fri, 8 AM - 8 PM ET. 2 Premium rating rules for nongroup insurance and small group plans (generally plans provided by employers with fewer than 50 employees) are similar. Disclaimer, National Library of Medicine Tobacco use is the largest cause of preventable illness in the United States. Reasons for not enrolling in marketplace coverage. The most common options include (i) HSA, HRA or FSA contributions; (ii) a decrease in employee contributions toward medical coverage (often referred to as a tobacco surcharge); and (iii) cash, gift cards or entries into a prize drawing. Under a law signed by Gov. 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). We found that the tobacco surcharge rate averaged approximately 14 percent and that it was associated with lower total enrollment as well as a reduced share of total enrollees who reported any tobacco use. By 1920, 46 states had implemented an age limit for tobacco sales, of which 14 set the limit at 21. And in states like California, Rhode Island, Vermont, the District of Columbia, Massachusetts, New York, and New Jersey are not allowed to charge higher premiums from tobacco users. The ACA's individual mandate in retrospect: what did it do, and where do we go from here? The interaction terms between surcharge state and current smoker show the key differenceindifference results. [2] After June 2015, eighteen other states raised their tobacco age restriction to 21. She is also lead author of the book, Rule the Rules on Workplace Wellness Programs, published by the American Bar Association. On May 20, 2019, Sen. Mitch McConnell (R) introduced a bill which would increase the tobacco age restriction to 21 at the federal level. 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. The prevalence of tobacco surcharge among small employers has significantly dropped mainly because the Department of Labor has become strict in enforcing provisions according to which tobacco cessation programs should be offered in conjunction with tobacco surcharges. It is currently unclear what amount of incentive is permissible under these ADA rules. 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; columns 3 and 4 show the likelihood of having marketplace insurance among those reporting having nongroup insurance or being uninsured. sharing sensitive information, make sure youre on a federal tobacco surcharge rules by state. Table1 compares sample characteristics across insurance type. [12] Under a law signed by Gov. Table TableA2:A2: AppendixS1 presents results from these regressions separately for the 2015 and 2019 samples. 8 Massachusetts has many laws that govern tobacco: Tobacco excise taxes. USA. The most common options include (i) HSA, HRA or FSA contributions; (ii) a decrease in employee contributions toward medical coverage (often referred to as a tobacco surcharge); and (iii) cash, gift cards or entries into a prize drawing. It does not apply to dependents covered under the medical plan. Employers that are ALEs (i.e., have 50 or more full-time equivalent employees . Federal government rules let employers charge smokers up to 50 percent of the cost of their health insurance benefits. 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. , Study design: 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. Additionally, among those facing a tobacco surcharge, a 10 percentage point increase in the size of the tobacco surcharge decreased the likelihood of enrollment in nongroup insurance by 8.6 percentage points (P=.02). Box 200130 Helena, MT 59620-0130 Respondents also listed tobacco surcharges as a major factor. 10 Tobacco surcharge may also be incorporated in the employer-sponsored health plans that can increase the standard premium by up to 50% unless a state has implemented a lower tobacco surcharge. County populations were pulled from the 2014 and 2018 American Community Survey annual county level estimates and aggregated up to the rating area level. , 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. marketing partners; and (ii) [InsureMeNow] and marketing partners may contact you with 1865 into law. The California Complementary Legislation (or "directory law"), Revenue and Taxation Code section 30165.1, requires the Attorney General to publish a directory of tobacco product manufacturers and brand families of cigarettes and roll-your-own tobacco that are lawful for sale in California. 19 Instead, the notice materials stated employees would only avoid the tobacco surcharge on a prospective basis. During the 1920s and 1930s, state laws trended towards a limit of 18 years. Evidence that tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by results from a separate survey of tobacco users. For example, tobacco surcharges could lead to less employer coverage as a result of higher premiums for tobacco users in the small group market or if large employers were more likely to charge surcharges in states that allowed them in small group and nongroup markets. Duncan MS, Freiberg MS, Greevy RA, Kundu S, Vasan RS, Tindle HA. 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. In August 2017, the United States Department of Labor (DOL), which enforces compliance with ERISA, sued Macys, Inc. as well as its third-party administrators for its self-insured health plan: Anthem Blue Cross Life and Health Insurance Company and Cigna. 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. . !function(){"use strict";window.addEventListener("message",(function(e){if(void 0!==e.data["datawrapper-height"]){var t=document.querySelectorAll("iframe");for(var a in e.data["datawrapper-height"])for(var r=0;r

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