Combat Tobacco Use by Revising the Affordable Care Act

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Combat Tobacco Use by Revising the Affordable Care Act and Making Healthcare Available to Smokers

Under the Affordable Care Act (ACA), premium surcharges can be placed on smokers that deter them from having insurance or from identifying as a smoker under their insurance policy [9]. This leads to smokers being less likely to obtain the healthcare they require and less likely to enroll in smoking cessation programs that are potentially covered or partially covered by insurance companies [9]. Healthcare, wellness programs, and cessations programs are unattainable by smokers under current policy.

INTRODUCING THE PROBLEM: The United States is combatting tobacco use, but still over 15% of adults smoke cigarettes [1]. Smoking is associated with increased rates of Chronic Obstructive Pulmonary Disease (COPD), stroke, cardiovascular disease, asthma, lung cancer, and a myriad of other cancers [2]. Thusly, as established by the Surgeon General, smoking is the leading preventable cause of death in the United States [3]. To most accurately combat smoking, we have to consider that those living at and below the poverty line are disproportionately smokers [4]. 25% of smokers are below the poverty line [5]. This is due to multiple factors, including ways in which the tobacco industry targets low socio-economic status (SES) communities [6]. For example, there are significantly more tobacco retailers and tobacco advertisements in these low-wage neighborhoods [7]. THE CURRENT POLICY: As aforementioned, smokers are at a greater risk for numerous diseases and chronic conditions. Therefore, they need access to healthcare. However, under the Affordable Care Act (ACA), insurance companies can impose a premium surcharge on smoking consumers of up to 50% [8].

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Furthermore, these surcharges are not subsidy-adjusted for low-income [8]. As a result, 27% of uninsured Americans are smokers [5]. Because lower SES are disproportionality smokers, the additional surcharges increase the already high cost of insurance and make it unattainable for most smokers. Therefore, smokers do not have access to the treatments and healthcare they require. Tobacco users are now less likely to enroll is tobacco cessation programs [9]. These programs are not always covered by insurance plans. When they are covered or partially covered, tobacco users either do not have insurance or are more likely to hide their tobacco usage from insurance companies and not enroll in cessation plans in order to avoid the high surcharges [9]. The purpose of the ACA premium surcharges is to balance out the additional costs caused by the increase in required healthcare for tobacco users. However, this is negated by the fact that tobacco users are now less likely to have health insurance or to identify as smokers.

Additionally, studies show that if insurance fully covers cessation programs, the insurance company will overall save money due to savings in eventual healthcare and medical costs [10]. SOLUTION: It is therefore proposed that the insurance premium surcharge for smoking consumers under the Affordable Care Act (ACA) is eliminated. It is ineffective in persuading smokers to quit. Because smokers are disproportionately of a lower socio-economic status (SES), the insurance companies should eliminate the surcharge and fully bear the cost of tobacco cessation and wellness programs [4]. It is more economically favorable because the general public will no longer bear the burden in taxes of uninsured smokers’ spontaneous healthcare costs. Additionally, funding the cessation programs will reduce overall costs for insurance companies by saving on all the healthcare needs of chronic smokers [10]. The insurance under the ACA makes appropriate healthcare unattainable for smokers, and the premium surcharges should therefore be eradicated.

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