Smokers pay more for life insurance because they’re more likely to die prematurely; so why not health insurance because they’re more likely to get sick?
One of the little-known details of the Affordable Care Act recently brought to light is that health insurers will be allowed to charge individual customers who smoke — especially older ones who presumably have smoked for a long time — up to 50 percent more for their coverage. The provision is bound to elicit howls when those individuals start shopping for insurance next year with the help of government subsidies, but it seems reasonable — provided they are given the same access to smoking cessation programs that workers with employer-provided insurance are — because it might give them just the incentive to quit.
Smoking is one of the biggest drivers of health-care costs in this country, accounting for $96 billion a year in outlays. Thus it hardly seems unfair to ask smokers, who suffer far more than their share of heart attack, stroke and cancer than nonsmokers, to pay more.
And those smokers most likely to make a claim on their insurance for a smoking-related illness are the ones who’ve smoked the longest. So making them shoulder more of the burden will moderate rate increases for nonsmokers, who are generally far healthier because they don’t smoke.
The big rub is that many individual insurance customers are low-income, lacking jobs that are good enough to get decent insurance benefits, which typically include programs that help smokers quit.
The carrot-and-stick approach makes sense here, though: Make smoking cessation programs available to all, then reward quitters with reduced premiums that accurately reflect their diminished impact on the system, while making smokers, who continue to absorb a disproportionate share of the system’s resources, pay more.