Clipboard, Search History, and several other advanced features are temporarily unavailable. The cigar and smoking tobacco excise imposed by M.G.L. Download our quit-smoking calendar and tip sheet for creative ideas on how and when to promote quitting tobacco to maximize engagement. Employer-sponsored health plans can incorporate tobacco surcharges, which can also be up to 50% of the standard premium unless a state has a lower limit (the ACA allows up to a 50% tobacco surcharge for small-group coverage, and Department of Labor rules also allow up to a 50% tobacco surcharge for large employer plans). Los Angeles Additionally, increased enrollment in nongroup plans in states that did not allow surcharges was not offset by a decrease in the likelihood of having other types of insurance like employer provided insuranceif anything, employer insurance takeup was higher in states without surcharges. 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. 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. Visit www.nysmokefree.com, for information, to chat online with a Quit Coach, or to sign up for Learn2QuitNY, a six-week, step-by-step text messaging program to build the skills you need to quit any tobacco product. During the 1920s and 1930s, state laws trended towards a limit of 18 years. Thus, people who use tobacco are advised to not just avoid health insurance because many health insurers have implemented smaller surcharges or some have also sip them altogether. Abbreviations: AGI, Adjusted Gross Income; FPL, Federal Poverty Level; HIU, Health Insurance Unit; SD, standard deviation. [13] However, the state's tobacco age restriction was raised to 21 in December 2019 by federal law. Tech: Matt Latourelle Nathan Bingham Ryan Burch Kirsten Corrao Travis Eden Tate Kamish Margaret Kearney Joseph Sanchez. 2016 Jul 1;35(7):1176-83. doi: 10.1377/hlthaff.2015.1540. [14] However, the state's tobacco age restriction was raised to 21 in December 2019 by federal law. Principal findings: In plan years 2011 and 2012, the program failed to offer employees a reasonable alternative standard and notice of that reasonable alternative standard. surcharge cannot exceed 50 percent of the total cost of health coverage. Allowing a tobacco surcharge reduced insurance enrollment among smokers by 4.0 percentage points (P = .01). Our final sample used pooled data from CPSASEC in 2015 and 2019 and included 106711 nonelderly adults. In order to examine health insurance enrollment by tobacco use, we linked data from both CPSASEC and CPSTUS. The first law in the United States regulating the sale of tobacco by age was passed in New Jersey in 1883 and set a minimum age of 16. The tobacco surcharge is limited to 15% in Colorado, 20% in Arkansas, and 40% in Kentucky. 27 In states that allow tobacco surcharges, tobacco users pay substantially higher premiums for nongroup health insurance than nonusers. Credit Card Surcharge Laws by State: A Guide for AEC Pros. First, there is known overreporting of nongroup health insurance plan participation among Medicaid eligible respondents in survey data including the CPS. As of January 1, 2021, 32 states and the District of Columbia set the minimum sales age at 21 years old; Mississippi set the minimum sales age at 21 for some tobacco products and 18 for others; two states set the minimum sales age at 19 years old and 15 states set the minimum sales age at 18 years old. Plan members who are tobacco users can avoid . Tom Wolf (D) on November 27, 2019, Pennsylvania's tobacco age restriction was set to increase from 18 to 21 on July 1, 2020. Health Aff (Millwood). 2020 Dec; 55(6): 983992. , At incomes over 138% FPL, insurance eligibility is substantively similar across states. We linked data from two components of the Current Population Survey-the 2015 and 2019 Annual Social and Economic Supplement and the Tobacco Use Supplement, which we combined with data on marketplace plan premiums. This blog post is for informational and educational purposes only. The 2019 ASEC included variables that specifically identify marketplace coverage, so we examined whether the effect is driven by those with marketplace plans using the 2019 data only. 13 All regressions are weighted using the appropriate weights from the Current Population Survey. Benefits Insight. In the 37 states that use the federal insurance exchange, healthcare.gov, the tobacco surcharge was paid by about 7 percent of 5.1 million consumers who enrolled, according to federal data. To learn more, visit our Employers page, Determining which participants were charged the tobacco surcharge, Determining which participants were reimbursed the tobacco surcharge, Withholding the tobacco surcharge from a participants paycheck and placing it in the health plan trust account; and. marketing materials using the information you provide. The program may include a tobacco surcharge to help motivate employees. Liber AC, Hockenberry JM, Gaydos LM, Lipscomb J. As such, several previous studies have shown that gaining access to health insurance can have large effect on both quitting smoking and cancer screening. In these years, adult members of households included in the basic monthly CPS were surveyed in June of the first year (2014 and 2018) and January and May of the second year (2015 and 2019). 26 This allowed us to examine the impact of surcharges on each type of insurance coverage without worrying about endogenous sample selection that could cause bias in the linear probability models where the sample is limited to individuals with nongroup plans and those who are uninsured. 2. Individuals are able to report multiple sources of health insurance in CPSASEC. Second, we separately estimated the effect of both the existence and the size of the tobacco surcharge, that is, whether allowing a tobacco surcharge influences insurance enrollment, and how the size of the surcharge implemented by insurers effects enrollment. Since tobacco surcharges can be set at the state level, this policy may be more easily altered than other aspects of the ACA which are subjected to federal regulation. Though insurance companies no longer base health insurance premium depending upon applicants medical history and they are not even allowed to reject an application based on their pre-existing conditions or based on their health history, but ACA allows health insurance companies to base premiums depending on factors like age, family size, geographic location, as well as tobacco use. 28 Under a law signed by Gov. The ACA's individual mandate in retrospect: what did it do, and where do we go from here? The state lowered the age of majority, which also served as a tobacco age restriction at the time, from 21 to 19 in 1976. Though the Affordable Care Act has included a provision to allow insurers to charge higher premiums from tobacco users but has not specified what constitutes tobacco use. romantic things to do in dubuque, iowa. 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. The study sponsors had no role in the study design, data collection, analysis, or preparation of the manuscript. This allows employees to avoid the surcharge by participating in the cessation program. Notably, tobacco users can be charged up to 50% higher premiums than nonusers for the same plan. Rate: 35% of the wholesale purchase price; Both cigarettes and other tobacco products are subject to the 4.5% state sales tax rate plus the general municipal sales tax rates when sold at retail. Some of those states later passed a state law raising the state-level tobacco age restriction to 21. Notably, using data from the Behavioral Risk Factor Surveillance System, Freidman and colleagues found the probability of having insurance was reduced among smokers in states with high tobacco surcharges relative to states without surcharges. Comparison of demographic characteristics by primary insurance type for nonelderly adults. Although Freidman et al grouped states into small surcharge, large surcharge, and no surcharge categories, they did not explicitly model each policy component. It is currently unclear what amount of incentive is permissible under these ADA rules. 11 One key difference is that tobacco users in small group plans can avoid paying the surcharge by enrolling in a tobacco cessation program. 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. Employees should also be aware they are required to certify tobacco use for themselves and their dependents. According to our estimates, the presence of a tobacco surcharge decreased the likelihood of enrollment in a nongroup plan by 9.0 percentage points (P<.01) among smokers without insurance through an employer or public program. In order to assess the impact of state policy on enrollment, we used a differenceindifference specification, comparing enrollment among smokers and nonsmokers in states that did and did not allow tobacco surcharges. Jun 28, 2013. The tobacco cessation wellness program is designed to promote health and prevent disease. Before But Macys tobacco affidavit also said, I understand that the tobacco surcharge will not be changed retroactively, and no refunds or credits will be issued.. Evidence Suggests That The ACA's Tobacco Surcharges Reduced Insurance Take-Up And Did Not Increase Smoking Cessation. While these rules may be frustrating to employers, ignoring them is not worth a lawsuit by the DOL. For the purposes of this study, we limited the sample to uninsured individuals (N=519). It was then decreased from 21 to 19 in 1963. Gehr Family Center for Health Systems Science and Innovation, An employer cannot set a deadline by which an employee can no longer use tobacco. The employer determined tobacco use status through an affidavit completed by each employee covered under the employer group health plan. Since 2014 the Affordable Care Act has permitted employers and insurance companies to charge tobacco users up to 50% more in premiums. To adjust for other potential differences across states, we controlled for Medicaid expansion status, the use of a statebased marketplace, tobacco taxes, and clean indoor air policies. Because the State Plan program does not use medical tests to detect nicotine usage, the amount of the tobacco surcharge can be as much as 50% of the total cost of employee-only health coverage. Finally, all models adjusted for year of survey (2015 or 2019). 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. We then took the mean of the median surcharge across all rating areas in the state weighted by the population of the rating area age 2064. Thank you. Health Serv Res. September 29, 2021. but it is unknown whether there are differential effects for smokers or those living in high surcharge states. Additionally, the elimination of the individual mandate has led to a decrease in enrollment, We then asked respondents to select all reasons they did not enroll in a marketplace plan. Weston gives this example: Say, for instance, your health insurance benefits cost the company $1,000 a month. The Affordable Care Act brought dramatic changes to the individual and small group health insurance premiums still, the use of tobacco by a person can affect the price one pays for the health coverage. Finally, we supplemented our main findings with qualitative data from a survey that provides more contexts for how tobacco surcharges may influence enrollment in nongroup plans. Please email us if you would like to suggest a revision. To be in full compliance with the ERISA wellness incentive rules, wellness programs that impose a tobacco surcharge on employees who use tobacco must pass a 5-factor test. Finally, we gathered data on tobacco surcharges from the CMS Health Insurance Exchange Public Use Files for 2015 and 2019. 4 Data comes from a June 2019 online survey of tobacco users using Qualtrics Research Panel collected and analyzed by the authors. Because tobacco surcharges are changing over time, this specification also allowed us to include state fixed effects. Youth access to tobacco law-RCW 70.155: Prohibits the sale and distribution of tobacco products to minors. The Potential and peril of health insurance tobacco surcharge programs: evidence from Georgias state employees health benefit plan, https://www.kff.org/other/stateindicator/individualmarketraterestrictionsnotapplicabletohipaaeligibleindividuals/, https://www.cms.gov/files/document/4120healthinsuranceexchanges2020openenrollmentreportfinal.pdf.

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