Kaplan CM, Kaplan EK. Tobacco products means any product made with or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product. WebRequire tobacco product retailers to obtain a license; Repeal the tobacco surcharge in healthcare premiums to increase access to tobacco cessation services; and Increase the cigarette tax by at least $1.00 per pack and create parity between the tax on cigarettes and other tobacco products. 
These are just some of the legal considerations employers should explore before adopting a tobacco user surcharge. Joint Acknowledgment/Disclosure Statement: This study was funded by a grant from the American Cancer Society (RSGI1723401CPHPS). Tobacco Surcharge Policies and Instructions. Clipboard, Search History, and several other advanced features are temporarily unavailable. Web2 Theoretically, tobacco surcharges could lead to lower premiums for nonusers, which could potentially lead to higher enrollment among that group.
WebTobacco Surcharge Policies and Instructions. Some call this difference in health insurance premium amounts a premium differential or a tobacco use surcharge.. 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. Proponents of tobacco surcharges argue that higher premiums for tobacco users could lead to lower premiums for nonusers, increase insurer participation, and create an incentive for tobacco users to quit. Columns 3, 4, and 5 show results limiting the sample to individuals with incomes above 138% FPL, which includes those who have incomes too high to qualify for Medicaid under the expansions, but who are eligible for subsidies in the marketplaces and are thus more likely to be affected by tobacco surcharges. However, if banning surcharges is not feasible, policy makers might consider limiting surcharges to below the 50% federal cap. 8 There has been a flurry of activity lately involving employer wellness programs that impose a tobacco surcharge on health insurance.
4. **, Founder and President, Center for Health and Wellness Law, LLC. 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). 2) use tobacco and be subject to the surcharge. 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. This finding was robust across a variety of specifications. These legal requirements include ACA, Americans with Disabilities Act (ADA), and other civil rights laws considerations. 64C increased to $3.51 per pack.
This blog post is for informational and educational purposes only. 18% said that having to pay more for premiums due to tobacco use was a reason that they did not enroll, and 7% said it was the main reason they did not enroll. 1 Tobacco use premium surcharge. All regressions are weighted using the appropriate weights from the Current Population Survey. Due to the sampling design of CPS, all households from CPSASEC can theoretically be linked to the CPSTUS in either January or May of 2015 or 2019.
Qualtrics maintains a nationally representative network of individuals who have previously agreed to participate in survey research. The CPS is a nationally representative, longitudinal survey that follows households over the same four consecutive months for two consecutive years (ie, four months on, eight months off, four months on). Under the Affordable Care Act (ACA), group health plans (and self-insured employers) can charge tobacco users up to 50% more for their health insurance premiums than non-tobacco users, and when they do this it is called a tobacco surcharge. Most exchange plans charge lower tobacco surcharges than allowed, but many tobacco users lack affordable coverage. Relative risk ratios from multinomial logit regression on type of health insurance plan. The plaintiffs in this case allege that the employer failed to notify employees of a reasonable alternative standard. We examined the impact of state level tobacco surcharge policy on health insurance enrollment decisions among smokers. All regressions are weighted using the appropriate weights from the Current Population Survey. Employers who financially penalize tobacco users miss an opportunity to help them, which is why the ACA reasonable alternative and reasonable design requirements are so crucial in a successful tobacco cessation program. If the reasonable alternative standard is a digital tobacco cessation program, the plan must make the program available, and may not require the individual to pay for the cost of the program.
Health-contingent programs are further divided between activity-only and outcomes-based programs. 6.Should employers be concerned about state smoker The plaintiffs are seeking a refund of all the tobacco surcharges collected by the employer since 2016. Premium rating rules for nongroup insurance and small group plans (generally plans provided by employers with fewer than 50 employees) are similar. Impact of allowing a state surcharge on enrollment in a health insurance planresults from differenceindifference linear probability model. 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. In states that allow tobacco surcharges, tobacco users pay substantially higher premiums for nongroup health insurance than nonusers. Get involved today by raising funds and awareness in your community. Would you like email updates of new search results? Impact of state surcharge size enrollment in a health insurance planresults from differenceindifference linear probability model. Another potential consideration is the effect of tobacco surcharges on nonusers. Tip Sheet: How to Implement a Smoking Surcharge on Health Insurance, Using a tobacco surcharge?
Allowing a tobacco surcharge reduced insurance enrollment among smokers by 4.0 percentage points (P=.01). 21 In addition to the RRRs shown, all regressions control for sex, age, age squared, race, family size, education, log family income, state Medicaid expansion status, state federal marketplace use, state cigarette taxes, clean indoor air laws, and year (2015 vs 2019). Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Finally, we ran a model using a definition of tobacco use closer to the definition used for enrollment in the ACA, which includes the use of other noncigarette tobacco products. ,
In order to focus on health insurance coverage among individuals most likely to be affected by tobacco surcharges, we made several sample exclusions. The lawsuits also teach us that wellness programs must not only offer a reasonable alternative standard but must make sure that anyone who completes that reasonable alternative standard qualifies for the entire reward for that plan year. Discrimination under the ADA includes requiring medical examinations and making disability-related inquiries, including medical history inquiries, unless 1 of 2 exceptions applies: (1) such exam or inquiry is job-related and consistent with business necessity; or (2) the medical exam is voluntary and part of an employee health program available at the worksite. FOIA 1 Therefore, if a tobacco cessation program is offered through a group health plan, the ACA incentive maximum of 50% of the total cost of employee coverage applies to those programs.
Study design: All models used CPSASEC weights, and standard errors are clustered at the state level. State tobacco surcharge policy may have a substantial impact on whether tobacco users choose to remain insured and consequently their ability to receive care critical for preventing and treating tobacco-related disease. In addition to the coefficients shown, all regressions control for sex, age, age squared, race, family size, education, log family income, state Medicaid expansion status, state federal marketplace use, state cigarette taxes, clean indoor air laws, and year (2015 vs 2019). Finally, we gathered data on tobacco surcharges from the CMS Health Insurance Exchange Public Use Files for 2015 and 2019. We compared insurance enrollment in states that did and did not allow tobacco surcharges, using a difference-in-difference approach to compare the policy effects among smokers and nonsmokers. Instead, the employer gave employees only two options: 1) dont use tobacco and avoid the surcharge; or. This table presents estimates from a differenceindifference linear probability model, examining the likelihood of the outcome of interest for smokers in surcharge states. Consistent with the family income calculation for health insurance qualification, we excluded income under $12200 for dependents. We assigned primary coverage to each respondent based on the following hierarchy: Medicare, employer, nongroup, Medicaid, other public, and uninsured. FOIA First, we used data that link detailed health insurance information including plan type with tobacco use data, which allowed us to examine the impact of tobacco surcharges on enrollment decisions for each market segment, rather than just the likelihood of being insured in any health insurance plan.
Setting up a tobacco surcharge may seem straight forward but for it to be effective, you need to be strategic.
We compared insurance enrollment in states that did and did not allow tobacco surcharges, using a differenceindifference approach to compare the policy effects among smokers and nonsmokers. If that is how employees feel, they may be compelled to complain to the EEOC that the companys wellness program violates the ADA. After calculating AGI, we excluded adults over 65 since they would likely be covered by Medicare. Because tobacco surcharges are changing over time, this specification also allowed us to include state fixed effects. We limited the sample to individuals in states with tobacco surcharges, comparing the impact of the size of the average tobacco surcharge on differences in insurance coverage between smokers and nonsmokers. 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. Bethesda, MD 20894, Web Policies Recent evidence has suggested that premiums for tobacco users have increased at a faster rate than premiums for nonusers. What is a tobacco surcharge? 15
Readers are encouraged to seek legal counsel for any advice or compliance determinations needed on specific situations. Learn 4 tips for making your tobacco cessation program more successful. The survey included tobacco users age 1864 with incomes above 138% FPL who reported being uninsured or insured through a marketplace plan.
Evidence that tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by results from a separate survey of tobacco users. Notably, smoking rates were higher among those without health insurance than those with nongroup coverage. Evidence Suggests That The ACA's Tobacco Surcharges Reduced Insurance Take-Up And Did Not Increase Smoking Cessation. government site.
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Marketplace Premiums Rise Faster For Tobacco Users Because Of Subsidy Design.
Employees are hiring attorneys who are familiar with the wellness incentive rules under the Employee Retirement and Income Security Act (ERISA) and are challenging employer wellness programs that are allegedly not in full compliance. Column 1 shows the effect of tobacco surcharges on the differences in insurance rates between smokers and nonsmokers for the full sample of nonelderly adults. WebCredit Card Surcharge Laws by State. Before PMC
