Mass. Blocks Higher Insurance Charges For Most Smokers

You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S.

And, it’s expensive.


The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses.

The federal Affordable Care Act says insurers can charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. “In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether to make smokers pay more for health insurance has created some unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

“First of all there is very little evidence that financial incentives or disincentives through premiums change behavior,” says Amy Whitcomb Slemmer, executive director at Health Care for All.

Her group and others in the public health world routinely support higher taxes for smokers. But Whitcomb Slemmer says she’s worried that higher insurance premiums will lead many smokers to drop their coverage.

“We were concerned that more would pay the penalty to not be insured,” Whitcomb Slemmer continues. “And, specifically, we’d be concerned that they (smokers) wouldn’t have access to what has been demonstrated to be very effective smoking cessation programming.”

In Massachusetts, Vermont, Rhode Island and the District of Columbia, this public health perspective has won the debate — for now. Insurers will not be allowed to add a surcharge for smokers. The Patrick administration says it’s open to considering this action in the future — if insurers come up with more accurate ways to determine who smokes and who doesn’t.

But there’s a twist. Insurers in Massachusetts have been able to hike premiums for smokers since the state passed its landmark health care law in 2006 (the one used as a model for the federal law). But almost no one is doing that.

“The idea here is that we try to moderate premiums for the entire market, not seek to target particular populations or individuals because of certain behaviors,” says Eric Linzer, senior vice president at the Massachusetts Association of Health Plans.

The ban on higher charges for smokers will apply to about half of Massachusetts residents who have insurance through their employer. Large employers, who follow federal insurance rules, will be able to target smokers, if they choose.

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  • Max

    Smokers have been subsidizing non-smokers for decades through egregious taxation. I don’t hear these preening stuck up democrats complain about that since they can keep taxes relatively lower on other things that non smokers enjoy. Anyway, it looks like non smokers will subsidize smokers at least for the first year which makes me very happy, since you idiots voted for this. Made your bed now lie in it.

  • J__o__h__n

    continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.” – incent is just as bad as incentivize, try again.

  • J__o__h__n

    We charge bad drivers more for insurance. Why not the same for smokers? The fact that car insurance is required is always mentioned as a reason for mandatory health insurance and should be applicable on this too.

  • Lisa V

    Why should people who don’t do drugs have to subsidize care for addictions? Why do people who eat healthy and exercise have to subsidize care for diet related illnesses? Why do people who practice safe sex have to subsidize care for sexually transmitted diseases? Why do people who don’t have children have to subsidize care for pregnancy and childbirth? Why do careful people have to subsidize care for reckless risk takers who get injured? Where do you draw the line??

    The bottom line is that EVERYONE deserves the same quality of healthcare!

    Fix the “for excessive profit” insurance companies and health care facilities and stop going after the little guys!

    • David F

      Lisa none of those you mentioned in your first paragraph should be subsidized by others who do not make the same choices. Just as you wouldn’t want to pay higher car insurance rates to subsidize bad drivers. It’s a choice, people need to be responsible for their choices and if that means paying more for insurance then so be it.

      You do not have a right to free healthcare and you don’t have a right to have others pay for your irresponsibility.

    • KC

      Lisa V is absolutely correct. Why should I subsidize for the diabetic who makes poor food choices or the overweight person who has high blood pressure because of their weight?

  • David F

    Why should non-smokers be forced to subsidize the health insurance of smokers? If you choose to take a greater risk then you should pay a higher premium. Just as those who live inland shouldn’t have to subsidize the home owners insurance for those choosing to live in coastal flood regions.

    Insurance premiums should be based on the risks you choose to take, be it where you live or how you choose to live. I will pay higher car insurance premiums if I get speeding tickets. That’s reasonable, it should be that way across the board for all insurance.

  • Jeff D

    No, I don’t think smokers should be singled out and demonized by the health insurance industry. The astronomical cost of health care in the USA is due to unspeakable corruption and greed within the insurance and health care industries. Reform the system with some real governmental regulation (or, better yet, a single-payer system like most other countries have) and we will all benefit. No need to lay the blame on the innocent. That’s exactly the type of diversion from their own practices that the corporate powers would want. And, by the way, I do not smoke and have never smoked.

  • J. Ferreira

    As smoking is a choice by the smoker, then there is absolutely every reason to demand an additional fee on smokers. Unlike those who have genetically pre-determined health issues over which they have little control, smoking-related health problems should not be financially borne by everyone else. If they don’t want to pay a ‘Smokers surcharge,” stop smoking or be denied health coverage AND health care. That may sound heartless, but when it comes to preventable health issues, this is one area where there should be little tolerance by the public for subsidizing poor choices.