So it’s not unreasonable that the Affordable Care Act dings smokers more than nonsmokers. Smoking creates predictable, serious, expensive diseases that drive up the nation’s health care costs. Even the tobacco industry conceded the point in the landmark tobacco settlement of 1998.
Still, something is amiss when a just-noticed aspect of the health care law could price older smokers out of the insurance market that the reform law compels them to buy into. The law allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting Jan. 1.
For example, a 55-year-old smoker could pay a penalty of as much as $4,250 a year. A 60-year-old could be slammed with a penalty of almost $5,100. Those figures are on top of the insurance premium itself.
Actuarially speaking, it’s a defensible position. Younger smokers may be a lesser problem, but older ones are likely to become heavy consumers of the health care system quickly. The premium penalty might even prompt some of those smokers to try to quit smoking between now and then.
But as social policy, it’s terrible. Smoking is legal, if unwise, and the government benefits from tobacco taxes. For decades, the industry sold the canard that smoking was safe, addicting millions of people on a product meant to deliver a nicotine fix. Those smokers should have known better, but now they are addicted and, as anyone who has tried to quit could attest, the addiction is fierce.
The law needs to cut those Americans some slack. The Republican budget proposed last year by Rep. Paul Ryan would have fundamentally remade Medicare, but would have exempted anyone 55 or older. Whatever anyone thought about the changes Republicans wanted to make, it was significant that the plan didn’t penalize those who were on the glide path to age 65. To do so would have been socially unfair and politically suicidal.
Similarly, the health reform law needs to allow for a period of adjustment for older Americans, in this case, smokers. It’s not unfair to require them to pay higher premiums, but given their ages and the nature of addiction, it is unfair suddenly to hit them with a huge expense many of them simply cannot afford.
There are other problems, too. Insurers are then incentivized to price older smokers out of the market so they don’t have to pay to treat their illnesses. Lower-income smokers, in particular, would be unable to afford health insurance, said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan research group.
The federal law allows states to limit or change the smoking penalty. Washington should have gotten this right from the start – Republicans and Democrats, alike, can take the blame for that failure – but New York needs to act. It can allow the penalty to rise with the passage of years, but it is unfair, without warning or grace period, to implement a penalty that could bankrupt Americans who bought Big Tobacco’s lie.