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A smoker holds a cigarette on May 31, 2011 in San Francisco, California. Since 1987, the World Health Organization has celebrated "World No Tobacco Day" to raise awareness to the health risks associated with smoking tobacco. Smoking is the second biggest cause of death globally and is responsible for the death of one in ten adults worldwide.
Obamacare could be expensive for some smokers. Under a provision of the federal health care law, states can allow health plans to charge tobacco users up to 50 percent more for their health insurance premiums. But there is a move afoot to protect California smokers from higher prices.
The provision allowing for a "tobacco surcharge" was designed in part to encourage smokers to quit. But critics say the smokers surcharge is discriminatory, which goes against the spirit of Obamacare.
Not only does the surcharge discriminate, but it can negate the benefits of subsidies offered under the federal health care law, said Karen Pollitz, a senior fellow with the Kaiser Family Foundation.
A low-income person buying a $6,000 policy who qualified for a subsidy might see the price of the policy drop to $3,000, but "the tobacco surcharge would knock it back up to $6,000 again," said Pollitz.
That was the finding of a study published last summer by the Institute for Health Policy Solutions in Washington, D.C. Institute President Rick Curtis wrote the study. He points out that the rate of smoking nationally and in California is highest among lower-income people – who often must juggle several jobs to support their families. The resulting stress, Curtis said, makes breaking the tobacco addiction even harder.
"For somebody who is totally hooked after many years, and older – and those kinds of people often do need more medical care, they have emphysema and so forth – they have two bad choices: go without health insurance and be impoverished that way, or get health insurance and be impoverished," said Curtis.
The Centers for Disease Control puts the nation’s annual price tag for smoking at more than $190 billion in medical care and lost productivity.
State Assemblyman Richard Pan (D-Sacramento) has written legislation that would make California among the first states to ban higher premiums for smokers.
"We want smokers to actually have health care coverage," said Pan. "And through having health care coverage they’ll have access to smoking cessation treatment as well as, of course, health care for not only smoking related but even their non-smoking related illness."
And that seems to make sense to those involved with the issue. Pan says his bill faces no opposition – not from cigarette companies, anti-smoking groups, anti-cancer advocates, or the American Lung Association.
Officials at the Lung Association's California branch said in a statement that because smoking is so hard to quit, it’s essential to provide tobacco users with affordable health insurance, rather than make them pay more for it.