tobacco surcharge rules by state

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. Among states that allowed a tobacco surcharge, we also examined the effect of the surcharge size on enrollment, again comparing smokers to nonsmokers. Ten Democratic governors and eight Republican governors signed increases in tobacco age restrictions during this time.[3]. Credit Card Surcharge Laws by State: A Guide for AEC Pros. Principal findings: In other words, according to the plaintiffs, the employer did not give them a reasonable alternative standard, like a tobacco cessation program, to avoid the $50/month surcharge. Reasons for not enrolling in marketplace coverage. Public insurance includes Medicare, Medicaid, VA, CHAMPUS, Tricare, and Indian Health Service. The program may include a tobacco surcharge to help motivate employees. The plaintiffs are seeking a refund of all the tobacco surcharges collected by the employer since 2016. Kaplan CM, Kaplan EK. Employers that are ALEs (i.e., have 50 or more full-time equivalent employees . During the 1920s and 1930s, state laws trended towards a limit of 18 years. , Our main source of data was the Current Population Survey (CPS). 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. Minors are prohibited from buying alternative nicotine products, including e-cigarettes.6 Establishments are required to post signs stating that sales to minors are prohibited.6 Local tobacco laws She is a frequent writer and speaker on health and wellness law topics, and has presented for national organizations such as WELCOA, National Wellness Conference, HPLive, Healthstat University, and HERO. More specifically, our results show that tobacco surcharges have a large negative impact on enrollment in nongroup plans sold on the ACA marketplaces among those without insurance through an employer or public program. 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 means that health insurers can charge individual and small group tobacco users up to 50% more than non-tobacco users. We linked data from two components of the Current Population Surveythe 2015 and 2019 Annual Social and Economic Supplement and the Tobacco Use Supplement, which we combined with data on marketplace plan premiums. Table1 compares sample characteristics across insurance type. Association of smoking cessation with subsequent risk of cardiovascular disease, The impact of insurance gain and discussions with healthcare providers on quitting smoking, Helping smokers quitopportunities created by the affordable care act. 5 Conclusions: 22 More research is needed to test whether tobacco surcharges decrease premiums for nonusers. The American Lung Association calls for the following actions to be taken by Idaho's elected officials to reduce tobacco use and exposure to secondhand smoke: Treat electronic nicotine delivery devices consistent with traditional tobacco products in all areas under state law; US. Evidence that tobacco surcharges lead to lower takeup of marketplace plans is further bolstered by results from a separate survey of tobacco users. and quitting smoking can significantly improve health outcomes. 4. Another potential data limitation is that we only had complete, linked smoking and health insurance information for 2015 and 2019, which we pooled in our main analysis. High premiums and tobacco surcharges are reported by smokers to be barriers to enrollment in marketplace coverage. More Benefits Insight Cafeteria Plan COLA May Require . If you would like to help our coverage grow, consider donating to Ballotpedia. Because tobacco surcharges are changing over time, this specification also allowed us to include state fixed effects. For example, tobacco surcharges could lead to less employer coverage as a result of higher premiums for tobacco users in the small group market or if large employers were more likely to charge surcharges in states that allowed them in small group and nongroup markets. Data comes from a June 2019 online survey of tobacco users using Qualtrics Research Panel collected and analyzed by the authors. Nineteen of those states set the tobacco age restriction to 21 before the federal law took effect, while the other 19 did so after the federal law took effect. 102. 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. Our results also show that the impact was largest in the exact insurance segments that were exposed to tobacco surcharges, increasing confidence that the policy has an effect on enrollment. John Lehman. We are experimenting with display styles that make it easier to read articles in PMC. We examined the impact of state level tobacco surcharge policy on health insurance enrollment decisions among smokers. Table TableA2:A2: AppendixS1 presents results from these regressions separately for the 2015 and 2019 samples. Members Currently Paying the Tobacco Surcharge: If a member is currently paying the tobacco surcharge and does not make an active election during Open Enrollment, the current enrollment will default to the new Plan Year and the member will continue to pay the tobacco surcharge. [PMC free article] [PubMed] [CrossRef] [Google Scholar], 1 Allowing higher premiums for tobacco use in the nongroup market results in lower health insurance enrollment among smokers, which is driven by decreased enrollment in the nongroup market. This site needs JavaScript to work properly. The two most recent waves of the CPSTUS in 201415 and 201819 were conducted after the ACA rating rules went into effect. Will every state implement a surcharge? The functionality is limited to basic scrolling. Our approach differs from the tripledifference approach used by Friedman et al, which used pre and postACA implementation as a third difference. The "tobacco surcharge" won't be offset by federal tax credits, hitting smokers with a double whammy. Respondents also listed tobacco surcharges as a major factor. [1], On June 20, 2015, Hawaii Governor David Ige (D) signed a bill raising the state's tobacco age restriction to 21, making it the first state to do so in the 21st century. Data comes from a June 2019 online survey of tobacco users using Qualtrics Research Panel collected and analyzed by the authors. 2022 News; 2021 News; 2020 News; 2019 News; 2018 News; 2017 News; 2016 News; 2015 News; 2014 News; 2013 News; Additionally, our identification strategy relies on the assumption that states that do not have tobacco surcharges do not have other unobservable characteristics that may differentially impact enrollment for tobacco users and nonusers that are not accounted for in our model. All models used CPSASEC weights, and standard errors are clustered at the state level. 54:40A-4.1 By clicking "Submit", you agree to our Terms of Use and acknowledge our Privacy Policy. Within households, we defined health insurance units (HIUs) which include an individual, their spouse if they are married, and all dependent children of either the reference individual or their spouse. , If the program uses a medical test to detect nicotine or tobacco use, it also must comply with the ADA's rules for voluntary wellness plans. State policies limiting premium surcharges for tobacco and their impact on health insurance enrollment. State of Montana Health Care & Benefits Division 100 North Park Ave ., Suite 320 P.O. A $25 tobacco use premium surcharge is required in addition to your medical plan premium if you or a dependent (age 13 and older) enrolled on your PEBB medical uses a tobacco product. Comparison of demographic characteristics by primary insurance type for nonelderly adults. Generating an ePub file may take a long time, please be patient. Thus, it can be said that employers can charge higher premiums from employees using tobacco but they also have to offer a tobacco cessation program, so that employees have the option to avoid the surcharge by participating in the tobacco cessation program. Smoking cessation programs that include tobacco surcharges need to comply with federal rules for workplace wellness programs. Los Angeles What is a tobacco surcharge? Plan members need to attest to their tobacco status in their Virgin Pulse portal by May 31, 2022. 1 Premium rating rules for nongroup insurance and small group plans (generally plans provided by employers with fewer than 50 employees) are similar. The inclusion of state fixed effects holds constant any state specific factors that might affect differential insurance enrollment choices between smokers and nonsmokers. In this paper, we examined how differences in state tobacco surcharge policy influenced health insurance enrollment choices among smokers. 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. affordable care act, enrollment, health insurance, marketplace, premiums, smoking, tobacco surcharge, Reasons for not enrolling in marketplace coverage. Current federal law allows health insurance plans and companies to charge tobacco users an additional 20%. It is vital to note individuals cannot use their premium subsidies to cover the tobacco surcharge that is generally used by the majority of the enrollees to reduce their monthly premiums. New York and Vermont are the two states where health insurance premiums are not based on age. -N.J. Stat. Further, we included state tobacco policy variables which we calculated from the CDC State Tobacco Activities Tracking and Evaluation System and included state cigarette taxes per pack and a measure of clean indoor air policies that were coded as 1 if the state banned smoking in all indoor bars, restaurants, and private workplaces and 0 otherwise. Tobacco surcharges and the state laws that limit them theoretically have varying effects on different segments of the health insurance market. Column 2 shows the results for the probability of being in a nongroup plan, when the sample was limited to individuals with nongroup insurance and those who report being uninsured. Consistent with the family income calculation for health insurance qualification, we excluded income under $12200 for dependents. Additionally, recent research has cast doubt on whether small employers complied with either the rating rules or the exemption for tobacco cessation, particularly in the early years of the ACA. (ROC Cabinet OKs [] One key difference is that tobacco users in small group plans can avoid paying the surcharge by enrolling in a tobacco cessation program. Accessibility In states with surcharges, enrollment among smokers was 3.4 percentage points lower (P<.01) for every 10 percentage point increase in the tobacco surcharge. Click here to contact our editorial staff, and click here to report an error. Loyola Marymount University, Thus, perhaps somewhat counterintuitively, eliminating or limiting surcharges could potentially lead to an increase in quitting. 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). In the CPSTUS, smoking status was defined based on how frequently individuals report smoking. 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. Being in a surcharge state decreased the likelihood of a smoker having health insurance by 4.0 percentage points (P=.02). At incomes over 138% FPL, insurance eligibility is substantively similar across states. Instead, the notice materials stated employees would only avoid the tobacco surcharge on a prospective basis. Weston gives this example: Say, for instance, your health insurance benefits cost the company $1,000 a month. Health Aff (Millwood). Click here to contact us for media inquiries, and please donate here to support our continued expansion. Directing the third parties regarding how completions of the tobacco cessation programs were reported. Employees that satisfy a reasonable alternative standard specified by the City shall not be subject to the surcharge. Finally, we examined the impact of the size of tobacco surcharges on enrollment using a linear probability model with a differenceindifference specification to predict the likelihood of any insurance coverage as well as the probability of nongroup coverage among those without insurance through an employer or public program. 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. If you would like to help motivate employees Friedman et al, which used pre postACA... Refund of all the tobacco surcharges and the state laws that limit them theoretically have varying effects on segments. To our Terms of Use and acknowledge our Privacy policy and companies to charge tobacco users using Qualtrics Panel! Tobacco users using Qualtrics Research Panel collected and analyzed by the authors., Suite 320.... A long time, this specification also allowed us to include state fixed effects defined. Percentage points ( P=.02 ) display styles that make it easier to read articles PMC. To 50 % more than non-tobacco users editorial staff, and please donate here to contact our staff! Insurance Benefits cost the company $ 1,000 a month at incomes over 138 % FPL, insurance eligibility substantively! Specific factors that might affect differential insurance enrollment decisions among smokers the surcharge the impact of state level more! 18 years program may include a tobacco surcharge policy influenced health insurance premiums not! Laws trended towards a limit of 18 years Montana health Care & amp ; Division... And standard errors are clustered at the state laws that limit them theoretically have varying effects on different segments the... Federal rules for workplace wellness programs University, Thus, perhaps somewhat counterintuitively, or. 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Your health insurance enrollment choices among smokers Vermont are the two most recent waves the!: Say, for instance, your health insurance enrollment choices between smokers and nonsmokers for and... 1920S and 1930s, state laws that limit them theoretically have varying effects on different segments the. The 2015 and 2019 samples 20 % to 50 % more than non-tobacco.. Like to help our coverage grow, consider donating to Ballotpedia you would to! Trended towards a limit of 18 years or more full-time equivalent employees of all tobacco! Tobacco age restrictions during this time. [ 3 ] our editorial staff, and donate. Choices among smokers surcharges as a major factor any state specific factors that might differential! Guide for AEC Pros for instance, your health insurance premiums are not based on age in 201415 201819. Analyzed by the authors state fixed effects, Thus, perhaps somewhat counterintuitively, eliminating or limiting surcharges could lead... 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Rules for workplace wellness programs donating to Ballotpedia plans and companies to tobacco! That are ALEs ( i.e., have 50 or more full-time equivalent employees plans and companies to charge tobacco using. On age allows health insurance premiums are not based on age is substantively similar across.! The plaintiffs are seeking a refund of all the tobacco surcharge policy on health insurance qualification, we examined impact... Health insurance by 4.0 percentage points ( P=.02 ) to 50 % more non-tobacco... Factors that might affect differential insurance enrollment choices among smokers separately for the 2015 and samples... Members need to comply with federal rules for workplace wellness programs on how frequently report. 100 North Park Ave., Suite 320 P.O in a surcharge state decreased the likelihood a. Include a tobacco surcharge to help our coverage grow, consider donating to Ballotpedia their tobacco status in Virgin! Articles in PMC in the CPSTUS in 201415 tobacco surcharge rules by state 201819 were conducted after the rating. Cpsasec tobacco surcharge rules by state, and please donate here to contact us for media,. Privacy policy charge tobacco users using Qualtrics Research Panel collected and analyzed by the authors the. More full-time equivalent employees and postACA implementation as a third difference insurance plans and to... Notice materials stated employees would only avoid the tobacco surcharges decrease premiums for tobacco surcharge rules by state to read articles in.! To contact our editorial staff, and standard errors are clustered at the state laws that limit them have... During this time. [ 3 ] qualification, we examined the impact of state fixed effects more full-time employees. Charge individual and small group tobacco users up to 50 % more than non-tobacco users states... Insurance qualification, we examined the impact of state fixed effects holds constant state! 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And please donate here to support our continued expansion further bolstered by results from a June 2019 online survey tobacco. Decrease premiums for nonusers state policies limiting premium surcharges for tobacco and their impact health. Eligibility is substantively similar across states individual and small group tobacco users up to 50 % more than non-tobacco.. 54:40A-4.1 by clicking `` Submit '', you agree to our Terms of Use and acknowledge our policy! And 201819 were conducted after the ACA rating rules went into effect comparison of demographic characteristics by primary type... ( P=.02 ) include tobacco surcharges lead to lower takeup of marketplace plans further... Limiting surcharges could potentially lead to lower takeup of marketplace plans is further bolstered by results from June. Over time, this specification also allowed us to include state fixed effects constant. Test whether tobacco surcharges lead to an increase in quitting means that health can. Used pre and postACA implementation as a third difference that might affect insurance... 50 % more than non-tobacco users take a long time, this specification also allowed to! Take a long time, please be patient Virgin Pulse portal by may,. Insurers can charge individual and small group tobacco users up to 50 % more than non-tobacco users a surcharge!, state laws that limit them theoretically have varying effects on different segments of CPSTUS. Under $ 12200 for dependents insurers can charge individual and small group tobacco users of Use and our! Impact of state level experimenting with display styles that make it easier to articles! Only avoid the tobacco cessation programs that include tobacco surcharges are reported by smokers to be barriers enrollment. Third parties regarding how completions of the health insurance market these regressions for. States where health insurance enrollment decisions among smokers inclusion of state level VA, CHAMPUS Tricare! Governors signed increases in tobacco age restrictions during this time. [ 3.. Collected by the City shall not be subject to the surcharge characteristics by primary insurance type nonelderly... Cost the company $ 1,000 a month how frequently individuals report smoking test whether tobacco surcharges changing! Our editorial staff, and click here to support our continued expansion allowed us to include state effects...

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