Most smokers want to quit. But how to nudge them in that direction is up for debate.
The health law allows new individual and small group health plans to charge smokers up to 50 percent higher premiums next year.
Small group plans (at companies that employ up to 100 people) can boost smokers' rates only in if plans also offer a wellness program aimed at helping people quit. But men and women insured through plans on the individual market don't get the same protection.
In recent years, as medical costs related to obesity, diabetes and other chronic conditions have skyrocketed, more employers have adopted wellness programs to try to stem the increases. About half of employers with 50 or more workers offered a wellness program in 2012, according to a study published earlier this year by Rand Health and conducted for the federal government. Among those that offered lifestyle management programs, more than three-quarters offered one related to smoking cessation.
In the individual market, however, wellness programs are rare. The Affordable Care Act provides for a demonstration project in 10 states to introduce wellness programs in the individual market, but it hasn't been implemented yet.
"In the individual market you don't have a workplace, and so the ability to avoid the [tobacco] rating increase by participating in a wellness program is not an option," says Dick Woodruff, vice president of federal relations for the American Cancer Society Cancer Action Network.
In some states, however, it won't be an issue. Six states and the District of Columbia have opted not to implement the smoking surcharge at all, according to the Department of Health and Human Services. A handful of others will limit the premium differential to less than 50 percent.
Andrews is a reporter with Kaiser Health News, a nonprofit news service.