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Health Care Reform:

Health Insurance & Affordable Care Act

Smokers and the Affordable Care Act: Q&A

What will quit-smoking treatments or programs include? continued...

But there are no ''typical'' tobacco cessation programs, according to a survey conducted by Georgetown University researchers.

What's needed, Sward says, is a comprehensive approach. According to the American Lung Association, tobacco cessation benefits should include the choices recommended by the Public Health Service. These include:

  • Nicotine -- from a patch, gum, lozenge, nasal spray, or inhaler
  • Medications -- bupropion (Zyban) and varenicline (Chantix)
  • Counseling -- individual, group, and phone

In one area, the law is specific: It requires that pregnant women on Medicaid be offered the treatments recommended by the U.S. Public Health Service. Those include asking about tobacco use and offering counseling, with no recommendation about medication use in pregnancy.

Who supports higher premiums for tobacco users?

The insurance industry supports higher rates because smokers have much higher health care costs than nonsmokers, according to Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade industry group.

"There is clear documentation of so much greater health care costs [for tobacco users], and we think that should be reflected in the rates," she says.

In 2004, smoking cost the U.S. $97 billion in lost productivity and $96 billion in direct health care costs, or $4,260 per adult smoker, according to the CDC.

More than half of Americans favor charging smokers more for insurance, according to a Gallup poll released in mid-August. 

Who is against higher premiums for tobacco users?

Many health organizations, including the American Lung Association and the American Cancer Society, are against higher rates for smokers and other tobacco users.

The higher premium, besides being discriminatory, may backfire, Sward says.

"We really urge the carrot over the stick approach," she says. "We know smokers want to quit and they need help to do so. It's in everyone's best interest that smokers have access to a good cessation program."

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