ATLANTA—Nearly half of small businesses that levied tobacco surcharges from their employees failed to offer tobacco cessation counseling as required by law, Georgia State University economist Michael Pesko and his coauthors found in the first study to look at tobacco surcharges in the small-group marketplace since the Affordable Care Act (ACA) took effect.
In 2016, 16 percent of small businesses used tobacco surcharges, with 47 percent of these businesses failing to provide the required tobacco cessation counseling. Another 14 percent of the employers who used tobacco surcharges did so in states that don’t allow them.
Pesko and his colleagues—Jaskaran Bain at Weill Cornell Medical College, (Johanna) Catherine Maclean at Temple University and Benjamin Lê Cook at Harvard University—found employers in the service and blue-collar industries, as well those with a larger percentage of older workers, were more likely to be noncompliant with ACA rules concerning when tobacco surcharges can be levied.
The ACA allows employer insurance plans in the small-group marketplace to charge tobacco users up to 50 percent more for premiums – the tobacco surcharge – if the employer offers a tobacco cessation program in which the employee fails to participate. Pesko and his colleagues reviewed 2016 survey data on nearly 300 small business employers to evaluate the prevalence of tobacco surcharges and tobacco cessation programs.
“The ACA no longer permits health insurers to set premiums based on health status, but setting premiums based on tobacco use, which could be a legal proxy for health status, remains allowable,” said Pesko, an assistant professor in the Andrew Young School of Policy Studies. “The lack of enforcement of the wellness program requirement of the law is unfortunate for tobacco users, who could be charged more for using tobacco without being provided with access to resources to quit.”
Cigarette smoking remains the leading cause of preventable death in the United States, causing more than 480,000 deaths a year. The authors conclude that enforcement of ACA wellness programs should be improved to increase access to tobacco cessation wellness programs for eligible tobacco users.
The article, “Nearly Half Of Small Employers Using Tobacco Surcharges Do Not Provide Tobacco Wellness Programs,” was published in the March issue of Health Affairs, a peer-reviewed journal in health, health care and policy.
Michael (Mike) Pesko is a health economist and an Assistant Professor at Georgia State University. Dr. Pesko’s research focuses on evaluating health policy changes, especially those affecting tobacco users.