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The Washington Post: Who still smokes in the United States — in seven simple charts

By Brady Dennis
Cigarette smoking among U.S. adults has fallen to the lowest rate in generations, according to data released Thursday by the Centers for Disease Control and Prevention. That’s good news, considering that smoking still accounts for about 480,000 deaths annually in the United States, along with an estimated $300 billion in health costs and lost productivity.
But the CDC numbers also offer an interesting glimpse at the 17 percent of adults who continue to light up. People in the Midwest, for instance, smoke more on average than Americans elsewhere in the country. People on Medicaid are more than twice as likely to smoke as those on Medicare. Adults with a GED certificate smoke at eight times the rate of those with graduate degrees. Asians smoke less than other ethnic groups. Men smoke more than women, but not by much.
Here are seven charts, based on CDC data, that detail the current landscape of smoking in the United States:
1) Half a century ago, more than two of every five adults were smokers. But that has fallen steadily over time. From 2005 to 2014, the adult smoking rate declined from 20.9 percent to 16.8 percent. Public health officials are hoping to to drive that rate below 12 percent by 2020.
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2) Cigarette smoking has fallen sharply among 18- to 24-year-olds. In fact, the percentage of smokers in that age group dropped by nearly a third over the past decade, CDC data show,  the sharpest decline of any group. But that striking change might be attributable, at least in part, to the growing popularity of e-cigarettes, hookahs and other “non-cigarette tobacco products,” CDC officials said.
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3) People with lower levels of education tend to smoke at higher rates. The new data also show that smoking among people with graduate and undergraduate degrees has fallen more sharply over the past decade than among most other groups.
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4) Smoking among multiracial people and those classified as American Indian or Alaska Natives (AI/AN) far outpaces that of other ethnic groups. Notably, Asians continue to have the lowest rate of smokers and, along with Hispanics, have cut their smoking rates steeply over the past decade. CDC officials said the disparities across ethnic groups, which are consistent with previous research, might partly be due to cultural differences related to the acceptability of tobacco use.
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5) Midwesterners still smoke at higher rates than anyone else in the country. This was true a decade ago. But Thursday’s data show that while other regions have cut smoking rates by 20 percent or more since 2005, the Midwest’s dropped only 14.4 percent.
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6) U.S. adults who are uninsured or on Medicaid smoke at rates more than double that of people who have Medicare or private insurance. There could be many factors at play here. But health officials said one contributing factor is likely the “variations in tobacco-cessation treatment coverage and access to evidence-based cessation treatments” across different insurance types.
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7) The number of heavy smokers seems to be declining. Between 2005 and 2014, the number of daily smokers dropped from 36.4 million to 30.7 million. Those daily smokers also reported smoking fewer cigarettes over time, from an average of 16.7 a day in 2005 to 13.8 a day in 2014. The number of people smoking more than 30 cigarettes a day fell by almost half.
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https://www.washingtonpost.com/news/to-your-health/wp/2015/11/12/smoking-among-u-s-adults-has-fallen-to-historic-lows-these-7-charts-show-who-still-lights-up-the-most/

Health Insurance Surcharge Has Vapers Fuming

By  via GOOD MORNING AMERICA

Under the Affordable Care Act, insurance companies can charge smokers and other tobacco users up to 50 percent more than non-smokers for a health insurance policy. But where do e-smokers fit in?

E-cigarettes are battery-operated nicotine inhalers that consist of a rechargeable lithium battery, a cartridge called a cartomizer and an LED that lights up during each puff. Although they contain no tobacco, the U.S. Food and Drug Administration plans on regulating them like cigarettes and cigars. This, it turns out, is complicating things for insurance companies.

While the ACA allows insurance companies to charge higher premiums to smokers and other tobacco users, the definition of a “smoker” is unclear under the law.

One way insurance companies could deal with e-cigarettes is to lump them in with tobacco products – a move that would subject so-called vapers to the same higher premiums as cigarette smokers. The companies could also swing the other way and decide to cover the cost of e-cigarettes as a means to help people quit smoking, despite a lack of evidence that the devices work as well as a patch. Insurers could also choose to ignore e-cigs altogether.

”The Affordable Care Act does not specify e-cigarette use for purposes of cessation coverage or tobacco surcharge application,” the American Cancer Society said in a statement to ABC News. “The lack of clarity may allow health plans to try to add the surcharge for e-cigarettes.”

If and when the FDA regulation of e-cigarettes goes into effect, insurance companies could change any of their current policies to reflect the agency’s direction. In the meantime, most companies claim they have too little experience with the devices to have a position, according to an informal poll by the National Association of Health Underwriters.

Carrie McLean, director of customer care for the online health insurance brokerage eHealth, said some insurers are telling their agents to add a smoking surcharge for those who vape.

“If a consumer indicates they use e-cigarettes, the carriers are expecting them to be uprated just as if they are a smoker,” she said, noting that consumers aren’t actually asked about the type of tobacco products they use during the health insurance application process – just whether they use them at all.

America’s Health Insurance Plans, an association which represents most of the country’s large health insurance companies, recommends that agents ask about regular tobacco use in the last six months and the most recent use. However, if a consumer were to ask for clarification about whether or not e-cigarettes count as tobacco use, then an agent is obliged to add the surcharge, McLean said.

“The problem arises because most people fill out their applications online and, as of now, most applications don’t ask specifically about e-cigarettes,” McLean said. “Consumers are left to decide on their own whether or not they consider themselves a tobacco user.”

It’s an important question to settle, as the price differential can be significant.

For example, a plan for a 40-year-old non-smoker with a $35,000 income that costs $3,857 a year minus a $532 tax credit would rise to $5,254 for someone labeled a smoker, according to the Kaiser Family Foundation’s exchange subsidy calculator. In some cases, the rate increase might even be larger than the 50 percent increase the ACA allows because government tax credits only apply to the base premium and not the tobacco surcharge.

Not surprisingly, e-cigarette advocates are fired up about vaping being likened to smoking by insurance companies. Cynthia Cabrera, executive director of the e-cigarette industry organization Smoke Free Alternatives Trade Association, said that e-cigarettes and other vaping products are a healthier lifestyle choice than combustible tobacco cigarettes, and argued that it seems inconsistent to apply the same higher insurance rates to vapers.

“The SFATA does not agree with any policy that positions users of electronic cigarettes and other vapor products in the same category as smokers,” she said. “These products do not emit smoke and do not contain tobacco, tar or any of the many carcinogens known to exist in combustible cigarettes.”

But the phenomenon of vaping is so new that experts say there’s insufficient science to determine whether e-cigarettes really are a healthier alternative to traditional tobacco products.

Dr. Ravi Ram, the chief medical officer for Blue Shield of Northeastern New York, said that although New York has chosen to eliminate rate increases for e-smokers, he suspects most plans would place e-cigarettes on par with cigarettes in terms of their health risk.

“Until you have some long term data and some actuarial differences to health outcomes such as lung cancer, emphysema, heart disease and other conditions which are significantly impacted by smoking, and likely to be impacted by e-cigarettes as well, you have to rate them the same,” he said.

http://abcnews.go.com/Health/health-insurance-surcharge-vapers-fuming/story?id=23628060

 

Affordable Care Act: Smoking sends health premiums higher

BY FRANCINE KNOWLES Staff Reporter

If you light up, prepare to get burned with higher premiums when buying insurance in the new health insurance marketplaces.
Under rules of the Affordable Care Act, in Illinois and most other states, insurers can charge smokers and other tobacco users as much as 50 percent more on their premiums due to the higher health risks they face compared to non-tobacco users.
In some cases, the surcharge wipes out the subsidy for which some smoking health plan enrollees would qualify in the marketplaces, said Karen Pollitz. She is senior fellow at Kaiser Family Foundation, a nonprofit focused on health-care issues.
“So you’d be back up to the sticker price,” Pollitz said. “The tobacco add-on is not covered by the tax-credit subsidies.”
Some insurers have imposed surcharges below 50 percent. Meanwhile Washington D.C. and states, including California, Massachusetts, Rhode Island, and Vermont have prohibited insurers from applying a tobacco surcharge. Other states lowered the maximum surcharge allowed.
There were 1.8 million smokers in Illinois in 2012, or 18.6 percent of adults 18 and older, and nearly 240,000 residents used smokeless tobacco, according to the Illinois Department of Public Health.
Blue Cross and Blue Shield of Illinois, among six insurers in the Illinois Health Insurance Marketplace, imposes a surcharge on tobacco users ranging from 10 percent at age 27 to 32 percent at age 54, according to BCBS spokeswoman Mary Ann Schultz.
“Generally, the effects of tobacco use are cumulative, so the costs increase with the length of time one has used tobacco,” she said in an email explaining the insurer’s rationale for the variance. “Since the length of time someone has used tobacco is reasonably well-correlated with age, the effect is for costs to increase with the member’s age. We don’t see many people in their later years who choose to start using tobacco.”
Coventry Health Care Inc. imposes a 20 percent surcharge on premiums for all smokers above age 21 who purchase insurance in the Illinois marketplace, Coventry spokesman Walter Cherniak Jr. said.
For a 55-year-old smoker choosing a Coventry silver PPO, the monthly cost would be $699.78 compared with $583.15 for a nonsmoker, he said. That’s $1,400 more a year for smokers.
Health Alliance Medical Plans, the insurance arm of Carle Foundation, imposes an 18 percent surcharge, said spokeswoman Kelli Anderson. Tobacco use is defined as using an average of four or more times per week in the past six months, excluding religious or ceremonial use, she said.
Humana Inc., Aetna Inc. and Land of Lincoln Health Inc. Co-op, all impose a 10 percent surcharge on smokers’ premiums, representatives said.
Consumers applying for insurance self-report whether they use tobacco. “They need to check off a box on the form,” said Schultz.
When making a policy purchase, insurance shoppers don’t have to prove whether they use tobacco. But smokers who might consider lying about tobacco use to cut their premium rates should think again.
“If a tobacco user does not check the box, and we later found out through a review of medical records or other reasons that he or she is a tobacco user, that is considered fraud,” Schultz said. “An insurance policy may be terminated if one commits fraud and does not share accurate medical information.”
Humana policyholders would be required to pay the difference in premium, according to spokesman Jeff Blunt.
Tobacco users who buy insurance have access to help in kicking the habit as part of their benefits. All health plans must cover 100 percent of the tab for smoking cessation programs with no co-pay, Pollitz said.
At Humana, members who participate in its smoking cessation programs who become tobacco-free are eligible for plan savings upon renewal, Blunt said.
http://www.suntimes.com/news/metro/23188991-418/affordable-care-act-smoking-sends-health-premiums-higher.html

Smokers and the Affordable Care Act: Q&A

WebMD Health News
By Kathleen Doheny
Reviewed by Lisa Zamosky
The Affordable Care Act has ended some age-old health insurance practices such as denying people with pre-existing conditions. But it does allow insurance companies to charge people who use tobacco 50% more for their premiums.
Supporters say the higher premiums make sense because smokers and other tobacco users have higher health care costs. Critics say the higher rate is more likely to make people lie about their tobacco use or go without coverage than it is to encourage them to quit their habit. Smokers without insurance also put their partners and children at risk.
Here’s what smokers and others need to know.

What does the Affordable Care Act allow insurers to charge tobacco users?

Companies can charge tobacco users up to 50% more. States, though, can mandate a lower percentage or no surcharge.

What is ”tobacco use,” and how is a smoker or tobacco user defined?

Tobacco use is the use of any tobacco product, including cigarettes, cigars, chewing tobacco, snuff, and pipe tobacco, four or more times a week within the past 6 months. (Religious or ceremonial use of tobacco is allowed, such as by Alaska natives or Native Americans). It’s an honor system.

Will every state charge the maximum?

Seven states and Washington, D.C., will not charge smokers higher insurance premiums. The states are: California, Connecticut, Massachusetts, New Jersey, New York, Rhode Island, and Vermont.
Connecticut voted against the higher premiums only for the small group Marketplace, not the individual Marketplace. The other states outlawed higher premiums for both individuals and small business policies.
Three states — Arkansas, Colorado, and Kentucky — will allow companies to charge tobacco users less than 50%.
The remaining states are expected to allow the full 50% additional charge.
The highest possible premiums, though, won’t be effective for the first year because of a limitation in the software systems. That is being fixed.
Tobacco users in a small business plan don’t have to pay the higher premium if they enroll in a quit-smoking program; tobacco users in an individual plan may get a break on the premium if they enroll in a program. The law, however, does not require companies to offer the break in the individual Marketplace.

Will the Affordable Care Act require coverage of quit-smoking programs?

Yes.
The law requires all new private health insurance plans and Marketplace plans to cover services recommended by the U.S. Preventive Services Task Force, with no cost-sharing fees. That includes tobacco cessation treatments.

What will quit-smoking treatments or programs include?

That is unclear.
Insurance companies don’t have a consistent approach to quit-smoking programs, says Erika Sward, a spokeswoman for the American Lung Association. “What we have seen is a patchwork quilt.”
While the Affordable Care Act requires that new plans cover services recommended by the task force, the task force does not give specifics. It recommends that doctors ask adults about tobacco use, provide cessation programs, and provide counseling for women who smoke during pregnancy.
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 aboutmedication 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.”
SOURCES: Erika Sward, spokeswoman, American Lung Association.Susan Pisano, spokeswoman, America’s Health Insurance Plans.Alicia Hartinger, Health and Human Services.U.S. Public Health Services.U.S. Preventive Services Task ForceGallup.