Families

1. Families • Families with lower incomes will be affected because they will not be able to afford health insurance. Therefore, when they do go to the hospital, they will be sicker and will require more treatment Individuals • The individual stills holds the right to smoke without having a surcharge. • Individuals will be held to the same premiums as others and not discriminated against because they smoke. Health care/Insurance • Smokers are less likely to have insurance which affects both the individual and the health care/insurances. INTRODUCTION IMPACT Health insurance companies began having the authority to apply surcharges to smokers after the Affordable Care Act was signed in 2010. This surcharge discriminated against smokers causing a higher premium or co-pay. Surcharges do not help smokers quit smoking because they find ways around the charges. Also, some smokers will not get insurance in order to opt out of paying the premium. According to Michelle Andrews (2013), “there is no evidence that charging a higher premium will stop them from smoking, but it might discourage them from getting health insurance.” Therefore, there are more reasons to cut the surcharge than to keep it. The surcharge causes more harm than it does good. STAKEHOLDERS The federal health care overhaul gives the states the option of allowing insurers that participate in the online health care exchanges to charge higher premiums to smokers—up to 50 percent higher than the standard rate (McDonald, 2013). Advocates for the poor and minorities also say that smokers’ surcharges is unfair, as it disproportionately will affect those populations since they are more likely to smoke and less likely to have employer-provider health insurance (McDonald, 2013). Dianne Phillips states “we don’t want to create more barriers to quitting, making it more expensive might put that insurance coverage out of their reach. The surcharges singles out smokers in a punitive way” (Toland, 2013). Jennifer Singletary of the American Lung Association states “the American Lung Association opposes the use of tobacco surcharges on health insurance for two main reasons: it’s not a proven way to help smokers quit and they can make health insurance unavailable for tobacco users” (Gordon, 2013) Banzhaf estimates that the smokers surcharge will increase health insurance costs by up to $12,00 annually per smoker (Gordon, 2013) Some critics say Wal-Mart’s surcharge may have the effect of forcing people to opt for less expensive plans or persuade them to drop coverage altogether. Dr. Kevin Volpp, the director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute at the University of Pennsylvania, pointed out that surcharges and stringent health targets might wind up endangering those whose health was already at high risk. “There is this potentially very significant set of unintended consequences,” he said(Abelson, 2011, p. B1). EVIDENCE IMPLEMENTATION Some benefits to having specialists available to smokers is that the smokers would become healthier. However, some may not have transportation available to utilize the services available for them. Health insurance companies would have to make sure they have transportation available through the use of social work or asking the patient if he or she has someone who could possibly drive them. This plan would benefit many, and it would not be difficult for policy makers to implement it into health care. They could offer incentives for patients who participate. Policy makers would also have to change the law that is enforced with the Affordable Care Act. EVALUATION Health insurance companies could require a yearly physical to determine if the services they offer are being utilized or working. This would also provide information about the patient to help determine if any other services need to be rendered. Respiratory specialists could also provide a summary report of the visits to the health insurance companies to update them on the smoker’s condition whether it is getting better or worse. If smoker are not discriminated against for smoking, then they would be able to have insurance. The cost of insurance and the surcharges are a huge barrier for smokers and insurance. "The effect of the smoking (penalty) allowed under the law would be that lower-income smokers could not afford health insurance," said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan research group that called attention to the issue with a study about the potential impact in California (NewsMax). If more smokers had insurance, then they would not wait until they are extremely sick to go to the hospital to get help. This would impact both the patient and hospital because it would not cost as much for either if the patients came earlier and had preventative care. Also, if patients received preventative care, it would impact the economy because their health care services would not cost as much. Families that are penalized with the smoking surcharge are typically poorer families which causes more hardship for these particular families. If they were not charged with the surcharge, they would have more money to take care of their families. The surcharge impacts the economy in many ways from the individual to the family to the hospital. Cutting the surcharge would have a huge impact on poor families and could potentially have a huge impact on the economy and health care. The smokers would be able to afford health insurance and utilize health care services as they are intended to be used. For smokers, health insurance companies could offer a different policy for them, so they could still afford to have insurance. The policy would help them quit if they wanted to do so and provide them with the opportunity to go to respiratory specialists if they are having problems. Health insurance companies should offer help to smokers instead of penalizing them for a lifestyle choice they have made. If health insurance offered help to them and provided more opportunities for prevention instead of charging them a surcharge, more smokers would have insurance. With the opportunity for patients to have a respiratory therapist available for their use, smokers could become healthier. Health insurance companies could provide incentives to those who participated in the services they offer. This would encourage more smokers to engage in preventative care and wellness programs. Some potential problems would be transportation and compliance with the services offered to smokers. SOLUTIONS ARRON HERRING NUR 4030 SURCHARGES FOR SMOKERS