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DC Exchange Bars Insurers From Charging Higher Premiums to Smokers

Monday, April 8, 2013
The Board cites the impact on low-income residents as a concern.

The DC Health Benefit Exchange (HBX) Executive Board today voted to prohibit health insurance companies from charging higher premiums to smokers and tobacco users. The action followed testimony by patient and public health advocates opposing a premium surcharge for smokers. An estimated one in five DC residents use tobacco regularly, with rates especially high among African Americans (30.8%).

The Affordable Care Act, the nation’s health reform law, allows states to permit as much as a 50 percent surcharge for people who have used tobacco at least four times a week over the last six months. Several national organizations – including the American Cancer Society and the American Lung Association – have opposed imposing such a surcharge, noting the potential impact on individuals and families with relatively low incomes. With today’s action, the District joins several other states to prohibit a tobacco use surcharge.

“Tobacco use is a pre-existing medical condition and a central tenet of our health reform efforts is to open the health insurance market to millions of people who have been shut out due to their health,” said Mohammad Akhter, M.D., chair of the HBX Board. “Charging smokers significantly more for health insurance is in direct conflict with our efforts to help people quit smoking.”

The Executive Board’s action follows recommendations by the HBX Standing Advisory Board, which includes a broad array of stakeholders.  The federal health law also requires health insurance companies to provide full coverage with no-cost sharing for smoking cessation services. Board members expressed their strong support for making consumers and their health care providers aware of those benefits.

For more information about the approved policies, visit