Should Smokers Pay More for Health Insurance?

Mar 6, 2013

Under the Affordable Care Act, health insurers will be able to charge smokers up to 50% more than non-smokers for health insurance. Fair or not, a Politico article points out how difficult that policy might be to enforce - and not simply because smokers could lie. For instance:

"Insurers can’t toss someone off the health plan in the individual market if they turn out to be a secret smoker. But they can levy the hefty surcharge on smokers if they are discovered to have lied. But in practice, it’s hard to tell who’s a smoker, which in this case is defined as someone who has smoked at least four times a week for the past six months."

Also, what if a smoker intends to quit but doesn't currently have access to a medically sound cessation program? Or what if being charged so much more for health insurance means you can't afford the help you need to stop smoking? Oh, the potential lawsuits.

Rhode Island doesn't have the highest rates of smoking in the U.S., but we still have a lot of smokers who could be affected.

We also have our share of obese people. Should they be charged more? Some people make the argument that because weight is something you can generally change with behavior, the rest of us shouldn't have to shoulder the burden of your inaction. Others say it's not so simple, that obesity is a complicated medical condition not easily tackled with behavior changes alone.

What do you think? Should people who engage in so-called "bad" behavior pay more for health insurance? If they don't, is it fair for others to handle the burden when they need expensive care? Is it even possible to draw the line between "bad" behavior and more complex medical problems? I'd love to hear your thoughts.