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Smokers in some states will pay more than non-smokers for insurance premiums if they obtain their coverage through new state health exchanges being established as part of the Affordable Care Act. In some cases, smokers’ premiums will be as much as 50 percent higher, according to USA Today.

Supporters of the rule argue smokers should pay more because their health costs are higher, and the steeper premiums may encourage them to quit. Critics say smoking should not be punished, because it is an addiction. They add smokers need insurance because of their health problems, and that there is no evidence higher insurance costs lead smokers to quit.

Currently, 44 states allow insurers to charge smokers higher fees. They also can be charged more for chronic health conditions, according to Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change. After January 1, insurers will not be allowed to charge higher fees for chronic conditions, but they can still charge smokers a penalty for using tobacco.

Low-income smokers may be especially hard hit by the higher tobacco fees, according to Georges Benjamin, Executive Director of the American Public Health Association. “Tobacco disproportionately targets low-income communities,” he said. “They are also more likely to die prematurely from tobacco-related conditions.” They may be charged more at a time when they are dealing with smoking-related illnesses such as lung cancer or chronic obstructive pulmonary disease, he said. He added states should provide smoking cessation assistance, instead of penalizing smokers financially.

American Lung Association Manager Jennifer Singleterry noted the insurance surcharge could cost smokers hundreds or even thousands of additional dollars. “People don’t usually quit when they’re forced to,” she said. “They quit when they’re ready.” She said family members of smokers, who have higher rates of asthma, may also forgo care because of the increased rates.

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