
Dr. Ernest Dorilas
Georgia State University, GeorgiaTitle: Tobacco surcharges associated with reduced ACA marketplace enrollment
Abstract
The Affordable Care Act (ACA)
allows insurers to charge tobacco users who have nongroup coverage up to 50
percent more than nonusers of tobacco. In this study we used 2014–19
administrative data on enrollees in the
federally facilitated ACA Marketplace, HealthCare.gov, to examine the
relationships among surcharge rates, total Marketplace enrollment, and
enrollment by tobacco users. We found that the tobacco surcharge rate averaged
approximately 14 percent and that it was associated with lower total enrollment
as well as a reduced share of total enrollees who reported any tobacco use. Our
analysis also found that tobacco surcharges have a significantly larger effect
on tobacco users’ share of enrollment in rural areas than in urban areas, which
may in turn contribute to urban-rural health disparities. Given that tobacco surcharges
may decrease Marketplace enrollment overall and shift the composition of
enrollment away from tobacco users, our findings suggest that reducing tobacco
surcharges may increase total Marketplace enrollment.
Biography
To be updated