Smokers, forced to pay more for health insurance, can get help with quitting

Seventy percent of smokers say they’d like to quit, and now, just three days into the new year, many may already be struggling to stick to their resolution to make 2012 a smoke-free year. If quitting were easy, after all, chances are good that nearly one in five adults wouldn’t still be smokers, a figure that hasn’t budged much in several years.

Smoking is such a familiar health hazard that some experts say it doesn’t get the attention it deserves; the focus is often on other lifestyle-related conditions, especially obesity. But smoking is still the No. 1 cause of preventable death in this country. Nearly half a million people die prematurely because of smoking-related illnesses, including lung cancer, heart disease and chronic obstructive pulmonary disease, according to the Centers for Disease Control and Prevention.

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Most smokers need some sort of assistance to quit, whether it’s counseling, support groups or medication to help reduce nicotine cravings. But getting that help can be difficult.

Scrambling to address budget problems, states this year will spend less than 2 percent of their tobacco-tax and tobacco-settlement billions on programs to help people quit smoking or prevent them from starting, according to a recent report by a coalition of public-health organizations. In the past four years, state spending on tobacco prevention and cessation has declined by 36 percent, to $457 million.

Tobacco-related health-care spending is nearly $100 billion annually, according to the CDC.

“It’s a travesty,” says Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids. “These programs more than pay for themselves.”

Carrots and sticks

While public funding falters, a growing number of companies offer smoking-cessation programs to their workers. Last year, two-thirds of companies with 200 or more workers offered such programs, while 31 percent of smaller companies did so, according to the Kaiser Family Foundation’s annual survey of employer-sponsored health benefits. (Kaiser Health News is an editorially independent program of the foundation.)

At the same time that they offer a helping hand to quit, more companies are also penalizing employees who don’t kick the habit by hitting them with higher health insurance premiums.

At firms with more than 20,000 employees, 24 percent vary premiums based on whether someone smokes, as do 12 percent of companies with 500 or more workers, according to the 2011 survey of employer-sponsored health plans by human resources consultant Mercer.

Public-health advocates generally agree that this punitive approach isn’t ideal. “The issue isn’t smokers; it’s smoking,” says McGoldrick. Charging people higher premiums may just make smokers drop their coverage, he says.

But employers argue that charging smokers more is fair. “The cost of medical care for smokers is considerably higher,” says Helen Darling, chief executive of the National Business Group on Health, an employer group. “Employers are increasingly saying that if someone costs the pool more, they should pay more.”