Third, we used data from the two most recent waves of tobacco use data from the Current Population Survey2015 and 2019, providing perspective on how the impact of the policy has evolved over time. These limits may not be binding in all cases, as many plans charge less than the maximum allowed, and there is substantial geographic variation in the amount of the sucharge. Americans Make Use of your Health Coverage Even while Being Healthy. (May 13, 2013) On May 9, 2013, that the Executive Yuan (Cabinet) of the Republic of China (on Taiwan) approved amendments to the Tobacco and Alcohol Tax Act and to the Tobacco Hazards Prevention Act that, if they become law, would, respectively, increase the taxes and the health surcharge on tobacco products. Employees are eligible for a discount/incentive at least once a year. State fixed effects were included in columns (2) and (4) include state fixed effects; however, they did not substantially affect the results. The Market Rules and Rate Review Final Rule (45 CFR Part 147) provides that each state will have age rating ratios of 3:1 using a federally established age curve, tobacco rating ratios of no more than 1.5:1 and per member rating unless a state requests ratios less than the standard, is a community rating state with uniform family tiers, or allows for averaging . The .gov means its official. Although third parties helped administer the tobacco cessation program for Macys, Macys had ultimate control of the wellness program, including: Because of these alleged violations, the DOL is asking the court for the following relief (in relation to the wellness program violations): Also in November 2021, a federal district court in Missouri certified a class action of 1500 casino workers who alleged, similar to the Macys case, that their employer violated ERISA with its tobacco surcharge. 7 Kaplan CM, Kaplan EK. , 2020 Sep;39(9):1540-1545. doi: 10.1377/hlthaff.2020.00015. 18. Alternatively, a state may require that the tobacco use surcharge be calculated as a share of the consumer's subsidized premium (instead of from the unsubsidized price, as under the default rules). The interaction terms between surcharge state and current smoker show the key differenceindifference results. Among states that allowed a tobacco surcharge, we also examined the effect of the surcharge size on enrollment, again comparing smokers to nonsmokers. On May 20, 2019, Sen. Mitch McConnell (R) introduced a bill which would increase the tobacco age restriction to 21 at the federal level. It does not apply to dependents covered under the medical plan. The health insurance premiums are low for people under the age of 21, and there is a cap of three times the rates that apply to a 21-year old. The nationwide average pre-subsidy premium in 2020 is about $576 per month for health plans sold in the exchange. Other important reasons for not enrolling included not knowing about the marketplaces and/or not knowing how to enroll (19% main reason, 29% a factor), believing they were not eligible (8% main reason, 16% a factor), coverage not meeting needs including provider networks or benefits (3% main reason, 14% a factor), not needing health insurance (8% main reason, 11% a factor), or missing the enrollment period (4% main reason, 8% a factor). Table TableA1:A1: AppendixS1 presents summary statistics by insurance type separately for the 2015 and 2019 samples. Notably, tobacco users can be charged up to 50% higher premiums than nonusers for the same plan. State policies limiting premium surcharges for tobacco and their impact on health insurance enrollment. Arkansas limits it to 20%, and Kentucky limits it to 40%. Comparison of demographic characteristics by primary insurance type for nonelderly adults. Approximately every four years, the CPS includes a Tobacco Use Supplement (CPSTUS), which asks questions about smoking and tobacco use. Click here to contact us for media inquiries, and please donate here to support our continued expansion. The lawsuits also teach us that wellness programs must not only offer a reasonable alternative standard but must make sure that anyone who completes that reasonable alternative standard qualifies for the entire reward for that plan year. State of Montana Health Care & Benefits Division 100 North Park Ave ., Suite 320 P.O. The American Cancer Society opposed the tobacco rating provision during the congressional debate about the health-care law. Income eligibility for assistance under the affordable care act: technical memorandum on estimates for nonelderly adults. States that prohibit tobacco surcharges completely are California, Massachusetts, New Jersey, New York, Rhode Island, Vermont, and Washington, D.C. Connecticut also prohibits tobacco surcharges, but only for health plans sold in the state's health insurance exchange (Access Health CT). , Table TableA3:A3: AppendixS1 presents results excluding individuals under 26 and classifying tobacco use as the use of any tobacco product rather than cigarettes only. to not pay the monthly surcharge) for 2023. Tobacco users will pay a surcharge for their health plan coverage beginning July 1, 2022. This paper contributes to a small existing literature on the impact of tobacco surcharge laws on health insurance enrollment. Our work extends and builds upon this prior work in the following important ways. Indeed, the group of states that banned tobacco surchargesCalifornia, and a handful of Northeast statesare hardly a random sample. County populations were pulled from the 2014 and 2018 American Community Survey annual county level estimates and aggregated up to the rating area level. Our main source of data was the Current Population Survey (CPS). Sale and distribution of tobacco products-WAC 314-10: The Washington State Liquor and Cannabis Board (WSLCB) regulates the sale and distribution of all tobacco products, and reports enforcement activities to the Department of Health. Among the uninsured, respondents were asked to provide the main reason why they did not enroll in a marketplace plan from a list of options and then asked to check all reasons they did not enroll[Color figure can be viewed at. Jun 28, 2013. , Table TableA2:A2: AppendixS1 presents results from these regressions separately for the 2015 and 2019 samples. All plans offered on the marketplace adhere to the ACA tobacco surcharge restrictions; however, more than half of nongroup plans offered outside of the marketplaces are not ACA compliant. The surcharge is an extra charge on your health plan if you're a tobacco user or for those who don't partake, they may receive a discount. Thursday, Feb 7 2013 Assembly Bill Would Block ACA Tobacco Surcharge Last week, Assembly member Richard Pan (D-Sacramento) introduced a bill ( AB 1X2) that would block an Affordable Care Act provision that allows insurers to charge smokers with an individual policy up to 50% more in premiums from being implemented in California. , We are experimenting with display styles that make it easier to read articles in PMC. In August 2017, the United States Department of Labor (DOL), which enforces compliance with ERISA, sued Macys, Inc. as well as its third-party administrators for its self-insured health plan: Anthem Blue Cross Life and Health Insurance Company and Cigna. We compared insurance enrollment in states that did and did not allow tobacco surcharges, using a difference-in-difference approach to compare the policy effects among smokers and nonsmokers. September 29, 2021. An employer cannot set a deadline by which an employee can no longer use tobacco. In plan years 2011 and 2012, the program failed to offer employees a reasonable alternative standard and notice of that reasonable alternative standard. The $25 surcharge (per person, per pay) applies to employees and spouses covered under the Einstein health plan. The most common options include (i) HSA, HRA or FSA contributions; (ii) a decrease in employee contributions toward medical coverage (often referred to as a tobacco surcharge); and (iii) cash, gift cards or entries into a prize drawing. 8 The DOL alleged that Macys tobacco cessation program violated the ERISA wellness program incentive rules for numerous reasons. This Ballotpedia article is in need of updates. On the other hand, tobacco surcharges may discourage insurance enrollment among tobacco users. Massachusetts has many laws that govern tobacco: Tobacco excise taxes. Albeit, the use of tobacco for religious or ceremonial purposes are excluded from the rule. but it is unknown whether there are differential effects for smokers or those living in high surcharge states. The challenges and successes of each state's fight against tobacco use, and tobacco prevention efforts. Compliance Overview: Tobacco Surcharges Legal Rules April 30, 2019 By Lesa M. Votovich As employers continue to show more interest in adding wellness programs to their employee benefit plans, they must also be cognizant of any federal and/or state laws that could impact the components of these programs. CarterHarris L, Slaven JE Jr, Monahan PO, SheddSteele R, Hanna N, Rawl SM. You may notice problems with Overall, this study found that tobacco surcharges led to significantly lower enrollment in nongroup health insurance among smokers. They found that 16 percent of the 278 small employers used tobacco surcharges, yet 47 percent of those companies failed to offer tobacco cessation counseling. Allowing a tobacco surcharge reduced insurance enrollment among smokers by 4.0 percentage points (P = .01). 4 Data comes from a June 2019 online survey of tobacco users using Qualtrics Research Panel collected and analyzed by the authors. Please email us if you would like to suggest a revision. Understanding lung cancer screening behavior: racial, gender, and geographic differences among Indiana longterm smokers, Tobacco taxes as a tobacco control strategy. , In other words, according to the plaintiffs, the employer did not give them a reasonable alternative standard, like a tobacco cessation program, to avoid the $50/month surcharge. USA, 2 Smokers living in states with high tobacco surcharges are less likely to have health insurance. Marketplace Premiums Rise Faster For Tobacco Users Because Of Subsidy Design. All State Health Plan members (employee only) must complete the tobacco attestation in order to eliminate the default surcharge of $60 a month for 2023. . We then took the mean of the median surcharge across all rating areas in the state weighted by the population of the rating area age 2064. We examined the impact of state level tobacco surcharge policy on health insurance enrollment decisions among smokers. 64C increased to $3.51 per pack. The https:// ensures that you are connecting to the We coded respondents as current smokers if they reported now smoking cigarettes either every day or some days. This definition is slightly different from the definition used to apply the tobacco surcharge, which is the use of tobacco products four or more times, on average, per week within the past six months. We used the narrower definition, considering only cigarette smokers because cigarette smokers make up most of the population of every day tobacco users Although state tobacco rating rules typically do not apply to large employers, it is possible that there are spillover effects. Premium rating rules for nongroup insurance and small group plans (generally plans provided by employers with fewer than 50 employees) are similar. All regressions are weighted using the appropriate weights from the Current Population Survey. Box 200130 Helena, MT 59620-0130 Data collection: Cameron M. Kaplan, PhD and Erin K. Kaplan, PhD. Health Aff (Millwood). Jay Inslee (D) on April 5, 2019, Washington's tobacco age restriction was set to increase from 18 to 21 on January 1, 2020. FOIA The survey included tobacco users age 1864 with incomes above 138% FPL who reported being uninsured or insured through a marketplace plan. Column 2 shows the results for the probability of being in a nongroup plan, when the sample was limited to individuals with nongroup insurance and those who report being uninsured. Under a law signed by Gov. Last updated January 6, 2022 , and state law. Another potential data limitation is that we only had complete, linked smoking and health insurance information for 2015 and 2019, which we pooled in our main analysis. The 2019 ASEC included variables that specifically identify marketplace coverage, so we examined whether the effect is driven by those with marketplace plans using the 2019 data only. Colorado limits the tobacco surcharge to 15%. and text messages is not a condition for purchase. tobacco surcharge rules by state. , Ten Democratic governors and eight Republican governors signed increases in tobacco age restrictions during this time.[3]. While these rules may be frustrating to employers, ignoring them is not worth a lawsuit by the DOL. The ACA requires that all health insurance plans provide tobacco cessation and lung cancer screening with no outofpocket costs. In states with surcharges, enrollment among smokers was 3.4 percentage points lower (P<.01) for every 10 percentage point increase in the tobacco surcharge. Our estimates indicate that the probability that a smoker had insurance decreases by 3.4 percentage points (P<.01) relative to nonsmokers for a 10 percentage point increase in the size of the tobacco surcharge. The DOL alleged that this refusal to refund or credit participants for the tobacco surcharge even if they met a reasonable alternative standard violated the ERISA requirement that the full reward be available to all similarly situated individuals of a wellness program. State government tax collections by source, State spending by function as a percent of total expenditures, Financial regulation in the United States, Education statistics in the United States. While in most states a tobacco surcharge is permitted, the rules have become quite complex. In states that allow tobacco surcharges, tobacco users pay substantially higher premiums for nongroup health insurance than nonusers. Since 2014 the Affordable Care Act has permitted employers and insurance companies to charge tobacco users up to 50% more in premiums. Pesko MF, Maclean JC, Kaplan CM, Hill SC. Tobacco surcharge may also be incorporated in the employer-sponsored health plans that can increase the standard premium by up to 50% unless a state has implemented a lower tobacco surcharge. In states with surcharges, enrollment among smokers was 3.4 percentage points lower (P < .01) for every 10 percentage point increase in the tobacco surcharge. All columns are derived from a single multinomial logit regression, and each column presents the relative risk ratios (RRR), comparing the risk of being in the insurance type of interest and being uninsured. Finally, we examined the impact of the size of tobacco surcharges on enrollment using a linear probability model with a differenceindifference specification to predict the likelihood of any insurance coverage as well as the probability of nongroup coverage among those without insurance through an employer or public program. Tobacco surcharges and the state laws that limit them theoretically have varying effects on different segments of the health insurance market. Our insurance expert will call you soon. 23 The functionality is limited to basic scrolling. Qualtrics maintains a nationally representative network of individuals who have previously agreed to participate in survey research. Age The health insurance premiums are based on an individuals age, as older people are charged higher premiums compared to younger people. The Affordable care Act allows health insurers to charge a 1.5-to-1 ratio for tobacco use. Most states, however, follow the federal law and allow insurers to impose tobacco surcharges of up to 50% but employer wellness programs must follow certain rules for those surcharges to be legal. Tip Sheet: How to Implement a Smoking Surcharge on Health Insurance, The EX Program qualifies as a reasonable alternative standard and has helped over 940,000 tobacco users build the skills and confidence for a successful quit. The plaintiffs in this case allege that the employer failed to notify employees of a reasonable alternative standard. Table1 compares sample characteristics across insurance type. Tobacco surcharges on 2015 health insurance plans sold in federally facilitated marketplaces: variations by age and geography and implications for health equity, Marketplace premiums rise faster for tobacco users because of subsidy design, Putting policy theory to work: tobacco control in California, Most exchange plans charge lower tobacco surcharges than allowed, but many tobacco users lack affordable coverage, Health insurance surcharges for tobacco use declined among small employers in 2018: an analysis of trends in small employer tobacco surcharges and cessation programs, Nearly half of small employers using tobacco surcharges do not provide tobacco cessation wellness programs, Evidence suggests that the ACAs tobacco surcharges reduced insurance takeup and did not increase smoking cessation. Health Aff (Millwood). 83 votes, 182 comments. We measured individual and household characteristics to be used as covariates in our regression models from CPSASEC. As additional robustness checks, we also examined subsamples including individuals with incomes between 138% FPL and 400% FPL, who are most likely to qualify for subsidies and those older than 25 who no longer qualify for dependent coverage. US. The ERISA wellness incentive laws have been in effect in their current form since 2013, which is a long time to get into compliance. [4] On December 20, 2019, President Donald Trump (R) signed H.R. All models used CPSASEC weights, and standard errors are clustered at the state level. The survey included tobacco users age 1864 with incomes above. If dependents (such as spouses and/or dependent children) may participate in the wellness program, the reward must not exceed 30 percent (or 50 percent) of the cost of the coverage in which an employee and any dependents are enrolled. Third Party Administrators (TPAs) that make payments to hospitals and ambulatory surgical centers on behalf of one or more insurance carriers (not self-insured plans) must file an annual electronic report with the HSN. 2 Our final sample used pooled data from CPSASEC in 2015 and 2019 and included 106711 nonelderly adults. We hypothesized that there would be lower enrollment among smokers, relative to nonsmokers, in states that allowed tobacco surcharges compared to states that outlawed rating by tobacco use. You also agree that: (i) [InsureMeNow] may share your personal information with its third-party When it recently extended Indiana's Medicaid waiver for three years, the Centers for Medicare and Medicaid Services (CMS) let the state raise monthly premiums for Medicaid enrollees who smoke. Tobacco users can . Specifically, our model compares the insurance status of smokers to nonsmokers across states with and without tobacco surcharges. Access to insurance and health care may be particularly important for tobacco users because they are at higher risk of developing numerous chronic health conditions and because all health insurance plans are required to provide tobacco cessation as an essential health benefit with no outofpocket costs. Another potential consideration is the effect of tobacco surcharges on nonusers. Tobacco Use People who use tobacco can be charged up to 50% more than the people who dont use tobacco. 9 5 Figure1 shows the results from our survey of uninsured tobacco users with incomes above 138% FPL. Health Aff (Millwood). 3 Michael F. Pesko, Georgia State University. Second, we separately estimated the effect of both the existence and the size of the tobacco surcharge, that is, whether allowing a tobacco surcharge influences insurance enrollment, and how the size of the surcharge implemented by insurers effects enrollment. [PMC free article] [PubMed] [CrossRef] [Google Scholar], 1 Standard errors, clustered at the state level are shown in parentheses. 2022 Mar;41(3):398-405. doi: 10.1377/hlthaff.2021.01313. Plan members need to attest to their tobacco status in their Virgin Pulse portal by May 31, 2022. One important limitation of our study is that although we compare enrollment rates by smoking status, smoking status is not experimentally varied across groups. Proponents of tobacco surcharges argue that higher premiums for tobacco users could lead to lower premiums for nonusers, increase insurer participation, and create an incentive for tobacco users to quit. Download our quit-smoking calendar and tip sheet for creative ideas on how and when to promote quitting tobacco to maximize engagement. Rate: 35% of the wholesale purchase price; Both cigarettes and other tobacco products are subject to the 4.5% state sales tax rate plus the general municipal sales tax rates when sold at retail. Members Currently Paying the Tobacco Surcharge: If a member is currently paying the tobacco surcharge and does not make an active election during Open Enrollment, the current enrollment will default to the new Plan Year and the member will continue to pay the tobacco surcharge. Descriptive statistics from linked CPSASEC and CPSTUS data pooled across 2015 and 2019. Thus, perhaps somewhat counterintuitively, eliminating or limiting surcharges could potentially lead to an increase in quitting. Beginning January 1, 2014 health insurance plans and employers will be able to charge up to 50% more. 8 Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Most exchange plans charge lower tobacco surcharges than allowed, but many tobacco users lack affordable coverage. [12] Under a law signed by Gov. 7 In November 2021, the Ohio District Court ruled that the DOLs case can move forward with the alleged tobacco surcharge violations for plan years 2011-2013. A few years back it was discovered by a Health Affairs analysis that more than 16% of the small employers were using tobacco surcharge, and about half of them were not offering a tobacco cessation program. sharing sensitive information, make sure youre on a federal Yep, among other crappy changes we just found out to our insurance, starting in 2014, as supervisors employed at UPS, we will have to pay $150 a month pre-tax if we or a spouse who is also enrolled in United Healthcare through UPS uses: tobacco products such as: cigarettes, cigars, pipe tobacco, chewing or dipping . Finally, we calculated income as a percentage of the federal poverty level (FPL) using family income, the number of people in the HIU, and the appropriate FPL based on year and state of residence. Consistent with the family income calculation for health insurance qualification, we excluded income under $12200 for dependents. State Specific Rating Variations. The plaintiffs state that the law requires the full reward be available upon completion of the reasonable alternative standard, which means the plaintiffs would be entitled to a refund of the $50/month penalty that they had already paid during that plan year. 19 Nearly Half Of Small Employers Using Tobacco Surcharges Do Not Provide Tobacco Cessation Wellness Programs. This table presents estimates from a differenceindifference linear probability model, examining the likelihood of the outcome of interest for smokers in surcharge states. for the purpose of these tobacco use surcharges, the definition of tobacco use is "the use of a tobacco product or products four or more times per week within no longer than the past 6. Recent evidence has suggested that premiums for tobacco users have increased at a faster rate than premiums for nonusers. Among those who would be able to purchase health insurance through the marketplaces but chose to remain uninsured, the tobacco surcharge was reported as a major factor in the decision. , The Affordable Care Act allows insurers to charge up to 50% higher premiums to tobacco users, making tobacco use the only behavioral factor that can be used to rate premiums in the nongroup insurance market. The ACA's individual mandate in retrospect: what did it do, and where do we go from here? It is worth noting that the relative risk ratio for the interaction term was marginally significant for employer sponsored health insurance. Alabama's tobacco age restriction had been above 18 since at least the 1960s. Even though we wont know the final outcomes of either case described above for a while, we can still draw lessons from these cases. Health Aff (Millwood). Ballotpedia features 393,617 encyclopedic articles written and curated by our professional staff of editors, writers, and researchers. [14] However, the state's tobacco age restriction was raised to 21 in December 2019 by federal law. prevent or reduce tobacco use) of the cost of employee-only coverage under the plan. . Column 1 shows the effect of tobacco surcharges on the differences in insurance rates between smokers and nonsmokers for the full sample of nonelderly adults. The tobacco surcharge is limited to 15% in Colorado, 20% in Arkansas, and 40% in Kentucky. Setting up a tobacco surcharge may seem straight forward but for it to be effective, you need to be strategic. Standard errors, clustered at the state level are shown in parentheses. At incomes over 138% FPL, insurance eligibility is substantively similar across states. Learn 4 tips for making your tobacco cessation program more successful. We compared insurance enrollment in states that did and did not allow tobacco surcharges, using a differenceindifference approach to compare the policy effects among smokers and nonsmokers. Smokers could find themselves burned by the Affordable Care Act. Los Angeles PMID: 35254928 DOI: 10 . 2 Since the ACA allows states to set their own policy regarding tobacco surcharges, it is one aspect of the ACA that may be more amenable to modification, especially during times when partisan divide in congress makes it difficult to amend federal regulations. Alaska increased its tobacco age restriction from 16 to 19 in 1988. **, Founder and President, Center for Health and Wellness Law, LLC. 17117 individuals opened the survey, and 1034 qualified for and completed the survey. Thus, a family of five will pay a higher monthly premium compared to a family of three. The first law in the United States regulating the sale of tobacco by age was passed in New Jersey in 1883 and set a minimum age of 16. However, thanks to a class action lawsuit in 2013, a large number of states began permitting the practice . The Office on Smoking and Health conducts and supports national and international surveys on tobacco use, smoking cessation, secondhand smoke exposure, and other tobacco-related topics among youth, adults and specific populations. It is currently unclear what amount of incentive is permissible under these ADA rules. The Affordable Care Act allows insurers to charge up to 50% higher premiums to tobacco users, making tobacco use the only behavioral factor that can be used to rate premiums in the nongroup insurance market. Instead, the employer gave employees only two options: 1) dont use tobacco and avoid the surcharge; or. By limiting the sample respondents in states with tobacco surcharges, we were able to estimate the effect of the size of the surcharge on insurance enrollment. Help expand Ballotpedia's elections coverage - volunteer with us. Additionally, tobacco users in a small business may be able to avoid the penalty by participating in a tobacco cessation program through . Tobacco. Further, smokers without insurance through an employer or public program were 9.0 percentage points less likely (P<.01) to enroll in a nongroup plan if they were subject to a tobacco surcharge. Among other requirements, in order for a tobacco surcharge to be permissible, the employer must offer a reasonable alternative to obtaining the reduced premium. Due to a "ObamaCare smoking glitch" where programmers couldn't get the charge to calculate correctly the tobacco surcharge wasn't implemented until 2015 in many states. This means that health insurers can charge individual and small group tobacco users up to 50% more than non-tobacco users. Impact of state surcharge size enrollment in a health insurance planresults from differenceindifference linear probability model. The first law in the United States regulating the sale of tobacco by age was passed in New Jersey in 1883 and set a minimum age of 16. [13] However, the state's tobacco age restriction was raised to 21 in December 2019 by federal law. In order to aggregate surcharge data to the state level, we first computed the median surcharge in each marketplace rating area by calculating the ratio between the plan premiums offered to tobacco and nontobacco users for a 45years old. Within households, we defined health insurance units (HIUs) which include an individual, their spouse if they are married, and all dependent children of either the reference individual or their spouse. The California Complementary Legislation (or "directory law"), Revenue and Taxation Code section 30165.1, requires the Attorney General to publish a directory of tobacco product manufacturers and brand families of cigarettes and roll-your-own tobacco that are lawful for sale in California. Additionally, the fact that the inclusion of state fixed effects in our model of the impact of surcharge size produced nearly identical results to the same model without state fixed effects gives us confidence that this identification assumption holds. -N.J. Stat. This decision of the ACA lawmakers turned out to be controversial, as some people believed that it is fair to charge higher premiums from tobacco users considering the adverse effect caused by the tobacco to a persons health and the additional cost incurred upon tobacco-related health problems. 13 This option wouldn't change the amount of the federal premium tax credit, a move foreclosed by federal law. Banning tobacco surcharges may be more effective than having a very low tobacco surcharge, since even asking about tobacco use during enrollment could have an effect on enrollment independent of the size of the surcharge. A $50 monthly tobacco surcharge will be applied to employees who declare tobacco usage. Now is a good time to review whether your wellness program is compliant with ERISA and other wellness program laws, including HIPAA, ADA, and GINA. Tobacco surcharges and the state laws that limit them theoretically have varying effects on different segments of the health insurance market. For example, tobacco surcharges could lead to less employer coverage as a result of higher premiums for tobacco users in the small group market or if large employers were more likely to charge surcharges in states that allowed them in small group and nongroup markets. Some of those states later passed a state law raising the state-level tobacco age restriction to 21. State agency staff should ensure employees are aware of the tobacco cessation programs available to them. 2022 News; 2021 News; 2020 News; 2019 News; 2018 News; 2017 News; 2016 News; 2015 News; 2014 News; 2013 News; The CPS is a nationally representative, longitudinal survey that follows households over the same four consecutive months for two consecutive years (ie, four months on, eight months off, four months on). , One key difference is that tobacco users in small group plans can avoid paying the surcharge by enrolling in a tobacco cessation program. Additionally, recent research has cast doubt on whether small employers complied with either the rating rules or the exemption for tobacco cessation, particularly in the early years of the ACA. 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. !function(){"use strict";window.addEventListener("message",(function(e){if(void 0!==e.data["datawrapper-height"]){var t=document.querySelectorAll("iframe");for(var a in e.data["datawrapper-height"])for(var r=0;r Graphic Organizer About La Liga Filipina, Richard Beckinsale House Sunningdale, Closest City In Illinois To Louisville, Ky, Short Run Supply Curve Formula, How Old Is Alec From Shriners Hospital, Credibility Of Broadcast Media, Benjamin Piper, Son Of John Piper,