Obamacare Won’t Solve Massachusetts’ Tobacco Problem

Increased premiums for smokers aren't enough to make people quit.


Image credit: Wikimedia Commons

Massachusetts anti-tobacco advocates are worried that the state’s progress in curbing tobacco use might be coming to a halt. In January, the New England Center for Investigative Reporting published an article saying that Massachusetts has diverted millions originally pegged for smoking cessation programs in order to offset the budget deficit. In interviews, local experts worry that  as smoking cessation programs lose strength, the state will not be able to rehabilitate smoking addicts, even as we make them pay more to support their habit.

At first glance, it seems that the concerns of anti-tobacco advocates are outdated. We have some of the strongest state laws in the nation regarding tobacco products and already low smoking rates in Massachusetts. New nation-wide Affordable Care Act stipulations, which go into effect next January, now include higher health insurance premiums for smokers. According to Obamacare, health insurance providers are able to charge smokers up to 50 percent more for healthcare premiums, making smoking an increasingly expensive habit. All this might suggest that smokers will all but vanish in the near future.

The reality isn’t so simple.

There is little doubt that money plays a role in how many cigarettes people buy. Nikysha Harding, director of the Tobacco Control program at the Boston Commission of Public Health says, “Any time Massachusetts does a tax hike on tobacco, we always see a heightened interest in cessation services and we do see that smoking rates go down in conjunction with increased pricing of tobacco.”

Raising tobacco prices won’t deter everyone, however. Goods that spur addiction don’t quite fit into the typical supply and demand curve. Addicts aren’t nearly as responsive to price differences, so economic incentives can’t be the sole basis of any state tobacco control program. Even those responsive to either anti-tobacco marketing campaigns or the economic incentives often require the help of cessation programs to actually quit. And it’s those cessation programs that are having trouble finding funding in the state’s current budget.

Greg Connolly, professor at the Harvard School of Public Health, maintains the importance of a comprehensive health policy that covers various facets besides providing economic incentives. Connolly says, “In regard to tobacco control, there’s no silver bullet—[it’s] made up of political leadership, very strong mass media, working it into the school system, and providing smokers with smoking cessation services.”

Connolly, who believes that the Affordable Care Act’s increased premiums only pay for the damages caused by smoking, has little faith in its ability to actually prevent that damage.

His belief is supported by the fact that some healthcare providers in Massachusetts already charge smokers higher premiums, but the new disincentives have not seen an accompanying decline in smoking rates. Marc Hymovitz, director of government relations and advocacy at the Massachusetts American Cancer Society, fears that an increase in premiums could do more harm than good, preventing lower-income smokers from gaining access to smoking cessation programs.  “It may seem like it’s a no brainer, but there is no evidence that shows [increasing insurance premiums] reduces smoking rates—what reduces it is tobacco control programs and increasing the price of tobacco products,” said Hymovitz.

All that means that even as Obamacare creates incentives to quit, without the cessation programs that help those who decide smoking is too expensive a habit, the new policy measures might be ineffective.