Medicaid smokers' surcharge proposed by Utah Representative

Robin Wulffson MD's picture
smoking cessation, lung cancer, helthcare costs, smoking surcharge, medicaid

ST, GEORGE, UTAH - On January 27, Republican Representative Paul Ray proposed a bill went before the Utah House Government Operations Committee, which requested a surcharge on Medicaid, the state/federal program that provides healthcare for low income residents.

He argued that if private health insurers can add a surcharge for smokers, a higher co-pay should also be charged to Medicaid recipients who use tobacco. If the bill passes it could become a first-in-the-nation state law imposing a higher co-payment for tobacco-using residents enrolled in Medicaid.

Medicaid recipients in Utah do not pay premiums; however, some are required to pay up to $5 co-payments for prescriptions or physician visits. According to the American Lung Association, smokers enrolled in Medicaid smoke at a rate 60% greater than the general population. Rep. Ray noted that smokers on Medicaid cost the state $104 million annually. He explained, "If they're paying $7 a day for a pack of cigarettes, they should be able to pay a $2 to $3 co-pay."

Rep. Ray said he believes his proposal is unique among state Medicaid programs. According to a spokesman for the Centers for Medicare & Medicaid Programs, the agency is unaware of any other states that are considering similar legislation. Many private health insurers have applied a surcharge for enrollees that smoke for decades. This surcharge is in recognition of the increased healthcare costs due to smoking.


The American Lung Association opposes the proposed co-payment. Jennifer Singleterry, the association's manager of smoking cessation policy said that there is no evidence that the surcharge would encourage smokers to quit. She argued that it would merely place an added financial burden on low-income smokers on Medicaid. She said, “We feel that this is a punitive measure for smokers."

Not surprisingly, a smokers’ advocacy and property rights organization, Citizen’s Freedom Alliance, Inc., also opposes the legislation. U.S. Director Gary Nolan claimed that anti-smoking legislation can readily pass because smokers are in the minority.

The proposed Utah bill has not been set in stone. It is being modified to include a wellness aspect with a smoking cessation program. Furthermore, Rep. Ray would like to eventually extend the anti-smoking concept to an entire wellness program that would include obesity and alcohol use. At the session, he noted that he plans to bring it back before the committee this week. He added that he does not expect much opposition within the Republican-dominant House and Senate. He explained, "I'm not trying to do this to punish people," he said. "I'm doing this to encourage people to be healthy."

According to the American Cancer Society, quitting smoking includes the following benefits:

  • Twenty minutes after quitting: Heart rate and blood pressure drop.
  • Twelve hours after quitting: The carbon monoxide level in one’s blood drops to normal.
  • Two weeks to three months: One’s circulation improves and lung function increases.
  • One to nine months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that rid the lungs of mucus secretions) begin to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • One year after quitting: The increased risk of coronary heart disease is half that of a continuing smoker.
  • Five years after quitting: The risk of cancer of the mouth, throat, esophagus, and bladder are decreased by 50%. Cervical cancer risk drops to that of a non-smoker. Stroke risk can fall to that of a non-smoker after two-to-five years.
  • Ten years after quitting: The risk of dying from lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx (voice box) and pancreas decreases.
  • Fifteen years after quitting: The risk of coronary heart disease is comparable to that of a non-smoker.

Source: Utah State Legislature

See Also: Cancer doesn't cure smoking, new study reports



In medicaid what is the percentage of surcharge for smokers in insurance.