Abstract 15711: Association Between State Tobacco Surcharge Policy and Health Insurance Enrollment, Health Care Utilization, and Smoking Cessation Behaviors

Abstract

Introduction: The Patient Protection and Affordable Care Act allows insurers to charge up to 50% higher premiums to people who use tobacco. Several states have outlawed tobacco surcharges or capped the surcharges to lower levels. Evidence on the impact of state policies limiting tobacco surcharges is limited. This study aims to examine the association between state tobacco surcharge policies and individuals’ health insurance enrollment, health care utilization, and smoking cessation behaviors. Methods: This study used data from the Population Assessment of Tobacco and Health (PATH) Study Wave 6 (Mar-Nov 2021). The study sample was adults 18-64 years old who reported smoking cigarettes 20 or more days in the past 30 days (N=4,235). Exposure was living in states limiting tobacco surcharges (outlawed or capped). Outcome variables were currently covered by health insurance, seen a health professional in the past 12 months, intention to quit within 12 months, and any quit attempt in the past 12 months. Single-wave sample weights and balanced repeated replication method were applied to generate representative estimates and variances. Multivariate logistic regressions were used to estimate the associations between exposure and outcomes, controlling for socio-demographic variables, other tobacco use status, and state Medicaid expansion and tobacco control policies. Results: Among study sample, 19.8% (95% CI: 16.0%-24.3%) lived in states limiting tobacco surcharges. Bivariate associations showed that people living in states limiting surcharges were more likely to be covered by health insurance (84.5%, 95% CI: 81.2%-87.3% vs. 75.0%, 95% CI: 72.9%-77.1%, p < 0.001). After adjusting for covariates, the association between state policies and health insurance coverage became statistically insignificant (adjusted odds ratio, aOR=1.09, 95% CI: 0.80-1.47). Participants living in states limiting surcharges were less likely to have intention to quit within 12 months (aOR=0.78, 95% CI: 0.65-0.94). Other associations were not statistically significant. Conclusions: This study indicated that people living in states limiting tobacco surcharges had lower intention to quit smoking. More studies are needed to evaluate the impact of tobacco surcharge policies.