Broad Tobacco-Related Insurance Premiums Are Unjustified & Injurious

I recently received this email:

“I am a 29 year old male from Upper Michigan, married with 3 kids.  My wife and I recently signed on with [company name redacted] as this was one of the only affordable health care options for our family and I like most all of their ‘principles’ or values.

“Only 1 problem; they require that you don't use any drugs, drink, smoke, chew, nothing.  I consider myself a healthy individual as I'm 6'3", 200 lbs and fit. I haven't seen a doctor in years, frankly because I haven't a need.  I don't use drugs, drink, or smoke. However, I've chewed Copenhagen snuff for about 15 years and never had a problem with it. I was the one who had 2, maybe 3 small dips each day, a can would last me a week. It was never excessive and never a problem.

“For the sake of [company] I quit chewing snuff a few months ago. Since I quit, I've noticed I'm short tempered with my wife and kids.  My performance at work has decreased, and I started gaining weight, and losing sleep. I think about it every day, and I feel no better without it. I feel like [company]'s penalty is harsh for dipping.  And they penalize the same for smoking or other hardcore drugs that I'd never do.

 
“I found you online, and I admire your courage to speak the truth about smoking and chewing.

“Please let me know if you can help educate my health ‘insurance’ company on the truth about chewing tobacco. Any help is appreciated.”
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This narrative is not unusual; over the years, I have received numerous similar complaints.  Many smoke-free tobacco users are pioneers; my research group published a study about them in 1995, and I have also told their stories in this blog. 
 
Unfortunately, smoke-free tobacco users continue to suffer from policies that consider all tobacco products – even medicinal nicotine – as equally dangerous, and all tobacco/nicotine users as high-risk.  This conflation of risks improperly raises premium costs, limits employment opportunities and degrades the quality of smoke-free tobacco users’ lives.  It also provides a financial windfall for insurers.
 
The federal government and health organizations often promote this conflation, and Obamacare legislation codified it, defining “smoking” as “using any tobacco product on average four or more times per week in the past six months.” (emphasis added)  It may be justifiable to charge smokers higher premiums, because they are at risk for many diseases that health insurance must cover and, on average, their lives will be shortened by 8-10 years, justifying higher life insurance premiums.  But use of smoke-free tobacco products which are associated with minimal or no added health risks should not incur such punitive premium treatment.
 

Many tobacco consumers avoid higher premiums by lying about their lifestyle choice.  Research shows that “tobacco users may be decreasingly likely to report their tobacco use status accurately to avoid surcharges” when enrolling in Healthcare.gov exchanges.  The problem for these individuals is that insurers and employers commonly require urine tests, which readily detect nicotine as long as three to four weeks after use. However, these tests do not distinguish how nicotine entered the body – via smoking or the use of smoke-free tobacco or medicinal nicotine.
  
As a health professional, I do not condone deliberate misreporting of tobacco use on insurance applications.  However, I do oppose the degradation of smoke-free tobacco users’ quality of life for no legitimate reason.

Motorcycles Aren't Cars and Cigarettes Aren't Smoke-Free Tobacco

What if the federal government told you that cars are as dangerous as motorcycles?  Well, you would be living – and dying – in TobaccoWorld.  Read my commentary that appeared in the Washington Examiner (here) and is reprinted below.

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Motorcycles are more dangerous than cars. We know this because a government agency, the National Highway Traffic Safety Administration, routinely provides data that confirms it.

For example, the NHSTA reports there were 0.85 auto-related deaths for every 100 million miles Americans drove in 2014. By contrast, the death rate for motorcycles was 22.96 for every 100 million miles, making motorcycles 27 times deadlier than cars.

What if the government ignored this difference in risk and assumed the motorcycle death rate applied to all vehicles? In other words, what if all vehicle manufacturers had to be governed by motorcycle regulations and what if insurance premiums for car owners were pegged at the much higher rates for motorcycles?

The effect of such irrationality would be intolerable, with cars priced out of reach, companies put out of business and consumers left without choice. Policymakers would never inflict such pain on the American driving public – at least, not on purpose.

But that's just the sort of irrationality being imposed on the nation’s consumers of smoke-free tobacco products, with tragic consequences. Federal agencies routinely conflate the risks of using smoke-free tobacco products with the risks of smoking, despite decades of scientific studies demonstrating that smoke-free products are vastly safer than cigarettes.

Smokeless tobacco products are required by the Food and Drug Administration to carry demonstrably inaccurate and misleading safety warnings. Companies that attempt to challenge those messages are held to the unnecessary and financially crippling standard of proving that their products would have virtually no health impact on the population.

Even when a company did provide irrefutable proof to change the warning labels in 2011, the FDA took four years to deny its citizen’s petition. Another company’s formal application from 2014 remains in FDA limbo.

The FDA ignores extensive evidence from federal surveys of the role e-cigarettes are playing in helping smokers to quit—including some 2.5 million successes—while the Centers for Disease Control and Prevention withholds evidence that smokeless tobacco is safer. 

The Affordable Care Act permits health insurers to charge higher premiums for any recreational nicotine use, not just smoking.  Most life insurance companies also fail to recognize established risk differences, as they charge higher premiums for users of all nicotine products, even medicines. 

No one confuses motorcycles with cars, just as no one, other than government officials, confuses cigarettes with e-cigarettes or cans of moist snuff. The risk differential between combustible and smoke-free tobacco products is proven and profound. It’s time to tell the public the truth, and to regulate accordingly.