ObamaCare and Smokers

September/30/2013 5:17AM
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Ted Cruz spoke on the senate floor for over 21 hours about the shortcomings of ObamaCare. The Republicans are threatening to shut down the government by defunding ObamaCare which can’t happen since the Senate and the President won’t let either happen.

Bill Clinton, the President’s Explainer-in-Chief explained why young people need to sign up for the insurance for the President, who seems to be totally clueless about his namesake plan. How embarrassing for Obama. The man who labeled Obama “The Amateur” doing the president’s work for him. Also, pimping for Hillary, who won’t be using Bill to explain things when she’s president.

Millions of words have been written or spoken about ObamaCare. The 30 million Americans who don’t have health insurance are the reason for ObamaCare.

Here’s the question I have that I’ve never heard asked or answered. How many of those 30 million smoke? If you go to the Kaiser Foundation calculator to see what the cost is for insurance in your state you find the questionnaire asks if you are a tobacco user. Then you are told the insurers may charge up to a 50% premium for tobacco users.

I know from consumer research I was involved in years ago that the biggest two groups of smokers are the young and the poor. The same two groups who are uninsured.

Here are the most current demographics I could find on smokers in the US:

Smokers and education

Adults with 16 or more years of education had the lowest smoking prevalence (11.3 percent). Adults with 9 to 11 years of education had higher smoking prevalence (36.8 percent) compared to adults with fewer or more years of education.

Smokers by socio-economic status

Smoking prevalence was higher among adults living below the poverty  level (32.3 percent) than those living at or above the poverty level (23.5 percent).

 Smokers by states

State-specific smoking prevalence among adults varied more than twofold in 1999, ranging from a low of 13.9 percent in Utah to   a high of 31.5 percent in Nevada.

The states with the highest current smoking prevalence among adults were Nevada (31.5 percent), Kentucky (29.7 percent) and Ohio (27.6 percent). The lowest smoking prevalence rates among adults were  found in Utah (13.9 percent), followed by Hawaii (18.6 percent),California (18.7 percent), Massachusetts (19.4 percent) and Minnesota   (19.5 percent). Smoking prevalence in Puerto Rico (13.7 percent)  was lower than in any of the 50 states.

Smokers by ethnicity/race

Smoking prevalence remained at the highest among American Indians/Alaska  Natives at 40 percent in 1998. Prevalence among African-Americans  (24.7 percent) and Caucasians (25.0 percent) remained higher than  among Hispanics (19.1 percent) and Asians/Pacific Islanders (13.7  percent). Smoking prevalence among racial/ethnic populations has  remained fairly stable in recent years. As smoking has declined  among the white non-Hispanic population, tobacco companies have  targeted both African-Americans and Hispanics with intensive merchandising, which includes billboards, advertising and media oriented to these        communities, and sponsorship of civic groups and athletic, cultural,  and entertainment events.

Lung cancer is the leading cause of cancer deaths among Hispanics.   Lung cancer deaths are about three times higher for Hispanic men    (23.1 per 100,000) than for Hispanic women (7.7 per 100,000).

African Americans – In 1997, about 6.7 million African American adults smoked  cigarettes, accounting for approximately 14 percent of the 48 million adult  smokers in the United States. The prevalence of current smoking among African  Americans is 26.7 percent, compared with 25.3 percent for Caucasians. Cigarette  smoking is more common among African American males than white males (32.1  percent versus 27.4 percent). Although African Americans smoke fewer cigarettes, on average, they tend to smoke brands with higher nicotine and tar levels.  African Americans are also more likely to smoke mentholated cigarettes.

About 76 percent of African-American cigarette smokers smoke menthol cigarettes as compared to 23 percent of Caucasians. These brands contain enough menthol to produce a cool sensation in the throat when smoke is inhaled. People who smoke menthol cigarettes can inhale more deeply or hold the smoke inside longer than smokers  of non-menthol cigarettes. This may explain why African-Americans,  are more likely than Caucasians to die from smoking related diseases  like lung cancer, heart disease and stroke. African Americans have higher lung cancer and oral cancer incidence, as well as higher mortality rates than whites.
American Indian and Alaska Native lands are sovereign nations   and are not subject to state laws prohibiting the sale and promotion  of tobacco products to minors. As a result, American Indian and   Alaska Native youth have access to tobacco products at a very young  age.

Smokers by gender

“Tobacco kills more than half a million women per year worldwide. This number is expected to double by 2020. Internationally, women are increasingly targeted by tobacco marketing.”

“More than 152,000 women died from smoking related diseases  in 1994.”

Currently about 22 million (22 percent) of women 18 years and   older, and at least 1.5 million adolescent girls in the United        States smoke cigarettes. Daily smoking rates among female high   school seniors have increased from 17.9 percent in 1991 to 23.6   percent in 1997. The gap in smoking prevalence between men and   women has narrowed dramatically in recent years. Although male  smoking prevalence dropped 24 percentage points between 1965 and  1993, the prevalence of female smoking dropped only 11 percentage   points during the same period. Women are beginning to smoke at    younger ages, increasing their risks of developing smoking related    diseases.

Smoking among U.S. women 18 years and older varies considerably  by racial/ethnic groups: American Indian/Alaskan Native, 35 percent; Caucasian, 24 percent; African American, 24 percent; Chicano/Latino, 15 percent; and Asian/Pacific Islander, 4 percent.

Education also affects smoking rates. The more formal education   a woman receives, the less likely she is to be a smoker. In 1995, 40 percent of women between the ages of 25 and 44 who did not finish  high school were smokers; 34 percent of high school graduates were  smokers; 24 percent of those with some college were smokers; and  only 14 percent of those who graduated from college were smokers.

Between 1960 and 1990, the death rate from lung cancer among women  increased by more than 400 percent, and the rate is continuing   to increase. In 1987, lung cancer surpassed breast cancer as the  number one cause of cancer deaths among women. The American Cancer   Society estimated that in 1998, lung cancer killed 67,000 women,  while breast cancer killed 43,500 women.

Smoking has a damaging effect on women’s reproductive health and   is associated with reduced fertility and early menopause. Women who smoke during pregnancy subject themselves and their developing   fetus and newborn to special risks, including pregnancy complications,  premature birth, low birth weight infants, stillbirth and infant   mortality. Research also suggests that intrauterine exposure to  secondhand smoke after pregnancy is associated with an increased risk of Sudden Infant Death Syndrome (SIDS) in infants. For every dollar invested in smoking cessation for pregnant women, about  $6 dollars is saved in neonatal intensive care costs and long-term care associated with low birth weight deliveries.

Between 8,000 and 26,000 children are diagnosed with asthma every year in the United States. The odds of developing asthma are twice  as high among children whose mothers smoke at least 10 cigarettes  a day. Between 400,000 and 1,000,000 asthmatic children have their condition worsened by exposure to secondhand smoke.

Smokers by age

“Each day, approximately 6,000 young persons try their first  cigarette and approximately 3,000 become daily smokers.”

“About half of all nicotine users start by age 13, …nicotine addiction is a pediatric disease” – Dr. David Kessler (U.S  FDA, 1996).

Middle School Students – The 1999 National Youth Tobacco Survey  estimates that about one in eight (12.8 percent) middle school  students reported using some form of tobacco (cigarettes, smokeless,  cigars, pipes, bidis or kreteks) in the past month. Current cigarette   use among middle school students was 9.2 percent (9.6 percent for  males, and 8.8 percent for females). The rate of smoking among  middle school students by race/ethnic groups was relatively equal,  with about one in ten African-American (9.0 percent), Caucasian  (8.8 percent) and Chicano/Latino (11.0 percent) middle school students reporting smoking cigarettes in the past month.
Cigar use was the second most preferred tobacco product used in middle school,  with 6.1 percent of students reporting smoking cigars in the past month. African   American middle students (8.8 percent) were significantly more likely to smoke  cigars than Caucasian students (4.9 percent). Current smokeless tobacco prevalence   among middle school students was 2.7 percent – 4.2 percent in males and 1.3  percent for females. Pipe tobacco use among middle school students was 2.4  percent – 3.5 percent for males and 1.4 percent for females.

Current use of novel tobacco products, such as bidis (or beedies)  and kreteks (also called clove cigarettes) was 2.4 percent and     1.9 percent, respectively among middle school students. There was  no statistically significant difference in bidi or kretek use among race/ethnic groups.

High School Students – More than one-third (34.8 percent) of high  school students reported using some form of tobacco in the past  month. More than a quarter (28.4 percent) of high school students    were current cigarette smokers, with male and female students smoking  at equal rates – 28.7 and 28.2 percent respectively. Current cigarette  smoking prevalence use by race/ethnic groups was higher among Caucasian  high school students (32.8 percent) followed by Chicano/Latino   (25.8 percent) and African-American (15.8 percent) students.

Cigar use among high school students was 15.3 percent. An estimated one in 5 male students (20.3 percent) had used cigars compared   to about 1 in 10 female students (10.2 percent) in the past month.   Males (11.6 percent) were significantly more likely to use smokeless   tobacco products than female (1.5 percent) high school students.   The use of bidis (5.0 percent) and kreteks (5.8 percent) among  high school students nearly equaled the use of smokeless tobacco   (6.6 percent).

Young Adults – Current smoking prevalence among young adults aged   18-24 years was 25. 8 percent in 1993, 28.7 percent in 1997 and   27.9 percent in 1998. The data suggests that smoking prevalence   among 18-24 year olds now equals that of 25 to 44 years olds (27.5  percent). In earlier years, smoking prevalence among young adults  was lower than that of 25 to 44 year olds. There was no significant change in smoking among adults aged 25-44 years for the same period.

That is the demographic profile of smokers.

Is this a problem no one has though about as enrollment begins on October 1st? What are the ramifications of all this for ObamaCare?

First, are the state insurance companies going to accept the tobacco user’s answers, or check them with a blood test? If they don’t check, the health care will costs will be significantly higher for these new enrollees than for the normal insurance population due to the higher rate of tobacco usage.

If they do check, will many enrol since the cost will be so much higher? But, some of that cost will be offset by tax credits. The tax credits will not offset tobacco usage, however that presumes I understand the formula, which I defy anyone to understand.

Basically, there will less enrollment than predicted due to costs being higher for tobacco users and the population of uninsured being higher than average tobacco users. For that same reason, the cost to insure this segment will be higher.

It appears the politicians and the media haven’t gotten around to this question yet, but you can bet the insurance companies have. That 50% premium will be another way to offset the cost of pre-existing conditions.

Stay tuned.

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