Virginia is poised to repeal the tobacco surcharge, an ineffective policy that disproportionately harms low- and middle-income Virginians. (Small, 2023) The Patient Protection and Affordable Care Act (ACA), which otherwise strengthened health care access and equity, allows health insurers in the individual and small-group markets to charge smokers up to 50 percent higher premiums relative to nonsmokers. (ACA, 2010) The law’s financial assistance does not apply to this surcharge, forcing enrollees to bear the entire cost of the penalty. This provision was a compromise between the ACA’s drafters, most of whom opposed the surcharge, and the health insurance industry, which argued that insurers would need to raise premiums on all enrollees if they could not charge smokers higher premiums.



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