The Affordable Care Act (ACA) permits states to allow health insurers to charge smokers buying individual policies up to 50% higher premiums. Additionally, the ACA requires all new private health insurance plans to cover services recommended by the U.S. Preventive Services Task Force (USPSTF) with no cost-sharing. These recommendations include tobacco cessation treatments. Individual states can adjust the size of the maximum surcharge within their borders in various ways, ensuring a lower financial barrier to coverage.
On April 8, the District of Columbia Health Benefit Exchange (HBX) Executive Board voted to prohibit health insurance companies from charging higher premiums to smokers and tobacco users. According to the District of Columbia HBX, an estimated one in five residents of the District of Columbia use tobacco regularly, with rates especially high among African-Americans, an estimated 30.8%.