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Insurance Penalties For Smokers Draw Wide Support

A woman smokes outside an office building in New York City.
Don Emmert
AFP/Getty Images
A woman smokes outside an office building in New York City.

When it comes to improving health, there are carrots and there are sticks.

One way to try to influence people's habits is by tying how much they pay for health coverage to their behavior.

Starting next year, for instance, Wal-Mart, the nation's largest private employer, will charge workers who smoke a penalty ranging from $260 to $2,340 annually on health insurance. That's a pretty big stick. As for a carrot, the retailer will offer free smoking-cessation help.

Across the country, employers are rewarding some workers, such as those who exercise, and penalizing those who are overweight or smoke. We wondered how that approach is going over, so we asked more than 3,000 adults across the U.S. in the latest NPR-Thomson Reuters Health Poll.

A solid majority — 59 percent — say that smokers should pay more for health insurance than nonsmokers. Nearly three-quarters of people in households with with annual income of $100,000 or more a year say smokers should pay more. Seventy percent of those with at least a college degree support higher rates for smokers.

How do the smokers feel? Slightly less than a third of them support higher fees for health insurance.

Americans aren't too keen on higher charges for people who are overweight or obese. Some 69 percent are opposed to that, leaving 31 percent in favor. People with at least a college degree and those living in $100,000-plus households were more likely to support a penalty. But the majority in all groups opposed higher fees for the overweight.

The question may have hit too close to home for some. Two-thirds of Americans are overweight or obese, about in line with the proportion in the poll that opposes higher insurance fees for the group.

Is it OK not to hire people because they are overweight or obese? Nope. Only 11 percent of those surveyed said that was a good idea compared with 89 percent against it.

Overall, people prefer insurance discounts for positive behavior over penalties for those who stray from the road to good health. Eighty-five percent of people polled support insurance breaks for people on the right track compared with 15 percent who are against them.

The telephone poll was conducted during the first half of September. The margin for error is plus or minus 1.8 percentage points. Click here to read the questions and full results. You can find the previous polls here.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Scott Hensley edits stories about health, biomedical research and pharmaceuticals for NPR's Science desk. During the COVID-19 pandemic, he has led the desk's reporting on the development of vaccines against the coronavirus.
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