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Smoking, Obesity, Health Insurance, and Health Incentives in the Affordable Care Act

Kristin Madison, PhD, JD1; Harald Schmidt, PhD2; Kevin G. Volpp, MD, PhD3,4
[+] Author Affiliations
1School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
2Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
3Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
4Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA. 2013;310(2):143-144. doi:10.1001/jama.2013.7617.
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One fundamental reform of the Patient Protection and Affordable Care Act (ACA) was to weaken the link between health status and insurance coverage. Issuers of individual policies will no longer be able to charge higher premiums to the seriously ill or turn away unhealthy enrollees. By adding these protections, the ACA brings individual policies more in line with other forms of insurance. Neither Medicare nor Medicaid charges higher premiums for individuals in poor health, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits group health plans from conditioning employee eligibility or premiums on health status–related factors such as cancer, heart disease, or diabetes.1

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