WASHINGTON - TelAve -- House Republicans plan to hold votes next week on a narrow health care bill that would allow expanded Affordable Care Act subsidies to expire as scheduled.

While it reportedly contains some new provisions,"they would be unlikely to immediately address rising health care premiums" [NYTimes] (https://www.nytimes.com/2025/12/12/us/politics/...), nor to hold down the ever-exploding cost of medical care.

But a simple tested concept would slash medical care costs more than enough to pay for the extension of the ACA subsidies argues public interest law professor John Banzhaf.

Fortunately, there is an easy way to slash unnecessary health care costs.

We should begin imposing some personal responsibility on the tiny minority of Americans responsible for more than half of the costs of Medicaid, and far too much of the costs of Obamacare,.

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Today more than half of the total cost of Medicaid is caused by the tiny minority of U.S. adults [only about 11%] who insist upon smoking cigarettes despite the huge costs their smoking imposes on our economy.

So one way to slash the proposed costs of Obamacare would be to do what many have long preached; finally begin imposing personal responsibility for unhealthy lifestyle choices.

Require those who currently enjoy Medicaid and Obamacare insurance at taxpayer expense to either quit smoking, or to pay the huge costs which their smoking now imposes on the overwhelming majority of American taxpayers.

This simple alternative which has been approved and advocated by the states' insurance commissioners, tested by many private companies, and incorporated in part under Obamacare, would save many lives, says Banzhaf.

Although fewer than 12% of U.S. adults still smoke, cigarette smoking cost the United States more than $600 billion in 2018, including more than $240 billion in healthcare spending.  A whooping 21.5% of that was imposed upon Medicaid, with only about 8% being paid by Medicare, and about the same for private health insurance.

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So if a majority of smokers - who now impose the costs of their outrageously dangerous lifestyle choice on the majority of taxpayers - could finally be financially pressured to quit, the program and taxpayers would save over $50 billion a year in Medicaid health care costs alone, and a corresponding amount under Obamacare.

One way to do this, as recommended by the NAIC, would be to require smokers to pay the excess costs their habit now unnecessarily imposes on taxpayers in order to keep their current health insurance coverage; just as smokers have always been required to pay more than nonsmokers for their life insurance; and in many cases also for their home and/or car insurance.

http://banzhaf.net/   jbanzhaf3ATgmail.com   @profbanzhaf