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Do smokers and the obese deserve insurance?

What's a health incentive – and what's a penalty? In the past few days, the perennial debate has reared its head again as the start of Obama's second term has brought us closer to changes in the health-care system, a stream of dire news stories on what that might mean for some Americans have inevitably cropped up.

Last week, the Associated Press warned ominously that starting next January, "Millions of smokers could be priced out of health insurance because of tobacco penalties in President Barack Obama's health-care law." For insurance companies that opt to enforce the full amount, the change could mean as much as a $5,000 premium spike per year for older smokers. That change would have a serious impact on low-income individuals, who "would depend [more] on the new federal health-care law" — and who account for a far higher proportion of the one in five Americans who smoke. Nearly 450,000 Americans die of smoking-related diseases every year.

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