Defining “tobacco use” for cigar smokers

Sarah Kliff has two very interesting articles at The Washington Post this week about the Affordable Care Act and tobacco. In the first, she looks at how the law prohibits or limits insurance companies charging higher prices to higher risk clients, with one key exception: They can charge smokers up to 50% more. Interestingly, anti-cancer groups and tobacco companies have teamed up to oppose this provision, though obviously for different reasons.

Her follow-up post examines the under-the-radar question of how the government should define “tobacco user” for health insurance purposes:

[...] the law says nothing more about what counts as “tobacco use.” And that’s a hard factor to regulate: Unlike age, where subscribers have one definite birth date, the idea of who counts and doesn’t count as a tobacco user is really fuzzy. Enter the regulators!

The impact on the cost of insurance for smokers could be huge, especially for those with lower incomes:

For a low-income American faced with the surcharge, their premium could jump from $708 to $3,308. That jump is larger than 50 percent due to the fact that the base premium gets a federal subsidy, while the tobacco surcharge does not.

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Regardless of whether this is good policy, it’s clear that frequent smokers of cigarettes should count as tobacco users. But what about people who only smoke an occasional cigarette socially? Or enjoy an infrequent cigar? Or people who use other forms of tobacco entirely? These users have very different risk profiles, but the law could treat them equally. This would put them in the difficult position of either paying exorbitantly for health insurance or lying about their status, the latter option putting them at risk for losing coverage.

Health and Human Services has invited comment on what questions should be asked of insurance applicants to determine whether they count as tobacco users. Kliff mentions a few suggestions, all of which inquire about use within a given period of time:

The Campaign for Tobacco Free Kids argues that it should be defined as smoking within a set amount of time.

“The Department will need to determine a period that is not so short as to allow allow a person to identify himself or herself as not a tobacco user if he or she ‘quit’ the day they applied for health insurance but not so long as to include people who have actually quit,” the group writes in public comment.

America’s Health Insurance Plans, which represents most health insurance companies, proposes a two-part question: “Have you used tobacco in the last twelve months?” and “Are you currently using tobacco products?”

These suggestions simply reframe the question, grouping people into smokers or non-smokers/quitters. They don’t address casual use. A casual cigar smoker would have to answer yes to both questions posed by America’s Health Insurance Plans. Twelve months is a long time! Should someone who enjoys an occasional cigar have to pay 50% (or more) higher on their insurance premiums, the same penalty faced by pack-a-day smokers?

A sensible definition would address not only recency of tobacco use, but also frequency within that time period (and possibly the form of tobacco used). Unfortunately, this consideration doesn’t appear to be part of the current discussion. That oversight, along with the looming threat of FDA regulation and calls for higher tobacco taxes, is one more item that could make this a tough year for the cigar industry.

Related: Here’s my article from The Atlantic a couple months ago arguing for a different approach to tobacco regulation. And at Quora, I reference some of the research comparing the risks of cigars and cigarettes.

Mixology Monday: Inversion

Hopped Up Nui Nui -- traditional recipe + 1 oz IPA.

It’s a good thing Mixology Monday has been revived or I might not have posted a new cocktail at all this month. The theme for February is “Inverted.” Host Putney Farm explains:

A while ago, while researching Julia Child’s recipes, we noticed that she was well-known for enjoying “upside-down” or “inverted” Martini’s (God bless her). This is a version of the classic cocktail that swaps the ratios of gin and vermouth, turning the Martini into something of a “long drink”. And if you are cooking for hours at a time (or gardening with a cocktail- something we highly recommend), the Inverted Martini is a very tasty drink.

We wondered if we could apply the same “inverted” approach to Mixology Monday and, at first, didn’t think it would work. But then we asked ourselves, what does “inverted” really mean? Well, here is the definition:
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To turn inside out or upside down
To reverse the position, order, or condition of
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Hmm…it appears that the definition is pretty broad. It seems that “inverted” really just means something “flipped on its head”. And that can mean almost anything, and leaves plenty of room for creativity. So we are going with the “inverted” theme. You can invert the ratios of spirits, liqueurs or bitters in a cocktail, but we suggest you go beyond that and “invert” whatever you want. Spirits, name, ingredients, proof, color, geography, garnish and glassware are all fair game. An apéritif made with Navy-Strength booze? Give it a try. A beer-based cocktail that tastes like champagne? Sure. A clear Manhattan? Worth a shot (and good luck with that). The only thing we expect is the unexpected. Have fun.

No ideas were springing to mind for this one, so I mentioned the prompt to my fellow bartender at Metrovino, Kj DeBoer. He came up with the solution in no time. Deschutes Brewery, he noted, makes a beer called Inversion IPA. Brilliant! I could “invert” a drink by adding Inversion IPA to it.

But which drink to choose? I thought immediately of tiki cocktails, which I view as prime candidates for the addition of beer. Tiki drinks are characterized by their use of rum, fruit, and big, spicy flavors. I like them, but I can usually only do about one per night before I’m ready to move on to drinks with more bitter elements. Hoppy beers are a great way to add bitterness to tiki drinks: They give the drinks backbone, hops play well with citrus, and shaking beer with the other ingredients makes for a frothy head, creating a velvety mouthfeel.

For this Mixology Monday, I decided to try adding Inversion IPA to the Nui Nui cocktail. This is one of the tiki drinks I gravitate to when it’s on the menu, offering bold, spicy flavors. Beachbum Berry credits it to Donn the Beachcomber’s Mandalay Bar at the Colonel’s Plantation Beefsteak House in Hawaii, circa 1958. My only addition is the beer, and I shake it rather than blend it.

2 oz amber rum
1 oz IPA
1/2 oz lime juice
1/2 oz orange juice
1/4 oz cinnamon syrup
1/4 oz Donn’s Spices #2
1 dash Angostura bitters

Shake with ice and strain into a glass filled with crushed ice. Garnish with an orange peel or cherries.

You can make your own syrups, but I’m lazy and live in Portland so I use those commercially available from B. G. Reynolds. For the rum I used El Dorado eight year, which may be overkill and isn’t traditional, but it sure is good. Feel free to substitute other IPAs if not constrained by a Mixology Monday theme.

Playing catch up

It’s been a while since I’ve posted. A few things that have come up in the past few weeks:

For Drink Portland, I took a look at three new rye whiskeys that have entered the market.

Year of Aquavit: EcoSalon is on board.

Department of Unlikely Coverage: Gizmodo discovers the Bone Luge. A very in-depth article!

The Oregonian gave Metrovino our first major review since Chef Dustin See took over in the kitchen and gave us high marks.