The Obama administration - in yet another health care overhaul delay - has quietly notified insurers that a computer system glitch will limit penalties that the law says the companies may charge smokers. A fix will take at least a year to put in place.
Older smokers are more likely to benefit from the glitch, experts say. But depending on how insurers respond to it, it's also possible that younger smokers could wind up facing higher penalties than they otherwise would have.
Some see an emerging pattern of last-minute switches and delays as the administration scrambles to prepare the Oct. 1 launch of new health insurance markets. People who don't have coverage on the job will be able to shop for private insurance, with tax credits to help pay premiums. Small businesses will have their own insurance markets.
Last week, the White House unexpectedly announced a one-year postponement of a major provision in the law that requires larger employers to offer coverage or face fines. Officials cited the complexity of the requirement as well as a desire to address complaints from employers.
"This was an administration that was telling us everything was under control," health care industry consultant Robert Laszewski said. "Everything was going to be fine. Suddenly this kind of stuff is cropping up every few days."
A June 28 Health and Human Services Department document couched the smokers' glitch in technical language:
"Because of a system limitation ... the system currently cannot process a premium for a 65-year-old smoker that is ... more than three times the premium of a 21-year-old smoker," the industry guidance said.
If an insurer tries to charge more, "the submission of the (insurer) will be rejected by the system," it added.
Starting in 2014, the law requires insurance companies to accept all applicants regardless of pre-existing medical problems. But it also allows them to charge smokers up to 50 percent higher premiums - a way for insurers to ward off bad risks.
For an older smoker, the cost of the full penalty could be prohibitive.
Premiums for a standard "silver" insurance plan would be about $9,000 a year for a 64-year-old non-smoker, according to the online Kaiser Health Reform Subsidy Calculator. That's before any tax credits, available on a sliding scale based on income.
For a smoker of the same age, the full 50 percent penalty would add more than $4,500 to the cost of the policy, bringing it to nearly $13,600. And tax credits can't be used to offset the penalty.
The underlying reason for the glitch is another provision in the health care law that says insurers can't charge older customers more than three times what they charge the youngest adults in the pool. The government's computer system has been unable to accommodate the two. So younger smokers and older smokers must be charged the same penalty, or the system will kick it out.
That's not what insurers had expected. Before the glitch popped up, experts said the companies would probably charge lower penalties for younger smokers, and higher penalties for older ones.
"Generally a 20-year-old who smokes probably doesn't have much higher health costs than someone who doesn't smoke in any given year," said Larry Levitt, an insurance market expert with the nonpartisan Kaiser Family Foundation. "A 60-year-old is another story."
The administration is suggesting that insurers limit the penalties across all age groups. The HHS guidance document used the example of a 20 percent penalty.
In that case the premium for a 64-year-old would be about $10,900, a significant cut from the $13,600 if insurers charged the full penalty.
It's unclear what insurance companies will do. A spokesman for America's Health Insurance Plans, the main industry trade group, said insurers were aware of the issue and expected the administration would fix it eventually.
Another workaround for the companies would be to charge the full penalty to both younger and older smokers. In that case, there wouldn't be any savings for older smokers, and younger ones would see a big price shock.
Levitt said he suspects insurers would keep the penalties low to sign up more young people. Laszweski said he thought they would do the opposite.
"It's going to throw cold water on efforts to get younger people to sign up," he said.
Workers covered through job-based health plans would be able to avoid tobacco penalties by joining smoking cessation programs because employer plans operate under different rules. But experts say that option is not guaranteed to smokers trying to purchase coverage individually.
China itself made the comparison possible: for decades, a now-discontinued government policy provided free coal for heating, but only in the colder north. Researchers found significant differences in both particle pollution of the air and life expectancy in the two regions, and said the results could be used to extrapolate the effects of such pollution on lifespans elsewhere in the world.
The study by researchers from China, Israel and the United States was published Tuesday in the Proceedings of the National Academy of Sciences.
While previous studies have found that pollution affects human health, "the deeper and ultimately more important question is the impact on life expectancy," said one of the authors, Michael Greenstone, a professor of environmental economics at Massachusetts Institute of Technology.
"This study provides a unique setting to answer the life expectancy question because the (heating) policy dramatically alters pollution concentrations for people who appear to be of otherwise identical health," Greenstone said in an email. "Further, due to the low rates of migration in China in this period, we can know people's exposure over long time periods," he said.
The policy gave free coal for fuel boilers to heat homes and offices to cities north of the Huai River, which divides China into north and south. It was in effect for much of the 1950-1980 period of central planning, and, though discontinued after 1980, it has left a legacy in the north of heavy coal burning, which releases particulate pollutants into the air that can harm human health. Researchers found no other government policies that treated China's north differently from the south.
The researchers collected data for 90 cities, from 1981 to 2000, on the annual daily average concentration of total suspended particulates. In China, those are considered to be particles that are 100 micrometers or less in diameter, emitted from sources including power stations, construction sites and vehicles.
The researchers estimated the impact on life expectancies using mortality data from 1991-2000. They found that in the north, the concentration of particulates was 184 micrograms per cubic meter - or 55 percent - higher than in the south, and life expectancies were 5.5 years lower on average across all age ranges.
The researchers said the difference in life expectancies was almost entirely due to an increased incidence of deaths classified as cardiorespiratory - those from causes that have previously been linked to air quality, including heart disease, stroke, lung cancer and respiratory illnesses.
Total suspended particulates include fine particulate matter called PM2.5 - particles with diameters of no more than 2.5 micrometers. PM2.5 is of especially great health concern because it can penetrate deep into the lungs, but the researchers lacked the data to analyze those tiny particles separately.
The authors said their research can be used to estimate the effect of total suspended particulates on other countries and time periods. Their analysis suggests that every additional 100 micrograms of particulate matter per cubic meter in the atmosphere lowers life expectancy at birth by about three years.
The study also noted that there was a large difference in particulate matter between the north and south, but not in other forms of air pollution such as sulfur dioxide and nitrous oxide.
Francesca Dominici, a professor of biostatistics at Harvard School of Public Health who has researched the health effects of fine particulate matter in the U.S., said the study was "fascinating."
China's different treatment of north and south allowed researchers to get pollution data that would be impossible in a scientific setting.
Dominici said the quasi-experimental approach was a good approximation of a randomized experiment, "especially in this situation where a randomized experiment is not possible."
She said she wasn't surprised by the findings, given China's high levels of pollution.
"In the U.S. I think it's pretty much been accepted that even small changes in PM2.5, much, much, much smaller than what they are observing in China, are affecting life expectancy," said Dominici, who was not involved in the study.
AP researcher Yu Bing contributed to this report.
ST. LOUIS (AP) -- After losing consecutive starts for the first time in his career, Lance Lynn resisted the temptation to alter his approach.
He has 11 wins prior to the All-Star break both of his years in the rotation because he stayed with the plan.
"That last one was all singles and bloops," manager Mike Matheny said after a 3-2 victory over the Miami Marlins wrapped up a three-game sweep Sunday. "The adjustment really is not to make too many adjustments.
"He was a bulldog," Matheny added.
Lynn outpitched Marlins All-Star Jose Fernandez and Matt Holliday homered for St. Louis, which rebounded from a 3-8 stretch that bumped them from the majors' best record.
The Cardinals regained a share of the NL Central lead with the Pirates, who lost to the Cubs.
"We've had some heartbreaks as of late," Lynn said. "To be able to get a sweep any time of the year is great. It would be nice to get hot right before the All-Star break and rattle off a bunch of wins."
Lynn (11-3) worked seven strong innings in 87-degree heat and matched All-Star Adam Wainwright for the team lead in wins. He struck out seven, fanning Giancarlo Stanton all three times, shaking off two outings in which he gave up nine runs in 13 2-3 innings.
"I tried to not even think about the last one," Lynn said. "You're going to have times where it seems like every time you throw a pitch and they hit it's a hit, no matter where it goes.
"That's kind of what the feeling was the last time," he said, "but it can't always be like that."
The 20-year-old Fernandez (5-5) worked six innings a day after getting the nod as the Marlins' lone All-Star and gave up three runs on four hits and a season-high four walks. He hadn't allowed more than two earned runs in his previous six outings.
"They were just better than us," Fernandez said. "I thought I made some good pitches but it's not a secret for anybody, the Cardinals are one of the best teams in the league."
The Cardinals swept the Marlins, with whom they share a spring training complex in Jupiter, Fla., for the first time since Aug. 4-7, 2011 at Florida, and the first time at home since May 23-25, 2000.
Trevor Rosenthal escaped a bases-loaded jam in the eighth by getting pinch-hitter Greg Dobbs on a groundout, getting some help when Stanton froze between second and third and could not score on Logan Morrison's hit.
"If a couple of things go our way or we make a couple of better plays, we win this game," Morrison said. "That's why they're going to be in the playoffs. That's why we're not, because they know how do those things.
"We're young. We're learning. We'll get there," Morrison said.
Edward Mujica pitched for the fourth straight game and finished for his 23rd save in 24 chances, giving him a win and two saves in the series.
Adeiny Hechavarria and Jeff Mathis had an RBI apiece for the Marlins, who had won eight of 10 entering the series and had been on a 19-11 roll for the majors' best record since May 31. Derek Dietrich doubled, walked and was hit by a pitch twice.
Holliday's 12th homer, and first in 12 games, was a 420-foot shot to straightaway center in the first.
Both teams manufactured a run early. A wide throw to the plate from first baseman Morrison helped Carlos Beltran score on the front end of a double steal with Holliday in the third for St. Louis, and Mathis had a squeeze bunt for an RBI in the fourth for the Marlins.
Stanton fanned three times for the second time in four games. He's 1 for 7 against Lynn with a homer, two RBIs, a walk and five strikeouts.
NOTES: Wainwright (11-5, 2.36) jumps ahead of rookie Shelby Miller in the rotation to start Tuesday against the Astros and Bud Norris (6-7, 3.22). Wainwright also will start the final game before the break, but didn't mind not being eligible to pitch in the All-Star Game. ... Kevin Slowey (3-6, 4.24) takes Ricky Nolasco's rotation spot for the Marlins Monday at home against the Braves and Mike Minor (8-4, 3.15). ... Duck Dynasty star Willie Robertson threw the ceremonial first pitch. ... Holliday grounded into his major league-leading 22nd double play in the fifth. Both teams had a pair of double-play balls in the finale and totaled 10 in the series, five by each. ... All three games were sold out and offered giveaways, with a porch flag for the finale following a Holliday jersey and Mike Shannon bobble head. ... The Cardinals earned their first sweep since taking four straight from Milwaukee May 2-5. The Marlins have been swept nine times, seven times in three-game series and twice in two-gamers.