You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S. And it’s expensive.

The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses. That’s why the federal Affordable Care Act permits insurers to charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. ”In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether smokers should pay more for health insurance has created unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

“First of all there is very little evidence that financial incentives or disincentives through premiums change behavior,” says Amy Whitcomb Slemmer, executive director at Health Care for All, a Massachusetts group that advocates for affordable health care access.

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