Countries that offer universal care such as Canada, The UK, France (also also NY State/NY City where I live) have a tobacco tax in the $5 to $7 range or more that helps to pay for the higher health care costs of smokers. NYC tax is $6.85 for city+state+fed. The US Federal tax is about $1. If the tax were increased by $5 for the 13 billion packed smoked each year it would yield approx $30 to $35 billion which could be used to mitigate the high cost of insurance for others.

Also, the medical ratio of youth to elderly is 1:6 and before the ACA, youth would pay about 1/6 of elderly costs. Congress unfairly mandated that ratio to be 1:3 meaning youth pay 75% more than they should. They already have to pay for student loans, save for a house, and now they have additional burdens paying for smokers and those who drink daily sugar Cokes and thus obese.

Tax tobacco like other countries and NYC/NYS and use that money to make premiums for youth and middle class more fair.