State Rep. Paul Ray, R-Clearfield, says charging smokers extra could be a powerful tool for avoiding the costs of treating preventable health problems like cancer, stroke and heart disease.
"I'm not trying to be mean to smokers," Ray told the Salt Lake Tribune. "But people who are voluntarily putting their health at risk ought to pay more toward their healthcare."
And, he said, it would be another move toward eliminating tobacco use.
"This will give [enrollees] another reason to quit."
Ray said details would have to be ironed out as to how the state would monitor and enforce the co-payment and whether enrollees would have to submit to urine or blood tests or self-disclose their smoking habit.
The U.S. government funds about 75 percent of Utah's $1.8 billion Medicaid program and Ray acknowledged it would have to approve changes to benefits and eligibility.
"I'm sure they'll have problems with it," said Ray, adding he may seek a waiver from existing rules.
Still, he said, "We're doing some groundbreaking here. This goes back to whether taxpayers should cover the cost of smoking."