A Utah lawmaker has a message for smokers on Medicaid.

If you want to use tobacco, go right ahead. But you’re going to pay — and with more than your health.

Rep. Paul Ray, R-Clearfield, is sponsoring legislation that would impose higher co-payments for tobacco-using Utahns enrolled in the low-income health insurance program.

The measure may be a first nationally though other states have, in recent years, passed laws requiring applicants for food stamps, cash assistance and Medicaid to undergo and pay for drug testing. The rationale: Taxpayer money shouldn’t support someone’s drug habit.

Ray voices the same sentiment, saying, “I’m not trying to be mean to smokers. But people who are voluntarily putting their health at risk ought to pay more toward their health care.”

Equally important, says Ray, is the imperative to snuff out tobacco use.

“This will give [enrollees] another reason to quit,” says Ray, who has pushed several anti-smoking policies over the years, including the most recent tobacco tax hike, which he says drove a decline in Utah cigarette sales.

“We sold 10 million fewer packs of cigarettes in 2010, and calls to the quit line increased,” he says.

Insurance penalties are in vogue in the private sector, with a growing number of employers tacking monthly surcharges onto the health insurance premiums of employees who use tobacco. Utah’s largest hospital chain, Intermountain Healthcare, embraced such a get-tough policy last year.

Utah’s 230,000 Medicaid recipients don’t pay premiums. But a third — excluding pregnant women and children — are on the hook for co-payments in the range of $3 or $5 when they visit their doctor or fill a prescription.

Charging extra, anywhere from $2 to $30 more, could prove a powerful tool for avoiding the costs of treating preventable health woes like cancer, stroke and heart disease, says Ray.

Cigarette smoking is estimated to cost this country $193 billion in lost productivity and health care spending, according to the Centers for Disease Control and Prevention.

And while Utah has notoriously low smoking rates, the habit is most prevalent among low-income households. Utahns of lower socioeconomic status — adults with less than a high school education — are nearly 10 times more likely to report cigarette use than those with a college degree, according to the state Department of Health.

Ray hasn’t yet worked through details, such as how the state would monitor and enforce the co-payment; whether enrollees would have to submit to urine or blood tests or self-disclose their smoking habit.

Without seeing the bill, which is still under draft, low-income advocates don’t have much to say about it. But the approach is not favored by the American Lung Association.

“We support carrots, not sticks; policies that encourage people to stop smoking,” said Jennifer Singleterry, the Washington DC-based group’s cessation-policy manager.