Most Americans get help quitting smoking for free. The poorest Americans don’t.
That’s because the Affordable Care Act required all private insurance plans to cover tobacco cessation treatment at no charge to the patient. But Medicaid, a state-run public health program for the low-income and disabled, has no such mandate.
And Medicaid beneficiaries are paying for it. A new report from the Centers for Disease Control and Prevention finds that states don’t offer many of the Health and Human Services Department’s recommended treatments, and the services they do cover come with co-pays, limits on the duration of use, and other barriers to access for Medicaid patients.
While all states cover some kind of tobacco cessation treatment in their Medicaid programs, the report finds, only seven states cover all seven FDA-approved medications and two recommended forms of cessation counseling (individual and group).
There’s a demand for the services, too. Medicaid beneficiaries have higher smoking rates than the general population, CDC data finds, with 30.1 percent of Medicaid enrollees under the age of 65 smoking, compared with 18.1 percent of all U.S. adults.
“Smoking-related disease is a major contributor to increasing Medicaid costs,” the report says. “The evidence from previous analyses suggests that states could reduce smoking-related morbidity and health-care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting the coverage, and monitoring its use.”
For the CDC report, researchers at the American Lung Association tracked coverage in state Medicaid programs between December 31, 2008, and January 31, 2014. They looked at whether there were any barriers to obtaining the services, such as co-pays or limits on the number of treatments.
Although more states increased the number of treatments covered between 2008 and 2014, more states also added barriers to accessing those treatments. That trend can be attributed, in part, to the Affordable Care Act’s requirement that state Medicaid programs cover all FDA-approved tobacco cessation medications by January 2014. Not all states used to offer that benefit, so as some added it, they also added it with restrictions.
There’s some evidence to suggest both a benefit for population health and state budget savings for mandating full coverage. Massachusetts required coverage of tobacco-cessation treatment for Medicaid beneficiaries in 2006, and saw smoking prevalence among the Medicaid population drop from 38 percent to 28 percent, as well as a nearly 50 percent reduction in hospital admissions for heart attacks and other heart conditions among the population using the benefit, according to a study funded by the CDC in 2010. For every dollar spent on providing the coverage, Massachusetts saved $3.12 in reduced medical spending on heart conditions.
In publishing the report, ALA Director of National Health Policy Jennifer Singleterry said they hope to make state Medicaid programs aware of the coverage gap, and encourage them to fully adopt the benefit.
CORRECTION: A previous version of the map accompanying this article indicated that New York and Tennessee both added and removed barriers. The two states have only added barriers.
What We're Following See More »
The Las Vegas Review-Journal, owned by casino magnate and GOP donor Sheldon Adelson, became the first major city newspaper to endorse Donald Trump over the weekend.“Mr. Trump represents neither the danger his critics claim nor the magic elixir many of his supporters crave,” the editorial read, acknowledging concerns about Trump’s temperament. “But neither candidate will ever be called to the dais to accept an award for moral probity and character,” the paper said. “And we are already distressingly familiar with the Clinton way, which involves turning public service into an orgy of influence peddling and entitlement designed to line their own pockets — precisely what a disgruntled electorate now rises up to protest.”
Hillary Clinton leads Donald Trump by 12 percentage points among likely voters, 50 to 38 percent, in a new ABC News tracking poll, "her highest support and his lowest to date in ABC News and ABC News/Washington Post polls. Gary Johnson has 5 percent support, Jill Stein 2 percent. Clinton led by only four points in the last ABC/Post poll on Oct. 13.
President Obama "will make a late splash into races for state senate and assembly over the next week, endorsing roughly 150 candidates across 20 states. He’ll also back a candidate for the North Carolina Supreme Court. The endorsements — which will come along with a variety of robocalls, social media posts, mailers, photos of Obama with the candidates taken as he’s been traveling to campaign in recent weeks, and even a few radio ads — are Obama’s biggest investment in state races ever by far."
If you need a marker for how confident Hillary Clinton is at this point of the race, here's one: CNN's Jeff Zeleny reports "she's been talking to Republican senators, old allies and new, saying that she is willing to work with them and govern."
"According to a new POLITICO/Morning Consult poll, the first national post-debate survey, 43 percent of registered voters said the Democratic candidate won, compared with 26 percent who opted for the Republican Party’s standard bearer. Her 6-point lead over Trump among likely voters is unchanged from our previous survey: Clinton still leads Trump 42 percent to 36 percent in the race for the White House, with Libertarian nominee Gary Johnson taking 9 percent of the vote."