Quitting Smoking Costs More If You’re Poor

A new CDC report finds that coverage for tobacco cessation treatment is lacking in state Medicaid programs.

A man smokes a cigarette on September 6, 2012 in Paris.
National Journal
Clara Ritger
April 3, 2014, 1 a.m.

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.

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