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.

What We're Following See More »
BIG CHANGE FROM WHEN HE SELF-FINANCED
Trump Enriching His Businesses with Donor Money
8 hours ago
WHY WE CARE

Donald Trump "nearly quintupled the monthly rent his presidential campaign pays for its headquarters at Trump Tower to $169,758 in July, when he was raising funds from donors, compared with March, when he was self-funding his campaign." A campaign spokesman "said the increased office space was needed to accommodate an anticipated increase in employees," but the campaign's paid staff has actually dipped by about 25 since March. The campaign has also paid his golf courses and restaurants about $260,000 since mid-May.

Source:
STAFF PICKS
Variety Looks at How Michelle Obama Has Leveraged Pop Culture
10 hours ago
WHY WE CARE

“My view is, first you get them to laugh, then you get them to listen," says Michelle Obama in a new profile in Variety. "So I’m always game for a good joke, and I’m not so formal in this role. There’s very little that we can’t do that people wouldn’t appreciate.” According to writer Ted Johnson, Mrs. Obama has leveraged the power of pop culture far beyond her predecessors. "Where are the people?" she asks. "Well, they’re not reading the op-ed pieces in the major newspapers. They’re not watching Sunday morning news talk shows. They’re doing what most people are doing: They are watching TV.”

Source:
RUSSIAN HACKERS LIKELY BEHIND THE ATTACKS
New York Times, Other News Organizations Hacked
11 hours ago
THE DETAILS

The FBI and other US security agencies are currently investigating a series of computer breaches found within The New York Times and other news organizations. It is expected that the hacks were carried out by individuals working for Russian intelligence. It is believed that these cyber attacks are part of a "broader series of hacks that also have focused on Democratic Party organizations, the officials said."

Source:
COLUMBIA UNIVERSITY STUDENTS PETITIONED
NLRB: Graduate Students Can Unionize
11 hours ago
THE DETAILS

In a 3-1 decision, the National Labor Relations Board ruled in favor of Columbia University graduate students, granting them the legal right to unionize. The petition was brought by a number of teaching assistants enrolled in graduate school. This decision could pave the way for thousands of new union members, depending on if students at other schools nationwide wish to join unions. A number of universities spoke out in opposition to this possibility, saying injecting collective bargaining into graduate school could create a host of difficulties.

Source:
QUESTIONS OVER IMMIGRATION POLICY
Trump Cancels Rallies
17 hours ago
THE LATEST

Donald Trump probably isn't taking seriously John Oliver's suggestion that he quit the race. But he has canceled or rescheduled rallies amid questions over his stance on immigration. Trump rescheduled a speech on the topic that he was set to give later this week. Plus, he's also nixed planned rallies in Oregon and Las Vegas this month.

Source:
×