States Make Little Progress in Helping Smokers Quit

State officials missed many opportunities in 2009 to help smokers quit. No state received an "A" for cessation coverage. To earn an "A" grade, a state must provide comprehensive cessation benefits with few barriers standing in the way of access to its Medicaid population and to state employees. As a result, states failed to realize the tremendous financial savings7 that can be achieved by expanding cessation coverage. The American Lung Association first added cessation coverage as a category for grading in its State of Tobacco Control 2008 report, recognizing that cessation is a critical component of reducing smoking prevalence and saving lives.

No state added comprehensive cessation benefits for its Medicaid recipients in 2009, which means only six states—Indiana, Massachusetts, Minnesota, Nevada, Oregon and Pennsylvania—offer comprehensive cessation benefits to their Medicaid populations. Five other states—Alabama, Connecticut, Georgia, Missouri and Tennessee—fail to offer any cessation benefits at all to Medicaid recipients. Elected officials are again missing an opportunity to save lives and money. In July, the Centers for Disease Control and Prevention (CDC) released a report showing further evidence that Medicaid recipients' tobacco use causes a tremendous economic burden for state budgets.8 Evidence that a comprehensive tobacco cessation benefit can help smokers on Medicaid quit was seen in results from Massachusetts (see sidebar).

In 2009, state employees fared better than Medicaid recipients in winning cessation coverage. While only five states offer comprehensive cessation benefits to their employees as recommended by the U.S. Public Health Service, a few states increased coverage in 2009. Delaware, Mississippi and Kentucky now offer additional coverage for cessation medications, which have been proven to help smokers quit more successfully. Tennessee now offers group counseling to its employees. Unfortunately, one state—Nebraska—took a step backwards by eliminating coverage for cessation medications.

In November, the Massachusetts Medicaid program (MassHealth) announced that its comprehensive tobacco cessation benefit has helped 33,000 smokers—26 percent of the program’s smokers—quit. There was also a decrease in hospitalizations for heart attacks, emergency room visits for asthma, and pregnancy complications.

Source: Massachusetts Office of Health and Human Services, Press Release: Patrick Administration Announces Positive Results from MassHealth Smoking Cessation Benefit, November 18, 2009, Available here.

The U.S. Public Health Service's Treating Tobacco Use and Dependence: 2008 Update is the benchmark by which cessation coverage is determined to be comprehensive. These guidelines make clear that recommended treatments for tobacco use should be covered by public and private health benefit plans. This is especially true for smokers enrolled in Medicaid. They smoke at rates over 60 percent higher than the national average. Nationwide, 38.8 percent of the Medicaid population smokes compared to 22.9 percent of the general population between ages 18 and 65.9 Direct costs related to smoking by Medicaid recipients amounted to an average of $607 million per state in 2004.10

For state tobacco cessation quitlines, which provide phone counseling to help tobacco users quit, the past year was busy. As many states and the federal government increased tobacco taxes, demand for quitline services increased dramatically. This demand underscored the importance of policymakers funding state quitlines adequately, and it provided evidence that most quitlines could help many more tobacco users quit if they were given more resources.

The American Lung Association attempted to obtain data on the reach and services offered by state quitlines to incorporate these measures into the report's cessation coverage grade. However, some of the necessary data were unavailable for all states, and our request for available data from the North American Quitline Consortium was not approved. While NAQC has indicated their willingness to work with us in the future, unfortunately these data are not able to be factored into the grades states receive for cessation coverage this year. We are working to obtain the needed data so that quitlines can be incorporated into the grades in next year’s report.

 

 

7 Armour BS, Finkelstein EA, Fiebelkorn IC. State-level Medicaid expenditures attributable to smoking. Prev Chronic Dis. 2009;6(3). http://www.cdc.gov/pcd/issues/2009/jul/08_0153.htm. Accessed July 23, 2009.

8 Ibid.

9 Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 2008. Analysis by the American Lung Association, Research and Program Services Division using SPSS software.

10 Centers for Disease Control and Prevention. Sustaining State Programs for Tobacco Control: Data Highlights 2006. 2006. Available at: http://www.cdc.gov/tobacco/data_statistics/state_data/data_highlights/2006/index.htm.