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American Lung Association report: Affordable Care Act offers opportunities to save lives, money by helping smokers quit

by jmaloni

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Thu, Jul 24th 2014 02:35 pm

Report shows cessation coverage in New York is inadequate

With more than 8 million Americans now accessing health insurance through new options in the Affordable Care Act, there has never been a more crucial time for policymakers and insurance plans to act to save lives - and public dollars - by expanding and easing access to tools and treatments to help smokers quit, according to the American Lung Association's "Helping Smokers Quit: Tobacco Cessation Coverage 2014" report. Released this week, the annual report notes many lives and billions of state and federal dollars - including more than $800 million in Medicaid spending - could be saved by ensuring coverage under the ACA comprehensively helps smokers end their nicotine addiction.

The Lung Association's annual report reviews each state's efforts to help smokers quit and provides an up-to-date look at federal coverage and requirements for quit smoking treatments under the Affordable Care Act. 

New York Needs to do More to Help Smokers Quit

New York state's coverage for tobacco cessation treatment is deemed inadequate in every category evaluated in the report. For Medicaid recipients, only four out of the seven recommended cessation treatments approved by the FDA to help people quit are covered. And while individual and group counseling is available to Medicaid recipients who want to quit, no phone counseling is offered. Other obstacles to helping Medicaid recipients quit are the limits on duration and limit on annual quit attempts that exist. Similarly for state employees, only one cessation treatment is universally covered, and coverage for the other six varies by plan. There is ample room for improvement.

"While New York's does offer some coverage to smokers who want to quit, it's far from the comprehensive coverage that we need to have in place to help more New Yorkers quit successfully," said Jeff Seyler, president and CEO of the American Lung Association of the Northeast. "More than 25,000 New Yorkers die each year as a result of smoking. We need to provide current smokers with the help they need to overcome their addiction so they can live longer, healthier lives." 

States Could Save Up to $833 Million in Medicaid Spending

The report noted significant savings in public spending could be achieved by making sure smokers on Medicaid have broader access to comprehensive smoking cessation resources. People enrolled in traditional Medicaid smoke at much higher rates than the general population (30.1 percent versus 18.1 percent for ages 18-65). Smoking-related diseases cost Medicaid programs an average of $833 million in taxpayer dollars per state in 2013. The Lung Association's report determined:

•Only two states provide comprehensive cessation coverage for all Medicaid enrollees: Indiana andMassachusetts;

•Several states, including Alabama, Connecticut, Georgia, Maine, Ohio and Vermont, improved Medicaid cessation coverage for smokers since last year;

•Thirty-five states charge copays for tobacco cessation treatments for individuals enrolled in Medicaid - even though evidence shows copays discourage use of treatment and many plans with higher-income enrollees are prohibited from charging them. New York requires copays in some Medicaid plans.

Tobacco use is the leading preventable cause of death in the U.S., costing the economy up to $333 billion annually. In the report, the American Lung Association asserts:

•Every smoker, including those on Medicaid, needs access to a comprehensive tobacco cessation benefit;

•Quit smoking treatments must be provided at no cost and be easy to access;

•Insurance plans and employers should publicize what treatments are available and how to access them; and

•Insurance plans and employers should not make it harder for tobacco users to afford health insurance by charging them more in premiums.

A comprehensive quit smoking benefit includes all medications FDA-approved for smoking cessation and three types of cessation counseling recommended by the Public Health Service Guideline on "Treating Tobacco Use and Dependence":

  • Nicotine gum
  • Nicotine patch
  • Nicotine lozenge
  • Nicotine nasal spray
  • Nicotine inhaler
  • Bupropion
  • Varenicline
  • Individual counseling
  • Group counseling
  • Phone counseling

In addition to making all these treatments available, the American Lung Association said insurance plans and policymakers must help smokers by not requiring copays or prior authorization, and not limiting the number of times a smoker can get the benefit per year or lifetime.

"Investing in smoking cessation programs has shown up to a 3-to-1 return on investment," Seyler said. "And we know the 2014 Surgeon General's report concluded that today's cigarette is more deadly and addictive than ever, making this investment not only smart, but necessary."

Tobacco Surcharges May Put Health Insurance Out of Reach for Families

The ACA allows individual and small group insurance plans to charge tobacco users up to 50 percent more in premiums than nonsmokers. This surcharge can be a difference of thousands of dollars per year for a smoker, and the Lung Association is concerned surcharges could make health insurance unaffordable for tobacco users and their families. New York and 10 other states, however, have chosen to limit or prohibit these surcharges

Lack of Information about What Private Health Plans Cover Makes it Hard for Patients to Make Health Care Choices

With new requirements for preventive services being implemented and more patients enrolling in health coverage through the ACA, the public is encountering barriers to accessing information on what treatments health plans actually cover, including smoking cessation treatments. Patients need this information to make informed choices when selecting and enrolling in health care plans. Additionally, this transparency is needed to evaluate whether plans are providing the right treatments to smokers who want to quit and other patients. The American Lung Association urges HHS and state policymakers to require health plans make this information publically available.

To help inform decisions and address outstanding needs for providing comprehensive smoking cessation coverage, the American Lung Association created an "Action Plan for Policymakers," listing critical steps to be taken by the federal government, state governments and health plans, employers and health systems to ensure those who want to quit get the help they need to succeed. The plan can be found as part of the entire report, found at www.lung.org/helpingsmokersquit.

'Three Bold Goals'

In January, the American Lung Association and its public health and medical partners announced plans to end tobacco use through the creation of "three bold goals":

1. Reduce smoking rates, currently at about 18 percent, to less than 10 percent within 10 years;

2. Protect all Americans from secondhand smoke within five years; and

3. Ultimately eliminate the death and disease caused by tobacco use.

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