Helping the poor give up smoking
Seventeen states offer no Medicaid coverage for quitting tobacco, researchers report

By Sarah Yang, Public Affairs

14 November 2001 | Although an increasing number of states are offering Medicaid enrollees some coverage for smoking cessation treatments and services, 17 states still provide no Medicaid coverage to help smokers quit, according to a nationwide survey headed by campus researchers.

The study found that 33 states and the District of Columbia provided at least some Medicaid coverage of smoking cessation services in 2000, up from 24 states and the nation’s capital in 1998.

“The states that don’t cover tobacco dependence treatments are really letting Medicaid enrollees down,” said Helen Schauffler, professor of health policy in the School of Public Health and lead author of the report.

The survey was funded by the Robert Wood Johnson Foundation and published by the U.S. Centers for Disease Control and Prevention in the Nov. 9 issue of its “Morbidity and Mortality Weekly Report.”

Providing insurance coverage of tobacco dependence treatments is particularly important for Medicaid enrollees because they have a disproportionately high rate of smoking, the researchers said. Medicaid currently provides health insurance for 32 million low-income Americans. More than 11.5 million enrollees smoke, a rate 50 percent higher than in the general population.

“Low-income Americans have the highest smoking rates and the least access to tobacco dependence treatments,” said C. Tracy Orleans, senior scientist at the Robert Wood Johnson Foundation and co-author of the report.

Schauffler noted that a typical 12-week course of drug therapy runs $200 to $400, putting the treatments out of reach for most low-income smokers.

“Many Medicaid recipients simply can’t afford the help they need to quit smoking,” said Rosemarie Henson, director of CDC’s Office on Smoking and Health.

The researchers argue that helping smokers quit not only provides health benefits, it can reduce costs associated with tobacco-related diseases. “Smoking cessation treatments are the gold standard for cost-effectiveness in medical care,” said Schauffler, who also heads the campus’s Center for Health and Public Policy Studies. “States that provide smoking cessation coverage would not only improve the health of Medicaid enrollees, they may get a return on their investment in health care costs.”

The economic benefits of tobacco dependence treatments are especially dramatic in the case of pregnant women, where for every dollar spent on smoking cessation programs, as much as three dollars are saved in costs for treating low-birth-weight babies and other tobacco-related complications.

Studies have shown that increasing smokers’ access to treatment options increases the number of their attempts to quit.

Treatments shown to be effective include over-the-counter drugs such as the nicotine patch, gum and nasal spray, as well as the prescription drugs sold under the names Zyban or Wellbutrin. The Public Health Service also recommends counseling services, said Schauffler.

“We recommend coverage for all these services,” said Schauffler. “Drug treatments and counseling together are more effective than either one alone.” Prescription drugs are covered in 31 states, while over-the-counter treatments are covered in 23 states. Only 13 states provide Medicaid coverage for counseling services.

California provides Medicaid coverage for all drug therapies, but dropped coverage for tobacco counseling services in 2000.

Although Medicaid is jointly funded by state and federal governments, its administration is largely left up to individual states. “We found large disparities among states in their Medicaid coverage for smoking cessation programs,” said Schauffler. “That supports the argument for providing the coverage on the federal level as part of the core benefit package under Medicaid.”

U.S. Senate Bill 854, introduced in May by Sens. Richard Durbin (D-Ill.), Sam Brownback (R-Kan.), Bob Graham (D-Fla.) and Jeff Bingaman (D-NM), would provide such coverage.