Lung Association Report: Affordable Care Act Offers Illinois Opportunities to Save Lives, Money by Helping Smokers Quit

Coverage in Illinois is adequate, more needs to be done

CHICAGO (July 22, 2014)

With more than 8 million Americans now accessing health insurance through new options in the Affordable Care Act (ACA), 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 today, the annual report notes that many lives and billions of state and federal dollars– including over $800 million in Medicaid spending –could be saved by ensuring that 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.

“Although Illinois’ coverage is adequate compared to the rest of the nation, a lot more needs to be done for individuals to get the treatment they need,” said Kathy Drea, Vice President of Advocacy for the American Lung Association in Illinois. 

“The good news is that the Illinois state employee health plan includes complete coverage of all cessation treatments, including counseling.  However, Illinois needs to do more for Medicaid recipients, with recipients receiving covered access to all cessation treatments including nicotine gum, patches, lozenges, inhalers and nasal sprays, along with Bupropion and Varenicline, but it does not include covered group, individual or phone counseling.  The Illinois State Health Insurance Marketplace benchmark does cover tobacco cessation medications but there are no mentions of coverage for cessation counseling,” she said.

States Could Save Up to $833 Million in Medicaid Spending
The report noted that 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 that:

Only two states provide comprehensive cessation coverage for all Medicaid enrollees: Indiana and Massachusetts;

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.

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

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

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 says that 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,” said Drea. “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. Eleven 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 Healthcare 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 healthcare 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 that 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 that 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 2014, the American Lung Association and our public health and medical partners announced our 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.

About the American Lung Association
Now in its second century, the American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease. With your generous support, the American Lung Association is “Fighting for Air” through research, education and advocacy. For more information about the American Lung Association, a holder of the Better Business Bureau Wise Giving Guide Seal, or to support the work it does, call 1 800 LUNG USA (1 800 586 4872) or visit www.lung.org.