American Lung Association Report Says Affordable Care Act Offers Landmark Opportunities to Save Lives, Money by Helping Smokers Quit

Policymakers, insurance plans and employers must now act to provide tools and treatments smokers need to quit

(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 2014report. 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. 

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.

“Many smokers gained new health insurance coverage under the ACA at the beginning of this year, so we know that 2014 could be a watershed year for making the forward-thinking changes in our health coverage policies that help smokers quit,” said Paul G. Billings, Senior Vice President, Advocacy and Education at the American Lung Association. “This is an important pathway to curbing health care costs and reducing the strain that tobacco-related illnesses place on our overall economy.  But we need lawmakers and insurance plans to act broadly and right now to ensure that comprehensive quit smoking benefits are available to all smokers. It’s not only the right thing to do, it’s the smart thing to do.”

The report notes that the ACA requires many health insurance plans to cover all preventive services, but until May 2014 it was unclear how this applied to tobacco cessation. On May 2,  the Departments of Health and Human Services, Labor and Treasury released crucial guidance on what health plans should be covering to help smokers quit, including a comprehensive benefit covered at least twice a year with no cost-sharing or prior authorization requirements. 

 “Investing in smoking cessation programs has shown up to a 3-to-1 return on investment,” said Billings. “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 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.

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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.